What is the central nervous system (CNS) involvement in the pathogenesis of herpes zoster (shingles)?

Updated: Feb 11, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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Whereas herpes zoster is classically described in sensory (dorsal root) ganglia, it can spread to affect any portion of the central nervous system (CNS). Involvement of the anterior horn cells can produce muscular weakness, cranial nerve palsies, diaphragmatic paralysis, neurogenic bladder, and colonic pseudo-obstruction. Wider involvement of the spinal cord can produce Guillain-Barré syndrome, transverse myelitis, and myositis.

In severely ill or immunocompromised patients, general CNS involvement can be observed in the form of meningoencephalitis or encephalitis. Such presentations may be indistinguishable from those of other forms of meningoencephalitis, though other evidence of acute zoster usually is present. [12] Cerebrospinal fluid (CSF) studies frequently reveal pleocytosis without elevated protein. These infections can be life-threatening.

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