SINCE Head and Campbell's classical description of the pathology of herpes zoster, it has been recognized that the principal sites of damage in this disease are the cell bodies of the first sensory neurones in the posterior root ganglia and the ganglia associated with certain of the cranial nerves. More recently, however, it has been emphasized, especially by Lhermitte, that this is not the only lesion possible, and that the virus can attack the central nervous system as well. Herpes zoster, like other virus diseases of the nervous system, may thus be considered as an infection involving the nervous system as a whole, though having a predilection for one particular type of nerve cell. Three cases seen recently seem to illustrate this aspect of herpes zoster and may therefore be of interest.Cases in which the central nervous system has been affected, normally fall into one of the following groups; firstly, those in which the anterior horns of the spinal cord are affected (anterior poliomyelitis); secondly, those which show evidence of involvement of the pyramidal or other tracts of the white matter of the spinal cord (transverse myelitis); thirdly, those in which the brain is involved (encephalitis). Individual cases may sometimes fall into more than one of these groups.The three cases seen personally appear to be examples of each of the three groups, the first showing involvement of the lower motor neurones of the second and third lumbar segments following a zoster of the corresponding dermatome; in the second case a paraplegia with sphincter disturbances followed herpes of the 10th and 11th dorsal segments; in the third case a left ophthalmic herpes was followed by a right hemiplegia, aphasia, and pupillary abnormalities. Case 1 .-A.W. Male, aged 68. History of present illness: He was admitted to hospital complaining of weakness and numbness of the left leg and the left side of the face, which came on in the leg over a period of two to three days about five weeks previously, and seems to have spread from the foot upwards to include the lower part of the abdomen. At the same time as the onset of the weakness and numbness, there appeared a crop of small blisters over the whole of the inner side of the left leg, from below the knee to the groin. 40These lasted about a week, leaving a thin papery scar. While the rash was present there was a fairly severe " drawing " pain involving the whole of the left leg. facial sensation and corneal reflexes normal; the other cranial nerves were normal.In the upper limbs there was no abnormality in muscular power, tone, or coordination, and no tremor. Sensation was normal and the tendon reflexes brisk and equal.In the trunk, muscular power was normal; touch and pain sensation were slightly diminished over the lower part of the abdomen on both sides. The abdominal reflexes were present on the right but absent on the left side.In the lower limbs, there was considerable loss of power, most marked in the flexors and adductors of the left hip and in the left quadriceps and hamstrings...
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