What is the role of imaging studies in the diagnosis of herpes zoster (shingles)?

Updated: Feb 11, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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No imaging tests are indicated in typical cases of cutaneous herpes zoster infection. Magnetic resonance imaging (MRI) may be used in cases of myelopathy or encephalopathy as a means of excluding other etiologies.

A small percentage of patients, particularly those with cranial nerve (CN) involvement, may develop headache and neck stiffness, necessitating a lumbar puncture to exclude meningitis. Because the inflammatory response involves the leptomeninges, cerebrospinal fluid (CSF) may show increased protein and a pleocytosis.

Because the diagnosis can almost always be made on clinical grounds, skin biopsy is seldom necessary; as a rule, it is reserved for cases that are difficult to diagnose (eg, atypical lesions).

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