Clinical and magnetic resonance analysis of varicella-zoster virus (VZV) transcranial nerve into brain-induced brainstem encephalitis

Abstract

Background: In this study, we summarize the clinical and magnetic resonance characteristics of patients with varicella-zoster virus transcranial brain-induced brainstem encephalitis. Methods: The patient's baseline data meet the inclusion criteria were collected. All patients were admitted to the hospital for routine blood, urine, and stool, blood glucose, blood pressure, blood lipids, homocysteine, liver function, renal function, electrolytes, eight items before the operation, autoantibodies, 24-hour dynamic EEG. All patients underwent a head MRI scan, and the patients underwent lumbar puncture, perfecting routine cerebrospinal fluid, biochemical and cytological examinations, and high-throughput examination of cerebrospinal fluid pathogens. Result: Seven patients were enrolled in this study. All patients were associated with skin herpes in the area of cranial nerve distribution. Herpes is complicated with V-cranial nerve in 1 case, facial nerve (6 cases), vestibular nerve (5 cases), tongue pharynx, vagus nerve (1 case). The interval of central nervous system injury after 6 cases of skin herpes were 3-20 days. Laboratory and EEG examinations showed that all patients had no abnormalities in autoantibodies and preoperative eight items; low blood routines showed elevated white blood cells in 4 cases, elevated blood glucose in 4 cases, and abnormal liver function in 2 cases. Magnetic resonance imaging showed the disease involved 2 cases of the dorsolateral medulla, 6 cases with bridge arm, 1 case with multiple lesions, and 1 case without abnormal findings. Conclusion: CZV-induced cranial nerve palsy and encephalitis can leave serious sequelae, even life-threatening, early diagnosis and early treatment are essential. For VZV infections confined to the cranial nerve, MRI is necessary even without evidence of brain stem injury, especially DWI sequences and 3D-CISS imaging can show extent of affected early cranial nerve.