RESUMEN
OBJECTIVE: To investigate the clinical and magnetic resonance imaging (MRI) characteristics of patients with varicella zoster virus (VZV) reactivation involving the cranial nerves and central nervous system (CNS). METHODS: This is a retrospective, multi-center case-series of 37 patients with VZV infection affecting the cranial nerves and CNS. RESULTS: The median age was 71 years [IQR 51.5-76]; 21 (57%) were men. Cerebrospinal fluid (CSF) was available in 24/37 (65%); median CSF white blood cell count was 11 [IQR 2-23] cells/µL and protein was 45.5 [IQR 34.5-75.5] mg/dL. VZV polymerase chain reaction (PCR) assays were positive in 6/21 (29%) CSF and 8/9 (89%) ocular samples. Clinical involvement included the optic nerve in 12 (32%), other cranial nerves in 20 (54%), brain parenchyma in 12 (32%) and spinal cord or nerve roots in 4 (11%). Twenty-seven/28 immunocompetent patients' MRIs were available for review (96%). Of the 27, 18 had T1 postcontrast fat saturated sequences without motion artifact to evaluate for cranial nerve enhancement and optic perineuritis (OPN). Eight/18 (44%) demonstrated OPN. All 8 experienced vision loss: 3 optic neuritis, 1 acute retinal necrosis, and 3 CNS vasculitis with 1 central and 1 branch retinal artery occlusion and 1 uveitis. Diplopic patients had cranial nerve and cavernous sinus enhancement. All immunosuppressed patients were imaged. Seven/9 (88%) had extensive neuraxis involvement, including encephalitis, vasculitis and transverse myelitis; one case had OPN. CONCLUSION: OPN is a frequent manifestation in VZV-associated vision loss among immunocompetent patients. Immunosuppressed patients had greater neuraxis involvement. Optimizing MRI protocols may improve early diagnosis in VZV reactivation.
Asunto(s)
Encefalitis por Varicela Zóster , Encefalitis , Herpes Zóster , Anciano , Sistema Nervioso Central/patología , Encefalitis por Varicela Zóster/complicaciones , Encefalitis por Varicela Zóster/diagnóstico por imagen , Femenino , Herpesvirus Humano 3/genética , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Estudios RetrospectivosAsunto(s)
Confusión/etiología , Encefalitis por Varicela Zóster/diagnóstico , Meningoencefalitis/diagnóstico , Lesión Renal Aguda/inducido químicamente , Aciclovir/efectos adversos , Aciclovir/uso terapéutico , Anciano , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/líquido cefalorraquídeo , Antivirales/efectos adversos , Antivirales/uso terapéutico , ADN Viral/líquido cefalorraquídeo , Diagnóstico Diferencial , Encefalitis/diagnóstico , Encefalitis por Varicela Zóster/líquido cefalorraquídeo , Encefalitis por Varicela Zóster/diagnóstico por imagen , Exantema/etiología , Enfermedad de Hashimoto/diagnóstico , Herpes Zóster Oftálmico/complicaciones , Herpes Zóster Oftálmico/tratamiento farmacológico , Herpesvirus Humano 3/inmunología , Herpesvirus Humano 3/aislamiento & purificación , Humanos , Imagen por Resonancia Magnética , Masculino , Meningoencefalitis/líquido cefalorraquídeo , Meningoencefalitis/diagnóstico por imagen , Meningoencefalitis/virología , Neuroimagen , RecurrenciaRESUMEN
Varicella zoster virus (VZV) can invade the brainstem or brain via the glossopharyngeal, vagus , or facial nerve, resulting in brainstem inflammation or encephalitis. We report the case of a 66-year-old male patient with a primary manifestation of medulla injury of the glossopharyngeal and vagus nerves, combined with a medulla lesion, who was misdiagnosed with lateral medullary syndrome. Facial nerve injury and earache subsequently occurred and human herpes virus 3 (VZV) was detected by second-generation sequencing of the cerebrospinal fluid. The final diagnosis was varicella zoster encephalitis, which improved after antiviral therapy.
