[Neurological complications of varicella-zoster virus (VZV) infection]

Sixty cases with varicella-associated neurological disorders from Japanese literature during recent 11 years were analyzed and compared with previous reports. Chief diseases were encephalitis (encephalopathy) (23.3%), cerebellar ataxia (21.7%), meningitis (18.3%), cerebral infarction (13.3%) and facial palsy (8.3%). Cerebellar ataxia, meningitis and cerebral infarction were found in young children under 9 years, and other disorders were seen also in older children and adults. Some cases had neurological symptoms before the appearance of skin rash. The number of cells in cerebrospinal fluid was increased in meningitis, encephalitis and myelitis. Though neurological complications due to varicella were rare, prognosis was not necessarily good, including several cases with death or severe sequelae. In our 4 cases of herpes zoster meningitis, marked intrathecal VZV-specific antibody production was found and they showed high antibody index. Oligoclonal band was found in one case. The pathogenesis of neurological complications of VZV infection was considered to be caused by direct viral invasion in herpes zoster and at least in some cases of varicella. Therapy with antiviral agents is necessary and vaccination is recommended for prevention.