Which physical findings suggest herpes zoster encephalomyelitis?

Updated: Jan 25, 2019
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Herpes zoster encephalomyelitis may give rise to localized mild leptomeningitis in the region of neurologic involvement. This is more common than is generally recognized and often results in pleocytosis in the cerebrospinal fluid (CSF). Leptomeningitis most likely occurs when CNs (especially CN V) are involved because of the presence of the recurrent nerve of Arnold, which branches from CN V1 to the tentorium. For this reason, meningeal symptoms (eg, headache, changes in sensorium, fever, and neck stiffness) are most common with HZO.

Rarely, symptoms of meningoencephalitis may be significant; at times, they may be severe enough to cause death. Westenend and Hoppenbrouwers reported fatal hemorrhagic encephalitis in an otherwise healthy woman. [64] Zoster encephalomyelitis may be mistaken for acute poliomyelitis. The spread of VZV to the central nervous system (CNS) also may occur during suppression of host resistance by neoplasms, by cytotoxic drugs, and, possibly, by radiation therapy.


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