Varicella–zoster virus myelitis—serial MR findings

Abstract

The authors describe a 32-year-old male in whom herpes zoster of the left upper extremity was complicated by the development of cervical myelitis. Contrast enhancement and abnormal signal intensity on T1 and T2 weighted images was seen at C1-C6 levels in the spinal cord and medulla. There was also slight enlargement of the cord at these levels. On serial MR imaging the degree of enhancement changed from marked to none with corresponding clinical improvement.

Longitudinally Disseminated Spinal Cord Lesions (Moth-eaten Appearance) in Varicella-Zoster Myelitis

“…Axial images showed a dominant involvement of the right dorsal horn (Picture 2 A: cervical, B: thoracic, C: lumbar). These findings were quite unusual and different from the findings in previously reported cases of VZ myelitis, which is usually localized at the spinal cord segment corresponding to the dermatome involved by herpes zoster infection (1,2). In spite of intensive treatment, the patient died of multiple organ failure 23 days after admission, and autopsy was not permitted.…”

Posterior horn varicella-zoster virus myelitis

“…Our laboratory findings and the good response of our patient to treatment with acyclovir suggest that MRI images may well show direct virus invasion of the spinal cord. The present case along with a few earlier reports [9,10,11], might demonstrate the spread of VZV from the dorsal root ganglia to the posterior horn at several spinal levels, some of which match the dermatome distribution of the vesicular rash. The unexpected central rather than peripheral spread of VZV infection from the dorsal root ganglia into the spinal cord might be facilitated in this patient by an immunodeficiency state resulting from the chemotherapy.…”

Painful legs and moving toes syndrome associated with herpes zoster myelitis

“…The MRI findings also supported the diagnosis of HZ myelitis for the following reasons: (1) the bottom lesion was at the level that corresponds to the dermatome distribution of the vesicular rash, and (2) the lesions were eccentric near the posterior horn, to which the HZ virus within the dorsal root ganglion may spread along the posterior nerve root [6]. The restricted lesions with contrast enhancement in the posterior column at C2-T11 may imply a disruption of the blood -cord barrier due to direct viral invasion and axoplasmic transport of HZ virus within the spinal cord [5,6]. Although VZV DNA by PCR was negative in the CSF, this is probably because the timing of CSF sampling was much too late [7]; the patient had 2 months history prior to presentation.…”