Related Experiment Video
Updated: Feb 13, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
[An Autopsy Case of Meningoencephalitis and Cerebral Infarction that Developed with Ramsay Hunt Syndrome and
Nobuo Yamashiro1, Takamura Nagasaka, Naoki Ooishi
1Department of Neurology, Faculty of Medicine, University of Yamanashi.
Abstract:
We report here the clinical presentation and subsequent autopsy of a 90-year-old man who developed small papules with pain and swelling in his right ear. On admission, he exhibited right facial nerve paralysis, neck stiffness and Kernig's sign. The cell count was elevated and the varicella-zoster virus-PCR was positive in the CSF. Brain magnetic resonance imaging showed hyperintense lesions in the left pons and left temporal lobe, in FLAIR images. We diagnosed the patient with Ramsay Hunt syndrome and meningoencephalitis due to varicella-zoster virus. Although the symptoms of meningitis improved following treatment with intravenous acyclovir (750 mg/day initially, raised to 1,125 mg/day), 16 days after admission, he died suddenly due to gastrointestinal hemorrhage. The autopsy findings included lymphocytic infiltration of the leptomeninges and perivascular space of the cerebrum, and slight parenchyma in the left temporal lobe and insula, as the main histological features. Encephalitis due to varicella zoster virus has been recognized as a vasculopathy affecting large and small vessels. Pathological confirmation is rare in varicella zoster virus meningoencephalitis.
Insights
This case study details a fatal outcome of varicella-zoster virus (VZV) meningoencephalitis in an elderly man, highlighting rare pathological confirmation of VZV vasculopathy.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Varicella-zoster virus (VZV) can cause serious neurological complications, including meningoencephalitis.
- Ramsay Hunt syndrome, a VZV reactivation, often presents with facial nerve paralysis.
Observation:
- A 90-year-old man presented with ear pain, facial paralysis, and signs of meningitis.
- Cerebrospinal fluid (CSF) analysis revealed elevated cell count and positive VZV PCR.
- Brain MRI showed lesions in the pons and temporal lobe.
Findings:
- The patient was diagnosed with Ramsay Hunt syndrome and VZV meningoencephalitis.
- Despite treatment with intravenous acyclovir, the patient died from gastrointestinal hemorrhage.
- Autopsy confirmed lymphocytic infiltration and VZV vasculopathy affecting cerebral vessels.
Implications:
- This case underscores the severe neurological potential of VZV reactivation in the elderly.
- Pathological confirmation of VZV meningoencephalitis and its associated vasculopathy is exceptionally rare.
- Understanding VZV-induced vasculopathy is crucial for managing severe neurological infections.
Related Concept Videos
01:24Nephrotic Syndrome I : Introduction
01:30Acute Coronary Syndrome I: Introduction
01:05Cerebral Hemispheres
01:17Irritable Bowel Syndrome I: Introduction
IBS is a chronic condition that can persist over a long period or recur frequently.
The pathogenesis of IBS involves a complex interplay of the following factors:
Altered...
01:43Sustainable Development
01:27Restless Leg Syndrome and Night Terrors
The exact cause of RLS is not fully understood, but it is believed to involve dopamine, a neurotransmitter that helps regulate muscle movement. Imbalances in dopamine levels...