Meningo-Encephalitis Complicating Herpes Zoster

Biggart, J. H.; Fisher, James

doi:10.1016/s0140-6736(00)41570-9

Cited by 28 publications

(8 citation statements)

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“…as was done by Schiff and Brain (1930), but nevertheless it seems difficult to account for the occurrence of a sudden hemiplegia in an otherwise healthy young adult of 26, with no evidence of arteriosclerosis elsewhere and no source of embolism. It therefore seems to us a reasonable assumption that the two conditions were associated and that the lesion was likely to be of the type described by Lhermitte and Vermes and by Faure-Beaulieu and Lhermitte (1929) in the brain stem and basal ganglia, rather than of that described by Biggart and Fisher (1938); that is, a localized haemorrhagic or destructive focus affecting the left pyramidal tract in its course between the cortex and mid-brain. The symptoms and course are quite unlike those of the generalized encephalitis occurring in Biggart and Fisher's or Schiff and Brain's cases, where there was drowsiness, confusion, and disorientation rapidly progressing to coma and death; a type of clinical picture analogous to that seen in epidemic encephalitis, or the encephalitis due to the viruses of the acute exanthemata.…”

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confidence: 76%

“…They have been described by Schiff and Brain (1930), Thalhimer (1924), Gundersen (1925), and Biggart and Fisher (1938). Netter (1930) has described cases in which the encephalitis preceded the zoster, but these are probably to be regarded, according to Schiff and Brain, as cases of symptomatic herpes."…”

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confidence: 99%

“…on the grounds that they are of a similar type to the lesions in the spinal cord, and do not resemble the lesions due to arteriosclerosis or thrombosis. Biggart and Fisher (1938) describe the patho-logical findings in their fatal case of encephalitisfollowing herpes zoster. To the naked eye the only visible change was injection of the meninges.…”

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Lesions of the Central Nervous System in Herpes Zoster

Gordon¹,

Tucker²

1945

Journal of Neurology, Neurosurgery & Psychiatry

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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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Lesions of the Central Nervous System in Herpes Zoster

Gordon¹,

Tucker²

1945

Journal of Neurology, Neurosurgery & Psychiatry

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“…The first is a retrograde spread of virus from the trigeminal ganglion to the Vth nerve nucleus. Here it reaches other cranial nerve nuclei, either by axonal spread along established interconnections (Biggart and Fisher, 1938;Godfredson, 1948;Goodbody, 1953), or by random spread (Cope and Jones, 1954;Acers, 1964). The former pathway could be along the proprioceptive neurones of the oculomotor muscles in the Vth nerve (Denny-Brown et al, 1944).…”

Section: Pathogenesismentioning

confidence: 99%

“…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). Other cranial nerves may be implicated simultaneously.…”

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External ocular motor palsies in ophthalmic zoster: a review.

Marsh¹,

Dulley²,

Kelly³

1977

British Journal of Ophthalmology

109

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SUMMARY Seventy-seven new patients suffering from ophthalmic zoster and a selected group of 69 old patients were carefully examined with regard to external ocular movements. An incidence of 31 % of ocular pareses was found in the new patients, and 58 in all were analysed. We were surprised to find several of these were contralateral and bilateral palsies. 28 % of the palsies were asymptomatic, due to diplopia being present only in extremes of gaze and the rapid development of suppression in the affected eye. The theories of aetiology of these pareses are discussed.Herpes zoster ophthalmicus produces widely varying lesions of the eye in 500% of cases (Edgerton, 1945a)

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Encephalitis Associated With Herpes Zoster

KRUMHOLZ¹

1945

Arch NeurPsych

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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...

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Meningo-Encephalitis Complicating Herpes Zoster

Cited by 28 publications

References 2 publications

Lesions of the Central Nervous System in Herpes Zoster

Lesions of the Central Nervous System in Herpes Zoster

External ocular motor palsies in ophthalmic zoster: a review.

Encephalitis Associated With Herpes Zoster

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