[Varicella-Zoster Virus Infections of the Central Nervous System]

Varicella-zoster virus causes varicella and herpes zoster and a wide spectrum of central nervous system (CNS) complications, such as meningitis, encephalitis, myelitis, and stroke. Severe manifestations are more often observed in older adults and patients with an immunocompromised status. CNS involvement may occur without accompanying skin eruptions, making clinical diagnosis challenging. Although the FilmArray^® Meningitis/Encephalitis Panel is a useful rapid detection tool, clinicians should be aware that false-negative results are possible, particularly in cases with low viral load or delayed presentation. Early initiation of high-dose intravenous acyclovir is crucial for improving outcomes. In recent years, a recombinant zoster vaccine has gained attention for preventing herpes zoster and for its potential protective effects against stroke and dementia, as suggested by observational studies. Comprehensive strategies integrating early diagnosis, prompt antiviral therapy, and vaccination are increasingly important in aging societies.