Zoster Encephalomyelitis

Rose, F. Clifford; BRETT, E. M.; BURSTON, J.

doi:10.1001/archneur.1964.00460200051005

Cited by 77 publications

(23 citation statements)

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“…As relentless ascending progression of zoster myeli tis ending in death has been reported in a number of cases [5,6], antiviral therapy might be necessary to halt the progression [7,16]. Our patient received an antivi ral agent, acyclovir, and his neurological symptoms did not show any further progression for 1 month during hospital stay.…”

Section: Discussionmentioning

confidence: 68%

“…The incidence and severity of HZ is greatly increased in persons with defective cel lular immunity such as advancing age, lymphoproliféra tive malignancies and immunosuppressive treatment [8], In these circumstances, dissemination and serious complications of HZ are also more frequent [8,9], How ever, our patient had no evidence of underlying malig nancy and was younger than the other patients with HZ myelitis reported in the literature [5][6][7], It is likely that the clinical manifestations of HZ infection are deter mined by a complex interplay of host-defense defects, activation of latent agents and environmental exposure The pathogenesis of HZ myelitis has been thought as a direct viral invasion because inclusion bodies and VZV particles were found in glial cells, and the virus was iso lated from the spinal cord of patients with zoster myelitis [5], Isolation of the VZV from the CSF or demonstration of the VZV antigen in CSF cells by immunofluorescence is a confirmative evidence for viral central nervous sys tem (CNS) infection but it is rarely successful [ 10,11], Therefore, the diagnosis is usually made on the clinical ground when characteristic CNS symptoms develop in the context of HZ. The association was clear in our case because the interval between the exanthem and the onset of neurologic symptoms was as short as 3 days.…”

Section: Discussionmentioning

confidence: 92%

“…Pathologic findings of zoster myelitis were described as inflammation and necrosis of the spinal cord in most autopsy studies [5,6], Hogan and Krigman [5] described the pathologic features in detail. They found chronic inflammatory changes, necrosis and fibrosis of the dorsal root ganglion contiguous to the involved dermatome and extensive necrosis of the gray and white matter of the spinal cord at that segmental level.…”

Section: Discussionmentioning

confidence: 99%

“…The vast majority of cases are uncomplicated and self-limited, but a wide spectrum of neurological complications such as motor neuropathy, encephalitis, myelitis, Guillain-Barre syndrome, cerebral vasculitis, multifocal leukoencephalitic syndrome and postherpetic neuralgia have been reported [3,4], Among these, myelitis without evidence of encephalopathy is quite rare [5][6][7] and the magnetic resonance imaging (MRI) findings in these cases have not been reported yet. We report a case with myelopathy following HZ skin eruption in which involvement of spinal cord was con firmed by MRI.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Herpes Zoster Myelitis: Positive Magnetic Resonance Imaging Finding

et al. 1991

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A 33-year-old man developed a progressive myelopathy after a characteristic skin lesion of herpes zoster involving the right C3 and C4 dermatomes. The lesions were recognizable in the T2-weighted image of the magnetic resonance imaging (MRI) as increased signal intensities throughout the long segments of the spinal cord with maximal in the cervical portion, which was compatible with the pathological findings reported in autopsy studies.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Case of Herpes Zoster Myelitis: Positive Magnetic Resonance Imaging Finding

et al. 1991

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“…An early study by Rose et al 10 in 1964 reviewed 40 patients with diffuse meningoencephalitis secondary to VZV. Cases autopsied demonstrated infiltration of the vascular intima and adventitia with giant and mononuclear cells, in both the brain and spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Central Nervous System and Renal Vasculitis Associated With Primary Varicella Infection in a Child

