Herpes zoster encephalitis

Appelbaum, Emanuel; Kreps, Sidney I.; Sunshine, Abraham

doi:10.1016/0002-9343(62)90179-1

Cited by 99 publications

(30 citation statements)

References 15 publications

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“…Thus, except for one patient there was no long-term follow-up which may explain these contrasting findings. Neuropsychiatric sequelae have been described by Appelbaum et al [1] in 3 of 9 patients who were studied up to 10 years after HZE but were not observed in our study group. However, none of the patients in Appelbaum's study received adequate virus inhibiting treatment which may account for this unfavourable outcome.…”

contrasting

confidence: 54%

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Good cognitive outcome of patients with herpes zoster encephalitis: a follow-up study

Wetzel¹,

Asholt²,

Herrmann³

et al. 2002

Journal of Neurology

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contrasting

confidence: 54%

“…The diagnosis of HZE includes an encephalopathic state, clinical evidence of herpes zoster with or without virological confirmation and an inflammatory cerebrospinal fluid (CSF) [7]. Mental changes are a main neurological symptom in HZE [1,7,10] but specific neuropsychological sequelae after the acute stage of HZE have not been adequately studied.…”

mentioning

confidence: 99%

Good cognitive outcome of patients with herpes zoster encephalitis: a follow-up study

Wetzel¹,

Asholt²,

Herrmann³

et al. 2002

Journal of Neurology

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“…The patient underwent a spinal fluid examination. Spinal fluid analysis yielded aslight lympho cytic cellular reaction in accordance with the finding that patients with herpetic rash can develop a lymphoccllular spinal fluid reaction [6], Computerized brain and orbital tomography were performed on the patient and reported to be normal.…”

Section: Introductionsupporting

confidence: 73%

Bilateral Retrobulbar Neuritis following Unilateral Herpes Zoster Ophthalmicus

Günduz

Özdemir²

1994

Ophthalmologica

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A 48-year-old male diagnosed with right-onset herpes zoster ophthalmicus developed visual acuity loss in the left eye during the following 3 weeks. Visually evoked cortical potential recordings revealed a marked increase in P100 latency and a marked decrease in its amplitude in both eyes. Pattern electroretinography suggested diffuse pathology with reduced positive and negative components. A possible transsynaptic or intraneural spread of the varicella-zoster virus in the optic nerve might be responsible for this unexplained contralateral loss of visual acuity.

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“…2 MRI brain showed non-enhancing signal change in the lower pons and medulla, which is hypodense on T1-weighted images, hyperintense on T2-weighted and FLAIR images. The feature is compatible to rhomboencephalitis ual deficit as high as 30 % [6,8]. Early diagnosis remains the corner stone for successful antiviral therapy [9] and can be achieved with the help of varicella zoster DNA PCR assay.…”

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confidence: 98%

Hypoglycorrhachia in herpes zoster associated encephalitis of an immunocompetent young male

Chan

Tam

et al. 2005

J Neurol

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Sirs: A thirty-one year old male was admitted to the Department of Medicine in Yan Chai Hospital with fever and headache. He had history of fever and sore throat for one week. His family doctor made a diagnosis of acute pharyngitis and gave him a course of amoxicillin. Few days later, he developed bilateral hearing loss and increasing early morning headache, exacerbated by cough. His temperature was 38°C. There was no sign of meningeal irritation. Scattered blisters were noted over the left side of his neck along the distribution of cervical nerve C3 and C4. Bilateral hearing loss was present. Audiometry test revealed neurosensory hearing loss in both ears. His complete blood count, renal and liver functions, chest radiograph, electrocardiogram and CT of the brain were normal. Lumbar puncture revealed clear CSF with an opening pressure of 200 mm H 2 O, white cell count 240 WBC per mm 3 (polymorphs 10 %, lymphocyte 90 %), protein 1.8 g/L, glucose 1.9 mmol/L. Simultaneous serum glucose was 6.9 mmol/L. CSF bacterial antigen test, cryptococcal antigen, fungal culture, PCR for TB and herpes simplex virus (HSV) DNA were negative. Brain MRI showed nonenhancing signal change in the lower pons and medulla, which was hypodense on T1-weighted images, hyperintense on T2-weighted and FLAIR images. The features were compatible with rhomboencephalitis (Fig. 1). IV acyclovir 10 mg/kg q8h was administered for 14 days. His fever came down on day 3 after the treatment began. His blisters and headache resolved gradually. Follow-up lumbar puncture showed normalization of CSF sugar with improvement in CSF protein and white cell counts. CSF viral titer revealed a 4-fold rise for IgG against varicella (pre-treatment titer 1: < 4, follow-up titer 1:16). PCR varicella-zoster DNA in his CSF before treatment was positive. He had mild residual neurosensory hearing loss and reported occasional tinnitus six months after the encephalitis. This case is a reminder that despite being a rare entity, a strikingly low CSF glucose can occur in herpes zoster-associated encephalitis. It can be potentially confusing to the attending clinician by mimicking other common infectious disease such as tuberculosis. Among 2 case reports in the past [1, 2], anti-tuberculous therapy was given to one patient before serological confirmation of varicella zoster meningoencephalitis. With the help of PCR assays, an early diagnosis can be achieved through detection of VZV DNA in CSF as soon as 24 hours after the onset of symptoms [3]. Compared with antibody indices [4], the intrathecal production of antibody is rarely detected before day 5 after onset of neurological symptoms, limiting the use of antibody index for early diagnosis of CNS infection. Currently available VZV DNA PCR assay methods have high specificity and do not cross-react with herpes simplex infection. The diagnostic sensitivity, however, ranges from 29 % to 100 % [5]. Therefore, we suggest that simultaneous analysis of CSF for both varicella-zoster virus DNA and antibody level should be studied in all s...

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Herpes zoster encephalitis

Cited by 99 publications

References 15 publications

Good cognitive outcome of patients with herpes zoster encephalitis: a follow-up study

Good cognitive outcome of patients with herpes zoster encephalitis: a follow-up study

Bilateral Retrobulbar Neuritis following Unilateral Herpes Zoster Ophthalmicus

Hypoglycorrhachia in herpes zoster associated encephalitis of an immunocompetent young male

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