Asunto(s)
Encefalitis por Varicela Zóster/complicaciones , Traumatismos del Nervio Glosofaríngeo/complicaciones , Bulbo Raquídeo/patología , Traumatismos del Nervio Vago/complicaciones , Anciano , Imagen de Difusión por Resonancia Magnética , Encefalitis por Varicela Zóster/diagnóstico por imagen , Traumatismos del Nervio Glosofaríngeo/diagnóstico por imagen , Humanos , Masculino , Bulbo Raquídeo/diagnóstico por imagen , Traumatismos del Nervio Vago/diagnóstico por imagenAsunto(s)
Ácido Aspártico/análogos & derivados , Colina/metabolismo , Encefalitis por Varicela Zóster/diagnóstico por imagen , Encefalitis por Varicela Zóster/metabolismo , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética/métodos , Ácido Aspártico/metabolismo , Humanos , LactanteAsunto(s)
Encéfalo/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Encefalitis por Varicela Zóster/diagnóstico por imagen , Herpesvirus Humano 3 , Imagen por Resonancia Magnética , Médula Espinal/diagnóstico por imagen , Anciano de 80 o más Años , Hemorragia Cerebral/etiología , Diagnóstico Diferencial , Encefalitis por Varicela Zóster/tratamiento farmacológico , Femenino , HumanosRESUMEN
A 56-year-old immunocompetent male developed brainstem encephalitis complicating Ramsay Hunt syndrome. The disease had a slowly progressing course of months after the triggering infection, much longer than previously reported. Furthermore, magnetic resonance imaging, physical-chemical, and cell count analyses on cerebrospinal fluid were normal, whereas polymerase chain reaction for varicella zoster virus DNA was positive. The simultaneous negativity of both imaging and basic CSF exams is very rare, although possible event which confirms the irreplaceable role of viral screening on CSF. A systematic review of similar reports with highlights on the unusual aspects of our case is also presented.
Asunto(s)
Tronco Encefálico/virología , ADN Viral/genética , Encefalitis por Varicela Zóster/diagnóstico por imagen , Herpes Zóster Ótico/diagnóstico por imagen , Herpesvirus Humano 3/genética , Tronco Encefálico/diagnóstico por imagen , Tronco Encefálico/patología , Diagnóstico Tardío , Progresión de la Enfermedad , Encefalitis por Varicela Zóster/complicaciones , Encefalitis por Varicela Zóster/patología , Encefalitis por Varicela Zóster/virología , Herpes Zóster Ótico/complicaciones , Herpes Zóster Ótico/patología , Herpes Zóster Ótico/virología , Herpesvirus Humano 3/aislamiento & purificación , Humanos , Inmunocompetencia , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Reacción en Cadena de la PolimerasaRESUMEN
Herpes zoster is a reactivation of the latent varicella zoster virus. Among the complications of herpes zoster is zoster-associated limb paresis. The clinical and imaging features of patients with zoster-associated limb paresis due to plexopathies (zoster-associated plexopathy) have had limited description in the literature. The Mayo Clinic patient data base was searched by diagnostic code for patients diagnosed with herpes zoster between January 1, 1996, and September 30, 2012. Patients who met the inclusion criteria for zoster-associated limb paresis or herpes zoster with MRIs obtained were reviewed. Ten patients with zoster-associated plexopathy were identified. Imaging abnormalities were found in 70% of patients. Secondary denervation changes in shoulder girdle muscles and nerve T2 signal hyperintensity were the most frequent abnormalities (50%), followed by nerve enlargement (20%). Enhancement was not evident in any cases despite early imaging in 80% of the cohort. These results demonstrate the clinical utility of MR imaging in confirming the diagnosis of zoster-associated plexopathy.
