The Spectrum of Neurological Manifestations of Varicella–Zoster Virus Reactivation

Abstract

Varicella–Zoster virus (VZV) is a pathogenic human alpha herpes virus that causes varicella (chicken pox) as a primary infection and, following a variable period of latency in different ganglionic neurons, it reactivates to produce herpes zoster (shingles). The focus of this review is on the wide spectrum of the possible neurological manifestations of VZV reactivation. While the most frequent reactivation syndrome is herpes zoster, this may be followed by the serious and painful post-herpetic neuralgia (PHN) and by many other neurological conditions. Prominent among these conditions is a VZV vasculopathy, but the role of VZV in causing giant cell arteritis (GCA) is currently controversial. VZV reactivation can also cause segmental motor weakness, myelitis, cranial nerve syndromes, Guillain–Barre syndrome, meningoencephalitis, and zoster sine herpete, where a neurological syndrome occurs in the absence of the zoster rash. The field is complicated by the relatively few cases of neurological complications described and by the issue of causation when a neurological condition is not manifest at the same time as the zoster rash.

Guillain–Barre syndrome of acute motor axonal neuropathy (AMAN) type associated with herpes zoster: a case report

“…Herpes zoster and varicella zoster manifests with several sensory and motor manifestations. Transverse myelitis, varicella associated segmental motor weakness, Ramsey hunt syndrome, GBS are some of many motor manifestations of herpes zoster [ 37 ]. We report a case of GBS following herpes zoster, which adds to the limited number of cases in published literature.…”

Herpes Zoster and Cardiovascular Disease: Exploring Associations and Preventive Measures through Vaccination

“…Herpes zoster encephalitis induced by viral dissemination into the central nervous system is a potential complication that can lead to virus-induced cerebral angiitis [ 53 ]. The presentation is similar to most cases of viral encephalitis and includes confusion, headache, fever, and meningeal symptoms [ 14 ]. Recognizing these neurological complications is crucial for prompt diagnosis and intervention.…”

“…When VZV spreads centrally along peripheral nerves toward the spinal cord, it can enter the spinal cord at levels corresponding to the affected dorsal root ganglia and nerves, leading to myelitis [ 14 ]. If the cervical spinal cord is affected, individuals with zoster myelitis may experience weakness in all four extremities and impaired sphincter function.…”

“…Giant cell arteritis, also recognized as temporal arteritis, is a chronic granulomatous inflammation affecting medium and large blood vessels, with the potential for severe, visual, and life-threatening consequences [ 59 ]. Although recent data indicate that herpes zoster might serve as an underlying immunological trigger for giant cell arteritis, the role of VZV in the development of giant cell arthritis remains a subject of controversy [ 14 ]. The prevalence of giant cell arteritis was notably higher among individuals with herpes zoster compared to the general population (0.340% vs. 0.143%, p < 0.0001) [ 60 ].…”

“…The incidence of herpes zoster is increasing with age; the incidence was found to be 10.9 cases per 1000 patient-years in people and was significantly higher in women than in men [ 13 ]. Several studies have unequivocally demonstrated that the occurrence of herpes zoster rises with advancing age [ 14 ].…”