Encephalitis Associated With Herpes Zoster

Abstract

This case is reported because the literature contains few records of cases of encephalitis complicating herpes zoster in which the brain was examined histologically after death. REPORT OF CASEHistory.\p=m-\Mrs.L. V., a housewife aged 58, white, was seen by one of us (S. K.) in consultation on April 6, 1942, because she had become restless, noisy and irrational. She had been in relatively good health except for occasional headaches and backache, for which she was taking acetylsalicylic acid. On March 7 neuralgic pain developed in the left side of the face and neck. Two days later examination by the family physician revealed a herpetic rash over the lower part of the face, the neck and the upper part of the shoulder and chest on the left side. The patient had a slight fever (temperature 99.5 to 100.0 F.) for several days. The vesicles disappeared in about fourteen days, but the pain persisted. On April 4 she complained of restlessness and insomnia. The next day she became irrational and noisy. On that day Dr. Maurice Oppenheim, a dermatologist, was called in consultation and concurred in the diag¬ nosis of herpes zoster, expressing the conviction that the patient now presented a cerebral ailment. Nothing in the history relative to previous diseases and habits had any apparent bearing on the present illness.Physical Examination.-Examination on April 6 by one of us (S. K.) revealed that the patient was well preserved. She was lying in bed and presented marked clouding of consciousness, accompanied by extreme rest¬ lessness. She did not respond to psychic stimuli, such as requests to protrude the tongue; she moaned, tossed about on the bed incessantly and reached out with her arms aimlessly into space. She was obviously out of contact with her environment but was not somnolent.There was pigmentation of the skin, involving the left side of the neck, the shoulder and the uppermost part of the chest, as well as the submental region and the lower portion of the face adjacent to the ear, an area representing the second, third and fourth cervical derma¬ tomes.The rectal temperature on the morning of examination was 104.6 F. ; the pulse was regular, with a rate of 120, and the respiratory rate was 34 per nïinute. The cardiac outline was within normal limits, and the heart presented no adventitious sounds. Except for bronchial rales the lungs were normal. The ab¬ domen was not tender. The spleen and liver were not From the palpable. The blood pressure was 125 systolic and 80 diastolic Neurologic Examination.-The pupils were small and equal and reacted to light. The patient could not co¬ operate in tests of ocular motion, but no strabismus or nystagmus was observed. The corneal reflex was present on both sides. There was no facial paralysis, nor was there any masking or rigidity of facial expression or rigidity of the trunk and extremities, such as one sees in paralysis agitans. It was impossible to determine whether the patient had any weakness of the soft palate or of the swallowing musculature. The tongue lay in the midline...

Intravenous vitamin C for reduction of cytokines storm in acute respiratory distress syndrome

“…The antiviral activities of ascorbic acid was known and it was published almost 80 years ago [5][6][7][8][9] when scientists were involved in work on poliomyelitis. Moreover, the use of ascorbic acid as a medicinally crucial agent against various diseases was also well established [10][11][12][13][14][15][16][17][18][19][20][21]. Applications of Vit-C are found in poliomyelitis [22][23][24][25][26].…”

External ocular motor palsies in ophthalmic zoster: a review.

“…The first is a direct cytopathic effect from the virus itself on the surrounding neural tissue (Cope and Jones, 1954). The second is an allergic response of the central nervous system to the virus, which is not primarily vascular (Krumholz and Luihan, 1945;Appelbaum et al, 1962;Rose et al, 1964). The third attributes it to an occlusive vasculitis induced by the virus (Gordon and Tucker, 1945;Feyrter, 1954;Anastostopoulos et al, 1958;Wray, 1972).…”

“…A meningoencephalitis may develop (Schiff and Brain, 1930;Krumholz and Luihan, 1945;Worster-Drought and Sargent, 1949;Appelbaum et al, 1962;Rose et al, 1964;Norris et al, 1970). Contralateral hemiplegia occurs rarely, either in an isolated form (Baudouin and Lantvejoul, 1919;Rollett and Colrat, 1926;Biggart and Fisher, 1938;Hughes, 1951;Cope and Jones, 1954;Minton, 1956;Laws, 1960;Acers, 1964), or accompanied by hemianopia (Franceschetti et al, 1955), aphasia and agraphia (Gordon and Tucker, 1945;Leonardi, 1949;Anastostopoulos et al, 1958).…”

Herpes Zoster

“…Worster-Drought and McMenemey (1933) and Whitty and Cooke (1949) describe cases of myelitis. Encephalitis is a serious complication and is commonly fatal (Schiff and Brain, 1930 ;Krumholtz and Luhan, 1945;Hassin and Rabins, 1946).…”