Asunto(s)
Neuropatías del Plexo Braquial/diagnóstico por imagen , Neuropatías del Plexo Braquial/etiología , Encefalitis por Varicela Zóster/complicaciones , Encefalitis por Varicela Zóster/diagnóstico por imagen , Edad de Inicio , Anciano , Anciano de 80 o más Años , Neuropatías del Plexo Braquial/diagnóstico , Electrodiagnóstico , Encefalitis por Varicela Zóster/diagnóstico , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Paresia/diagnóstico por imagen , Paresia/etiologíaAsunto(s)
Neoplasias de la Mama/complicaciones , Carcinoma/complicaciones , Encefalitis por Varicela Zóster/complicaciones , Neoplasias de la Mama/diagnóstico por imagen , Carcinoma/diagnóstico por imagen , Encefalitis por Varicela Zóster/diagnóstico por imagen , Femenino , Herpesvirus Humano 3/patogenicidad , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Trastornos de la Pupila/etiologíaRESUMEN
The aim of the study was to describe the clinical and epidemiological characteristics of the central nervous system (CNS) infection by varicella zoster virus (VZV) in patients older than 65 years in a tertiary community hospital. We retrospectively analysed the results of cerebrospinal fluid (CSF) testing in patients older than 65 years between 2007 and 2014 with clinically suspected VZV infection with CNS involvement. Patients whose CSF samples were positive for VZV DNA were included, as were those with negative results who simultaneously presented herpes zoster and CSF or magnetic resonance imaging findings suggestive of CNS infection, and in whom other possible aetiologies had been ruled out. The study included 280 patients. The disease was considered to be caused by a VZV infection in 32 patients (11.4%), of which 23 cases were virologically confirmed (detection of VZV DNA in CSF). The most frequent diagnosis of the patients with VZV CNS infection was encephalitis (83.3%), followed by meningitis (13.3%) and cerebellitis (3.3%). The mean annual incidence of VZV CNS infection was 3.0 cases per 100,000 inhabitants. VZV was the most common cause of encephalitis and viral meningitis, ahead of herpes simplex virus (n = 9). At the time of discharge, 12 (40%) patients showed neurological sequelae. Five patients (20%) died during hospitalization, all with encephalitis. Patients with a fatal outcome had significantly higher median age and longer delay before initiating acyclovir. In conclusion, VZV was the first cause of encephalitis in our elderly population. Despite acyclovir treatment, there was a high rate of case fatality and sequelae at discharge.
Asunto(s)
ADN Viral/líquido cefalorraquídeo , Encefalitis por Varicela Zóster/epidemiología , Herpesvirus Humano 3/patogenicidad , Meningitis Viral/epidemiología , Infección por el Virus de la Varicela-Zóster/epidemiología , Aciclovir/uso terapéutico , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Sistema Nervioso Central/patología , Sistema Nervioso Central/virología , Encefalitis por Varicela Zóster/diagnóstico por imagen , Encefalitis por Varicela Zóster/tratamiento farmacológico , Encefalitis por Varicela Zóster/mortalidad , Femenino , Herpesvirus Humano 3/efectos de los fármacos , Herpesvirus Humano 3/fisiología , Humanos , Incidencia , Imagen por Resonancia Magnética , Masculino , Meningitis Viral/diagnóstico por imagen , Meningitis Viral/tratamiento farmacológico , Meningitis Viral/mortalidad , Estudios Retrospectivos , España/epidemiología , Análisis de Supervivencia , Infección por el Virus de la Varicela-Zóster/diagnóstico por imagen , Infección por el Virus de la Varicela-Zóster/tratamiento farmacológico , Infección por el Virus de la Varicela-Zóster/mortalidadRESUMEN
OBJECTIVE: The aim of this study was to report the case of a male patient with Parkinson disease who developed brachial plexopathy (BP) due to varicella-zoster virus, which was successfully treated with human immunoglobulin. METHOD: We report the case of a 75-year-old male subject with a diagnosis of Parkinson disease who came to our hospital complaining of pain, skin lesions, and strength loss in his right arm during the past 2 months. Physical examination revealed vesicular rash compatible with varicella-zoster virus lesions. Nerve conduction studies and magnetic resonance imaging of the brachial plexus showed inflammatory changes at that level. A trial with oral valacyclovir followed by intravenous methylprednisolone bolus was administered without further response. However, human intravenous immunoglobulin resulted in complete recovery of the symptoms. CONCLUSIONS: Human immunoglobulin is effective in BP due to zoster infection and must be considered if standard treatment fails. To the best of our knowledge, this is the first report of BP associated to zoster infection successfully treated with intravenous immunoglobulin.
Asunto(s)
Neuropatías del Plexo Braquial/tratamiento farmacológico , Neuropatías del Plexo Braquial/etiología , Encefalitis por Varicela Zóster/complicaciones , Inmunoglobulinas Intravenosas/uso terapéutico , Anciano , Neuropatías del Plexo Braquial/diagnóstico por imagen , Neuropatías del Plexo Braquial/virología , Encefalitis por Varicela Zóster/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Conducción Nerviosa/efectos de los fármacos , Enfermedad de Parkinson/complicacionesAsunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Encefalitis por Varicela Zóster/diagnóstico por imagen , Glioma/diagnóstico por imagen , Gliosis/diagnóstico por imagen , Aciclovir/análogos & derivados , Aciclovir/uso terapéutico , Anciano , Antivirales/uso terapéutico , Diagnóstico Diferencial , Encefalitis por Varicela Zóster/líquido cefalorraquídeo , Encefalitis por Varicela Zóster/complicaciones , Encefalitis por Varicela Zóster/tratamiento farmacológico , Gliosis/etiología , Humanos , Inmunocompetencia , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Valaciclovir , Valina/análogos & derivados , Valina/uso terapéutico , Adulto JovenRESUMEN
We describe an extraordinary case of an immunocompetent patient who developed sacral-distribution zoster, followed 3months later by neurological disease that progressed for 6years and was attributed to varicella zoster virus (VZV) infection of the brain. Despite the prolonged infection, neurologic symptoms and signs resolved rapidly and completely after treatment with intravenous acyclovir.
