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CSF and MRI findings in patients with acute herpes zoster
M Haanpää1, P Dastidar, A Weinberg
1Department of Neurology, Tampere University Hospital, Finland.
Objective:
To explore MRI and CSF findings in patients with herpes zoster (HZ) and to correlate the findings with clinical manifestations of the disease.
Methods:
Fifty immunocompetent patients (mean age, 59 years; range, 17 to 84 years) with HZ of fewer than 18 days duration participated. None had clinical signs of meningeal irritation, encephalitis, or myelitis. In 42 patients (84%), the symptoms constituted pain and rash only. Six patients (12%) had motor paresis, and three patients (6%) had ocular complications. One to three CSF samples were obtained from 46 patients (the first sampling taken 1 to 18 days from onset of rash), and 16 patients (all with either trigeminal or cervical HZ) underwent MRI of the brain. The clinical follow-up continued at least 3 months.
Results:
CSF was abnormal in 28/46 patients (61%): pleocytosis (range, 5 to 1,440 microL) was detected in 21, elevated protein concentration in 12, varicella zoster virus (VZV) DNA in 10, and immunoglobulin G antibody to VZV in 10. These changes were more common in patients with acute complications, although they did not predict development of postherpetic neuralgia (PHN). In 9/16 patients (56%), MRI lesions attributable to HZ were seen in the brainstem and cervical cord. At 3 months, 5/9 patients (56%) with abnormal MRI had PHN, whereas none of the 7 patients with no HZ-related lesions on MRI had any remaining pain.
Conclusions:
Subclinical extension of viral inflammation into the CNS occurs commonly in HZ. This finding may have implications for treatment of HZ and prevention of various associated complications.
Insights
Herpes zoster (HZ) commonly involves subclinical central nervous system (CNS) inflammation, detected via MRI and CSF analysis. These findings may impact HZ treatment and complication prevention strategies.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Herpes zoster (HZ) is a viral infection caused by the varicella-zoster virus (VZV).
- HZ typically presents with a painful rash but can have neurological complications.
Purpose of the Study:
- To investigate Magnetic Resonance Imaging (MRI) and Cerebrospinal Fluid (CSF) findings in patients with HZ.
- To correlate these findings with the clinical presentation and outcomes of HZ.
Main Methods:
- Fifty immunocompetent HZ patients with symptoms under 18 days were studied.
- CSF analysis and brain MRI were performed on subsets of patients.
- Clinical follow-up extended to at least 3 months.
Main Results:
- Abnormal CSF findings (pleocytosis, elevated protein, VZV DNA/antibodies) were present in 61% of patients.
- MRI revealed HZ-related lesions in the brainstem and cervical cord in 56% of scanned patients.
- Abnormal MRI findings correlated with a higher incidence of postherpetic neuralgia (PHN) at 3 months.
Conclusions:
- Subclinical inflammation of the central nervous system (CNS) is common in HZ.
- These subclinical findings may influence the management and prevention of HZ complications.
- Early detection of CNS involvement could lead to improved patient outcomes.