Related Experiment Video
Updated: Mar 14, 2026
Inducing Meningococcal Meningitis Serogroup C in Mice via Intracisternal Delivery
Published on: November 5, 2019
Definition and management of varicella zoster virus-associated meningoradiculitis: a case report
Vincent Luisier1, Lalensia Weber1, Daniel Fishman2
1Internal Medicine Division, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland.
Background:
The varicella zoster virus affects the central or peripheral nervous systems upon reactivation, especially when cell-mediated immunity is impaired. Among varicella zoster virus-related neurological syndromes, meningoradiculitis is an ill-defined condition for which clear management guidelines are still lacking. Zoster paresis is usually considered to be a varicella zoster virus-peripheral nervous system complication and treated with oral antiviral therapy. Yet in the literature, the few reported cases of herpes zoster with mild cerebral spinal fluid inflammation were all considered meningoradiculitis and treated using intravenous antiviral drugs, despite absence of systemic signs of meningitis. Nevertheless, these two clinical pictures are very similar.
Case Presentation:
We report the case of an alcohol-dependent elderly Caucasian man presenting with left lower limb zoster paresis and mild cerebral spinal fluid inflammation, with favorable outcome upon IV antiviral treatment. We discuss interpretation of liquor inflammation in the absence of clinical meningitis and implications for the antiviral treatment route.
Conclusion:
From this case report we suggest that varicella zoster virus-associated meningoradiculitis should necessarily include meningitis symptoms with the peripheral neurological deficits and cerebral spinal fluid inflammation, requiring intravenous antiviral treatment. In the absence of (cell-mediated) immunosuppression, isolated zoster paresis does not necessitate spinal tap or intravenous antiviral therapy.
Insights
Varicella zoster virus reactivation can cause neurological issues. This case suggests meningoradiculitis requires IV antivirals, while isolated zoster paresis may not need spinal taps or IV treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- Varicella zoster virus (VZV) reactivation impacts the nervous system, particularly with impaired immunity.
- Meningoradiculitis, an ill-defined VZV neurological syndrome, lacks clear management guidelines.
- Zoster paresis, a VZV peripheral nervous system complication, is typically treated with oral antivirals.
Purpose of the Study:
- To discuss the interpretation of cerebrospinal fluid (CSF) inflammation in the absence of clinical meningitis.
- To clarify implications for antiviral treatment routes in VZV neurological syndromes.
- To differentiate management between zoster paresis and meningoradiculitis.
Main Methods:
- Case report of an elderly alcohol-dependent man with zoster paresis and mild CSF inflammation.
- Review of literature on VZV-related neurological syndromes and treatment approaches.
- Analysis of clinical presentation, CSF findings, and treatment outcomes.
Main Results:
- The patient presented with zoster paresis and mild CSF inflammation, responding favorably to IV antiviral treatment.
- The case highlights the similarity between zoster paresis and meningoradiculitis presentations.
- Mild CSF inflammation in the absence of systemic meningitis signs was observed.
Conclusions:
- Varicella zoster virus-associated meningoradiculitis necessitates meningitis symptoms, peripheral deficits, and CSF inflammation for IV antiviral treatment.
- Isolated zoster paresis without immunosuppression does not warrant spinal tap or IV antiviral therapy.
- Distinguishing between these VZV neurological syndromes is crucial for appropriate treatment decisions.