2001

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ABSTRACT. A 7-year-old girl with primary varicella presented with encephalopathy and focal neurologic deficits 10 days after her first skin lesions appeared. She was discovered to have bilateral wedge-shaped renal infarctions, and ischemic lesions in the conus medullaris, cerebral cortex, and deep gray matter consistent with a medium and large vessel arteritis on magnetic resonance imaging. This complication has never before been reported in an immunocompetent child with primary varicella infection, and it represents a rare but serious complication of childhood chickenpox. Pediatrics 2001;107(1). URL: http://www.pediatrics.org/cgi/content/full/107/1/e9; varicella, child, vasculitis, cerebral arteritis, renal arteritis.ABBREVIATIONS. VZV, varicella-zoster virus; MRI, magnetic resonance imaging; CSF, cerebrospinal fluid; IgG, immunoglobulin G; IgM, immunoglobulin M; PCR, polymerase chain reaction. V aricella-zoster virus (VZV) may produce a wide spectrum of neurologic diseases in children, including postinfectious encephalitis, 1 Reye's syndrome, 2 acute cerebellar ataxia, 3 and herpes zoster ophthalmicus with delayed contralateral hemiparesis. 4,5 VZV recurrence in the trigeminal or cervical distribution may be associated with a vasculopathy affecting both large and small arteries, typically producing stroke or stroke-like symptoms weeks to months after eruption of the vesicles. 6 This vasculopathy is more common in immunocompromised patients. 7 We describe a VZV arteritis in an immunocompetent child occurring 10 days after the onset of the initial rash of primary varicella, producing ischemic vascular lesions in the brain, spinal cord, and kidneys. CASE REPORTA 7-year-old girl in good health presented with confusion, lethargy, and right-sided weakness for ϳ2 hours on the day of admission. She had healing skin lesions consistent with a recent history of primary varicella 10 days before presentation. Her initial rash resolved after a few days with no new lesions, and 7 days before admission she had returned to school. Four days before admission, she complained of headache and eye pain on exposure to light and developed a low-grade fever with occasional vomiting. Over the next 48 hours, she became difficult to awaken. She could not stand without support and was unsure of what to do with a popsicle offered to her. The act of swallowing would induce projectile vomiting. She began to repeat the words "I am" in response to all questions. On the day of admission, she could not be aroused and was brought to the hospital.In the emergency department, her temperature was 98.6°F with pulse, 74 beats per minute; respiratory rate, 16 breaths per minute; and blood pressure, 112/70 mm Hg. Numerous healing cutaneous lesions consistent with recent varicella infection were present. No open vesicles were noted on her skin, ears, or mouth; hepatosplenomegaly or lymphadenopathy was not present. She was awake but minimally responsive to forceful pinching. Pupils were equal, round, and reactive with a right gaze preference. A left facia...

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Varicella-Zoster Encephalomyelitis

McCormick¹,

Rodnitzky²,

Schochet³

et al. 1969

Arch Neurol

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V A R I C E L L A -Z O S T E RARICELLA-ZOSTER (V-Z) encephalomyelitis is relatively uncommon. Detailed morphologic and virologic studies on such cases are extremely few. Our recent studies of two patients on whom complete autopsies were done, form the basis of this study. In one of these patients V-Z virus was cultured from the brain. Electron microscopic demonstration of virus particles in the brain was obtained on both cases. We believe this to be the first reported isolation of the V-Z virus and the first electron microscopic demonstration of the virus in human brain.Type A intranuclear inclusion bodies were seen in the brain and spinal cord of both patients. We are aware of no recorded observations of type A inclusions in the central nervous system (CNS) in patients with clinical herpes zoster and only one such report in a case of disseminated varicella. The literature, insofar as it is pertinent, is reviewed and a synthesis of our observations and those of others attempted. Report of CasesCase 1.-A 414-year-old boy with acute lymphocytic leukemia, diagnosed in September 1967 when his peripheral white blood cell count (WBC) was 500,000/cu mm, with 95% lymphoblasts, was admitted to the University of Iowa Hospital on Dec 12, 1968 because of diarrhea, nausea, vomiting, and irritability of one week's duration.During the past year he had received prednisone, vincristine sulfate, mercaptopurine, methotrexate (intrathecal 4-amino-N10-methyl pteroylglutamic acid), cyclophosphamide (Cytoxan), and cranial and mediastinal radiation. His illness had been complicated in November 1967 by varicella, which he contracted after exposure to an infected sibling. In March 1968, the patient developed seizures, headaches, and spinal fluid pleocytosis for which he received intrathecal methotrexate and cranial irradia¬ tion. From Nov 20 to 26, he received radiation to the left side of the chest and right cervical regions. At the time of admission he was re¬ ceiving cyclophosphamide (36 mg daily) and prednisone (15 mg daily).Physical examination revealed a chronically ill, irritable child, with alopecia. There was bilateral papilledema. There were decreased breath sounds over the entire left hemithorax, and the liver was palpable 1.5 cm below the right costal margin. No enlarged lymph nodes were palpable. The neurologic examination was within normal limits except for generalized irritability.An admission hemogram revealed a WBC of 2,600/cu mm, with 43% lymphocytes and 43% myelocytes, a hemoglobin level of 13.5 gm/100 ml, and a platelet count of 55,000.On the day after admission he had a rightsided motor seizure. The cyclophosphamide was discontinued and cranial radiation and in¬ trathecal methotrexate were instituted. The last dose of intrathecal methotrexate was given

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Zoster Encephalomyelitis

Cited by 77 publications

References 2 publications

A Case of Herpes Zoster Myelitis: Positive Magnetic Resonance Imaging Finding

A Case of Herpes Zoster Myelitis: Positive Magnetic Resonance Imaging Finding

Central Nervous System and Renal Vasculitis Associated With Primary Varicella Infection in a Child

Varicella-Zoster Encephalomyelitis

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