Asunto(s)
Antivirales/uso terapéutico , Encefalitis por Varicela Zóster/complicaciones , Enfermedades del Sistema Nervioso/tratamiento farmacológico , Enfermedades del Sistema Nervioso/etiología , Encéfalo/diagnóstico por imagen , Encéfalo/virología , Encefalitis por Varicela Zóster/diagnóstico por imagen , Encefalitis por Varicela Zóster/tratamiento farmacológico , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/diagnóstico por imagenRESUMEN
BACKGROUP AND PURPOSE: There are limited data regarding the diagnostic yield of transcranial color-coded Doppler (TCCD) in acute encephalitis. We present our preliminary observations of consecutive ultrasound evaluations in 2 patients with acute encephalitis and we review the possible diagnostic role of TCCD in such cases. METHODS: We describe two cases of acute encephalitis that presented with aphasia and confusion and underwent repeat TCCD evaluation at baseline and after 48 hours in both patients. We also critically review the current literature regarding potential TCCD applications in acute central nervous system infections. RESULTS: Serial TCCD evaluations revealed the following triad of abnormal findings in both patients: (i) elevated pulsatility index (PI) in the left middle cerebral artery (M1 MCA) at baseline (>1.2), (ii) increased PI in left M1 MCA by >25% in comparison to right M1 MCA, and (iii) decrease in PI in left M1 MCA by >25% at the follow-up evaluation at 48 hours. The decrease in PI in left M1 MCA coincided with symptom improvement in both patients. DISCUSSION: The focal transient increase in left M1 MCA PI may be attributed to focally increased intracranial pressure or peripheral vasospasm of distal left MCA branches. Since there are limited reports in the literature concerning TCCD evaluation of patients with central nervous system infections, our preliminary findings require independent confirmation in a larger series of patients.
Asunto(s)
Encefalopatía Aguda Febril/diagnóstico por imagen , Encefalitis por Varicela Zóster/diagnóstico por imagen , Meningitis por Listeria/diagnóstico por imagen , Ultrasonografía Doppler en Color/tendencias , Ultrasonografía Doppler Transcraneal/tendencias , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Predicción , Humanos , Imagen por Resonancia Magnética , Arteria Cerebral Media/diagnóstico por imagen , Flujo Pulsátil/fisiología , Tomografía Computarizada por Rayos XRESUMEN
The role of brain 18F-FDG PET in the diagnostic evaluation of encephalitis has been recently suggested, especially in limbic encephalitis, but descriptions are mainly limited to small case reports. However, the evaluation of cerebral metabolism by 18F-FDG PET has never been described for varicella-zoster virus encephalitis. We report the first case of varicella-zoster virus encephalitis in which 18F-FDG PET revealed brain metabolic abnormalities. Brain metabolic PET imaging was analyzed by comparing the patient's brain 18F-FDG PET scans to that of 12 healthy subjects. Compared with healthy subjects, significant hypometabolism and hypermetabolism were found and evolved over time with treatment.
Asunto(s)
Encéfalo/diagnóstico por imagen , Encefalitis por Varicela Zóster/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , CintigrafíaRESUMEN
We studied the rare case of an older adult with dementia following herpes zoster encephalitis (HZE). This 71-year-old woman presented to us approximately 1 year following resolution of a rapid-onset episode of HZE, and subsequently underwent neuropsychological and neuroimaging examinations. Cognitive assessment revealed impairments in general cognitive functioning, verbal and nonverbal memory, executive functions, speed of information processing, attention/working memory, and motor skills. The patient's neuroimaging data, when compared to a demographically similar healthy control sample (n = 9), demonstrated moderate central and perisylvian brain volume loss, several subcortical lesions in the white matter, and resting state whole brain and hippocampal hypoperfusion. These findings highlight neuropsychological changes evident in a dementia syndrome of this type, and they suggest that early identification and treatment of HZE has implications for the preservation of long-term cognitive functioning.
