Clinical characteristics analysis of 33 cases of cutaneous varicella zoster virus infection involving the nervous system
Journal Title: Chinese Journal of Nervous and Mental Diseases - Year 2024, Vol 50, Issue 12
Abstract
[Objective] To summarize the clinical features, characteristics of cerebrospinal fluid, electrophysiological manifestations, imaging changes, treatment strategies, and prognosis of patients with varicella zoster virus (VZV) complicated by neurological involvement. [Methods] A retrospective analysis was conducted on 33 patients diagnosed with VZV-associated neurological infections and treated at Beijing Jishuitan Hospital, Capital Medical University, between 2013 and 2024. The clinical characteristics of these patients were thoroughly examined. [Results] Among the 33 patients, 22 were males (66.7%) and 11 were females (33.3%), with a mean age of (60.7±14.3) years. All patients presented with cutaneous herpes zoster, with 22 cases (66.7%) starting with herpes zoster and 11 cases (33.3%) starting with symptoms of neurological damage. Neurological involvement predominantly affected the cranial nerves in 27 cases (81.8%), with facial nerve being the most commonly involved (51.5%). The most common manifestation was facial paralysis (51.5%), followed by head and facial pain (33.3%). It could also be manifested as dizziness (12.1%), ophthalmoplegia (9.1%), hearing loss (9.1%), fever (3.0%), hoarseness (3.0%), and bucking (3.0%). Spinal nerve was involved in 3 cases (9.1%): 2 with spinal radiculitis and 1 with Guillain-Barré syndrome, which was characterized by limb numbness, weakness, and dysuria. Additionally, spinal cord was involved in 3 cases (9.1%) including 2 involving the thoracic spinal cord and 1 involving the cervical spinal cord, which was presented as limb numbness, pain, and weakness. No cases of VZV-induced encephalitis, meningitis, or vasculitis were reported. 14 patients underwent cerebrospinal fluid examination, and 5 patients (35.7%) had elevated pressure, 11 patients (78.6%) had elevated white blood cells, and 5 patients (35.7%) had elevated protein. Neuroimaging did not revealed any responsible lesion in 21 patients with cranial nerve involvement who underwent cranial magnetic resonance image. Among the three patients with spinal cord involvement, the lesion segment was all one vertebral segment. Two cases (2/3) showed circular or mild enhancement after enhancement, while one case (1/3) had no enhancement. Except for one patient who was transferred to another hospital due to HIV infection, all other patients showed clinical improvement upon discharge following antiviral therapy, with or without adjunctive glucocorticoid treatment. [Conclusions] The primary neurological complications of VZV include cranial nerve paralysis, spinal radiculitis, Guillain-Barré syndrome and myelitis. Early initiation of antiviral therapy, particularly when combined with glucocorticoids, is associated with improved clinical outcomes.
Authors and Affiliations
Ying LI, Qian YOU, Xutong ZHAO, Xuejun GUO, Xufeng CHEN, Lin LEI, Hongtao HU
Keywords
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- EP ID EP759217
- DOI 10.3969/j.issn.1002-0152.2024.12.001
- Views 7
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