Neurological complications of varicella zoster virus reactivation

Abstract

Purpose of the review Varicella zoster virus (VZV) reactivation results in zoster, which may be complicated by postherpetic neuralgia, myelitis, meningoencephalitis and VZV vasculopathy. This review highlights the clinical features, laboratory abnormalities, imaging changes and optimal treatment of each of those conditions. Because all of these neurological disorders produced by VZV reactivation can occur in the absence of rash, the virological tests proving that VZV caused disease are discussed. Recent findings After primary infection, VZV becomes latent in ganglionic neurons along the entire neuraxis. With a decline in VZV-specific cell-mediated immunity, VZV reactivates from ganglia and travels anterograde to the skin to cause zoster, which is often complicated by postherpetic neuralgia. VZV can also travel retrograde to produce meningoencephaltis, myelitis and stroke. When these complications occur without rash, VZV-induced disease can be diagnosed by detection of VZV DNA or anti-VZV antibody in CSF and treated with intravenous acyclovir. Summary Awareness of the expanding spectrum of neurological complications caused by VZV reactivation with and without rash will improve diagnosis and treatment.

Cervical dermatomal zona misdiagnosed as ulnar nerve entrapment

“…There are few published cases in the English language involving the ulnar nerve and fewer with radial or median nerve distribution 16–20. After the primary VZV infection, reactivation in ganglionic neurons can be caused by decline of cell-mediated immunity due to advanced age, neoplastic disease and immunosuppression leading to development of herpes zoster 21. Our patient reported no disease that would cause immunosuppression.…”

“…Although some patients may have vesicles located some distance away from the involved dermatome, the pain can also spread to neighbouring dermatomes 3–5. In these cases, a virological confirmation such as PCR assays or viral culture may be required 21. The diagnosis may be challenging when the rash has already disappeared, or in ganglioradiculopathy known as ‘zoster sine herpete’, when pain occurs without cutaneous lesions 8.…”

“…The diagnosis may be challenging when the rash has already disappeared, or in ganglioradiculopathy known as ‘zoster sine herpete’, when pain occurs without cutaneous lesions 8. If the diagnosis of zoster sine herpete is suspected, cerebrospinal fluid and blood should be investigated for VZV DNA, anti-VZV IgG and IgM antibody 21. This investigation can be helpful to diagnose a patient with postherpetic neuralgia presenting after a variable asymptomatic period 21.…”

A Rare Clinical Entity in the Differential Diagnosis of Mastalgia: Thoracic Zona

“…According to some authors, it is stated that symptom treatment alone is adequate for patients under 50 years of age. Some authors suggest analgesic and antiviral drugs in patients over 50 years and those with immune suppression (16). Initiation of antiviral treatment is recommended within 72 hours of the onset of the rash (6).…”

Focal Encephalitis Following Varicella-Zoster Virus Reactivation without Rash

“…Neurological complications of VZV reactivation include zoster induced postherpetic neuralgia, myelitis, meningoencephalitis, VZV vasculopathy, and stroke [2]. Stroke as a complication of VZV reactivation is reported in the elderly but is rare in childhood [3].…”