Asunto(s)
Demencia/etiología , Encefalitis por Varicela Zóster/complicaciones , Anciano , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Demencia/diagnóstico por imagen , Demencia/virología , Encefalitis por Varicela Zóster/diagnóstico por imagen , Encefalitis por Varicela Zóster/psicología , Femenino , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Pruebas Neuropsicológicas , RadiografíaRESUMEN
The aim of the study was to describe the clinical and radiological features of childhood post-varicella cerebral infarction (PVCI). A retrospective review was undertaken of children with arterial ischaemic stroke (AIS) who had experienced varicella zoster virus (VZV) infection within the preceding year. Twenty-four children (15 males, nine females; age range at time of VZV infection 2mo-6y) were identified, with a median of 4 months between VZV and AIS (range 1wk-12mo). All had infarction in the middle cerebral artery (MCA) territory and abnormalities of the M1 segment; arteriopathy affected other arteries in 10 children. After a median of 27 months, six patients had recurrent transient ischaemic attacks (TIA), with new infarcts in two of 22 children on re-imaging. Arterial disease improved in 11 children, was stable in four, and progressed in seven (of whom four had recurrent TIA and two had re-infarction). PVCI affects young, previously healthy children within a few months of VZV infection and is characterized by MCA territory infarction and proximal MCA disease. One quarter of patients have recurrence, usually, but not inevitably, associated with progressive arteriopathy. Treatable co-existing AIS risk factors should always be excluded. A more comprehensive diagnostic evaluation should be considered in children with AIS who do not fit the clinical and radiological profile outlined, even where there is a history of recent VZV infection.
Asunto(s)
Encéfalo/diagnóstico por imagen , Encefalitis por Varicela Zóster/complicaciones , Encefalitis por Varicela Zóster/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/etiología , Ataque Isquémico Transitorio/etiología , Adolescente , Encéfalo/irrigación sanguínea , Circulación Cerebrovascular/fisiología , Niño , Preescolar , ADN Viral/líquido cefalorraquídeo , ADN Viral/inmunología , Encefalitis por Varicela Zóster/inmunología , Femenino , Lateralidad Funcional/fisiología , Humanos , Inmunoglobulina G/inmunología , Lactante , Infarto de la Arteria Cerebral Media/diagnóstico , Infarto de la Arteria Cerebral Media/fisiopatología , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Angiografía por Resonancia Magnética , Masculino , Radiografía , Recurrencia , Índice de Severidad de la EnfermedadAsunto(s)
Encefalitis por Varicela Zóster , Infecciones por VIH/complicaciones , Herpesvirus Humano 3/fisiología , Activación Viral , Infecciones Oportunistas Relacionadas con el SIDA/fisiopatología , Infecciones Oportunistas Relacionadas con el SIDA/virología , Encéfalo/diagnóstico por imagen , ADN Viral/líquido cefalorraquídeo , Encefalitis por Varicela Zóster/diagnóstico por imagen , Encefalitis por Varicela Zóster/fisiopatología , Encefalitis por Varicela Zóster/virología , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/aislamiento & purificación , Herpesvirus Humano 3/patogenicidad , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Varicella-zoster virus (VZV) infection of the central nervous system (CNS) is rare after hematopoietic stem cell transplantation (SCT). Here, we describe the first patient who developed VZV encephalitis after cord blood transplantation (CBT). A 35-year-old man with myelodysplastic syndrome-overt leukemia underwent CBT. On day +23, a neutrophil count consistently greater than 0.5 x 10(9)/L was achieved. On day +42, 1 mg/kg per day of prednisolone therapy was initiated for grade III acute graft-versus-host disease (GVHD). Then, the dose of prednisolone was slowly reduced. For exacerbation of chronic GVHD, the dose of prednisolone was again increased to 1 mg/kg per day on day +231. On day +265, localized cutaneous zoster in the left thoracic region occurred, but soon resolved after acyclovir therapy. On day +309, he suddenly developed diplopia. Subsequently, right facial palsy and hearing impairment occurred. No skin rash was observed. Magnetic resonance imaging (MRI) scans revealed multifocal abnormal high-signal intensity in the CNS. A high level of VZV DNA was detected in a cerebrospinal fluid specimen. He was diagnosed with VZV encephalitis. Acyclovir was given intravenously for 40 days. Four months after the onset, the neurologic symptoms had incompletely resolved. MRI scans showed substantial resolution but with mild residual lesions. The present report indicates that VZV should be considered as a possible causative agent in patients who develop multifocal neurologic symptoms of the CNS after SCT.