Neurological Manifestations of Varicella Zoster Workup

  • Author: Wayne E Anderson, DO; Chief Editor: Karen L Roos, MD   more...
 
Updated: May 11, 2011
 

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.
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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.
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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.
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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.

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Contributor Information and Disclosures
Author

Wayne E Anderson, DO  Assistant Professor of Internal Medicine/Neurology, College of Osteopathic Medicine of the Pacific Western University of Health Sciences; Clinical Faculty in Family Medicine, Touro University College of Osteopathic Medicine; Clinical Instructor, Departments of Neurology and Pain Management, 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 & Ethics, California Medical Association, and San Francisco Medical Society

Disclosure: Cephalon Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; King Honoraria Speaking and teaching; Forest Honoraria Speaking and teaching

Specialty Editor Board

J Stephen Huff, MD  Associate Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

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.

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

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; Director, Neuropathy Association Center of Excellence, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University School of Medicine

Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Neurological Association, American Paraplegia Society, Consortium of Multiple Sclerosis Centers, and National Multiple Sclerosis Society

Disclosure: Nothing to disclose.

Chief Editor

Karen L Roos, MD  John and Nancy Nelson Professor of Neurology, Professor of Neurological Surgery, Department of Neurology, Indiana University School of Medicine

Karen L Roos, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association

Disclosure: Nothing to disclose.

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Herpes zoster in the ophthalmic (V1) distribution of the trigeminal nerve. Note the unilateral distribution of the rash and how the V1 distribution may extend to the tip of the nose. Though at risk for keratitis with zoster in this distribution, the patient had a normal ocular examination. Patient consented to picture distribution for educational use; written permission on file; contributed by JS Huff.
 
 
 
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