eMedicine Specialties > Neurology > Neurological Infections

Varicella Zoster: Differential Diagnoses & Workup

Author: Wayne E Anderson, DO, Assistant Professor of Internal Medicine/Neurology, Western University of Health Sciences; Assistant Professor of Family Medicine, Touro University College of Osteopathic Medicine; Consulting Staff in Pain Management, Department of Neurology, California Pacific Medical Center; Consulting Staff in Neurology, Department of Neurology, California Pacific Medical Center
Contributor Information and Disclosures

Updated: Nov 23, 2009

Differential Diagnoses

Aseptic Meningitis
HIV-1 Associated Progressive Polyradiculopathy
Bell Palsy
Migraine Headache
Hemifacial Spasm
Migraine Headache: Neuro-Ophthalmic Perspective
Herpes Simplex Encephalitis
Persistent Idiopathic Facial Pain
HIV-1 Associated Distal Painful Sensorimotor Polyneuropathy
HIV-1 Associated Multiple Mononeuropathies

Other Problems to Be Considered

Syphilis
Vestibular neuronitis
Malignant and nonmalignant pain syndromes
Back pain

Workup

Laboratory Studies

  • In cases of typical zoster special laboratory studies are unnecessary.
  • In cases of zoster sine herpete, DNA analysis by PCR appears more useful than the standard assays, especially for early diagnosis.

Imaging Studies

  • Magnetic resonance imaging (MRI) may be used in cases of myelopathy or encephalopathy to exclude other etiologies.
  • Carreau and colleagues visualized facial nerve lesions with enhanced MRI in peripheral facial palsy.

Other Tests

  • Lumbar puncture: Because the inflammatory response involves the leptomeninges, cerebrospinal fluid (CSF) may show increased protein and a pleocytosis.
  • Biopsy can provide definitive diagnosis but is seldom necessary.

Histologic Findings

Varicella-zoster virus is a DNA virus. The viral genome encodes approximately 70 proteins. Once activated at the spinal root or cranial nerve neurons, an inflammatory response occurs that also encompasses the leptomeninges. Both plasma cells and lymphocytes are noted. In at least one case of motor neuron involvement, lymphocytic infiltration and myelin breakdown were observed with preservation of axons.

More on Varicella Zoster

Overview: Varicella Zoster
Differential Diagnoses & Workup: Varicella Zoster
Treatment & Medication: Varicella Zoster
Follow-up: Varicella Zoster
Multimedia: Varicella Zoster
References
Further Reading
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References

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Keywords

varicella-zoster, VSV, varicella-zoster virus, zoster treatment, zoster symptoms, VZV infection, chickenpox, chicken pox, herpes zoster, shingles, Ramsay-Hunt syndrome, zoster multiplex, zoster sine herpete, keratitis, postherpetic neuralgia, PHN, varicella zoster

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Contributor Information and Disclosures

Author

Wayne E Anderson, DO, Assistant Professor of Internal Medicine/Neurology, Western University of Health Sciences; Assistant Professor of Family Medicine, Touro University College of Osteopathic Medicine; Consulting Staff in Pain Management, Department of Neurology, California Pacific Medical Center; Consulting Staff in Neurology, Department of Neurology, California Pacific Medical Center
Wayne E Anderson, DO is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Law Medicine and Ethics, California Medical Association, and San Francisco Medical Society
Disclosure: Cephalon Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; King Honoraria Consulting

Medical Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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