Postherpetic Neuralgia Workup

  • Author: W Alvin McElveen, MD; Chief Editor: Robert A Egan, MD   more...
 
Updated: Jan 19, 2012
 

Laboratory Studies

  • No laboratory work is usually necessary in cases of postherpetic neuralgia (PHN).
  • Results of cerebrospinal fluid (CSF) evaluation are abnormal in 61%.
    • Pleocytosis is observed in 46%, elevated protein in 26%, and varicella zoster virus (VZV) DNA in 22%.
    • These findings are not predictive of the PHN clinical course.
  • Viral culture or immunofluorescent staining may be used to differentiate herpes simplex from herpes zoster in cases that are difficult to distinguish clinically.
  • Antibodies to herpes zoster can be measured. A 4-fold increase has been used to support the diagnosis of subclinical herpes zoster (zoster sine herpete). However, a rising titer secondary to viral exposure rather than reactivation cannot be ruled out.
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Imaging Studies

A study by Haanpaa et al revealed the following:[6]

  • MRI lesions attributable to HZ were seen in the brain stem and cervical cord in 9 patients (56%).
  • At 3 months after onset of HZ, 5 patients (56%) with an abnormal MRI had developed PHN.
  • Of the 7 patients who had no HZ-related lesions on MRI, none had residual pain.
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Histologic Findings

Although HZ symptoms may be confined to a few sensory dermatomes, pathological changes may be more widespread. Affected ganglia of the spinal or cranial nerve roots are swollen and inflamed with a primarily lymphocytic reaction. Some ganglion cells are swollen while others are degenerated.

Inflammation extends into the meninges and root entry zone and may be present in the ventral horn and perivascular space of the spinal cord. Pathological changes in the brain stem are similar to those in the spinal root and spinal cord. In the months following infection, fibrosis occurs in the ganglia, peripheral nerve, and nerve root. Degeneration occurs in the ipsilateral posterior column.

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Contributor Information and Disclosures
Author

W Alvin McElveen, MD  Director, Stroke Unit, Lakewood Ranch Medical Center; Neurologist, Manatee Memorial Hospital

W Alvin McElveen, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Neuroimaging, American Stroke Association, and Southern Clinical Neurological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ralph F Gonzalez, MD  Private Practice, Bradenton Neurology, Inc; Consulting Staff, Department of Neurology, Blake Hospital, Lakewood Ranch Medical Center, Manatee Memorial Hospital

Ralph F Gonzalez, MD is a member of the following medical societies: American Academy of Neurology and Florida Medical Association

Disclosure: Nothing to disclose.

Douglas Sinclair, DO  Consulting Staff, Department of Neurology, Blake Medical Center and Bradenton Neurology, Inc

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph Carcione Jr, DO, MBA  Consultant in Neurology and Medical Acupuncture, Medical Management and Organizational Consulting, Central Westchester Neuromuscular Care, PC; Medical Director, Oxford Health Plans

Joseph Carcione Jr, DO, MBA is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James H Halsey, MD  Professor, Department of Neurology, University of Alabama Medical Center

James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Robert A Egan, MD  Director of Neuro-Ophthalmology, St Helena Hospital

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, and Oregon Medical Association

Disclosure: Nothing to disclose.

References

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Hypopigmented rash in thoracic dermatome of postherpetic lesion.
 
 
 
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