varicella zoster encephalitis

Summary

Summary: Inflammation of brain tissue caused by infection with the varicella-zoster virus (HERPESVIRUS 3, HUMAN). This condition is associated with immunocompromised states, including the ACQUIRED IMMUNODEFICIENCY SYNDROME. Pathologically, the virus tends to induce a vasculopathy and infect oligodendrocytes and ependymal cells, leading to CEREBRAL INFARCTION, multifocal regions of demyelination, and periventricular necrosis. Manifestations of varicella encephalitis usually occur 5-7 days after onset of HERPES ZOSTER and include HEADACHE; VOMITING; lethargy; focal neurologic deficits; FEVER; and COMA. (From Joynt, Clinical Neurology, 1996, Ch 26, pp29-32; Hum Pathol 1996 Sep;27(9):927-38)

Top Publications

  1. Abendroth A, Arvin A. Immune evasion as a pathogenic mechanism of varicella zoster virus. Semin Immunol. 2001;13:27-39 pubmed
  2. Ofek Shlomai N, Averbuch D, Wolf D, Engelhard D. Varicella zoster virus encephalitis in a previously healthy five-year-old child with herpes zoster ophthalmicus. Pediatr Infect Dis J. 2005;24:476-7 pubmed
  3. Outteryck O, Senechal O, Berteloot D, Delalande I, Mounier Vehier F. [Cerebral vasculitis secondary to Varicella-Zoster virus infection]. Rev Neurol (Paris). 2005;161:836-9 pubmed
    ..Central nervous system infection by the varicella-zoster virus (VZV) can be responsible for myelitis, meningitis, ventriculitis and large and small-vessels encephalitis...
  4. Fukuno K, Tomonari A, Takahashi S, Ooi J, Takasugi K, Tsukada N, et al. Varicella-zoster virus encephalitis in a patient undergoing unrelated cord blood transplantation for myelodysplastic syndrome-overt leukemia. Int J Hematol. 2006;84:79-82 pubmed
    ..MRI scans showed substantial resolution but with mild residual lesions. The present report indicates that VZV should be considered as a possible causative agent in patients who develop multifocal neurologic symptoms of the CNS after SCT...
  5. Sugisaki K, Yoshida H. Varicella zoster virus meningoencephalitis accompanied by sporadic skin lesions in an older immunocompetent adult. J Infect Chemother. 2007;13:270-2 pubmed
    ..VZV reactivation was strongly suspected because of the results of anti-VZV antibody evaluations in serum and CSF, although the skin lesions were not similar to those of herpes zoster...
  6. Miravet E, Danchaivijitr N, Basu H, Saunders D, Ganesan V. Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection. Dev Med Child Neurol. 2007;49:417-22 pubmed
    ..A more comprehensive diagnostic evaluation should be considered in children with AIS who do not fit the clinical and radiological profile outlined, even where there is a history of recent VZV infection. ..
  7. Miyazaki Y, Riku Y, Goto Y, Mano K, Yoshida M, Hashizume Y. VZV vasculopathy associated with myelo-radiculoganglio-meningo-encephalitis: an autopsy case of an immunocompetent 66-year-old male. J Neurol Sci. 2008;275:42-5 pubmed publisher
    ..To the best of our knowledge, few cases have been described pathologically in an immunocompetent individual. Further studies are needed to investigate the pathogenesis and treatment of VZV vasculopathy. ..
  8. de la Grandmaison G, Carlier R, Chretien F, de Truchis P, Orlikowski D, Gray F. "Burnt out" varicella-zoster-virus encephalitis in an AIDS patient following treatment by highly active antiretroviral therapy. Clin Radiol. 2005;60:613-7 pubmed
  9. Braun Falco M, Hoffmann M. Herpes zoster with progression to acute varicella zoster virus-meningoencephalitis. Int J Dermatol. 2009;48:834-9 pubmed
    ..The general recommendation of starting oral glucocorticosteroids from day 1 of antiviral treatment in older patients must be questioned, as it may stimulate VZV replication and dissemination. ..

More Information

Publications80

  1. Aribandi M, Aribandi L. MRI of trigeminal zoster. Neurology. 2005;65:1812 pubmed
  2. Tavazzi E, Minoli L, Ferrante P, Scagnelli P, Del Bue S, Romani A, et al. Varicella zoster virus meningo-encephalo-myelitis in an immunocompetent patient. Neurol Sci. 2008;29:279-83 pubmed publisher
    ..We also provide a MRI description of VZV related multifocal myelitis, not previously available. As supported by other reports, we underline the necessity of a prompt therapeutic intervention in this life-threatening condition. ..
  3. Sanz Fernández G, Franco Macias E, Rodriguez Uranga J, López Muñoz M. [Acyclovir neurotoxicity vs. encephalitis due to varicella zoster in a patient with chronic renal failure]. Rev Neurol. 2004;39:400 pubmed
  4. Eguia P, Garcia Monco J, Ruiz Lavilla N, Diaz Konrad V, Monton F. SUNCT and trigeminal neuralgia attributed to meningoencephalitis. J Headache Pain. 2008;9:51-3 pubmed publisher
    ..Both disorders resolved in parallel with the resolution of encephalitis, which suggests a causal link. In conclusion, headache attributed to intracranial infection may have the clinical features of SUNCT or TN. ..
  5. Makihara N, Toyoda K, Okada Y, Imayama S, Yasumori K, Ibayashi S. [Case of meningoencephalomyelitis due to reactivation of varicella-zoster virus associated with generalized chickenpox-like eruptions]. Nihon Naika Gakkai Zasshi. 2004;93:1634-6 pubmed
  6. Kawabe K, Sekine T, Murata K, Sato R, Aoyagi J, Kawase Y, et al. A case of Vernet syndrome with varicella zoster virus infection. J Neurol Sci. 2008;270:209-10 pubmed publisher
    ..Only a few cases of VS due to VZV have been reported previously. Our case is the first case that detected VZV-DNA in CSF by PCR. ..
  7. Tenenbaum T, Kramm C, Laws H, Nurnberger W, Lenard H, Göbel U. Pre-eruptive varicella zoster virus encephalitis in two children after haematopoietic stem cell transplantation. Med Pediatr Oncol. 2002;38:288-9 pubmed
  8. Notarangelo L, Mazzolari E. Natural killer cell deficiencies and severe varicella infection. J Pediatr. 2006;148:563-4; author reply 564 pubmed
  9. Halperin J. Diagnosis and management of acute encephalitis. Handb Clin Neurol. 2017;140:337-347 pubmed publisher
    ..Overall long-term outcomes are favorable in the majority of patients with encephalitis, a proportion that hopefully will improve with further advances in diagnostic technology and therapeutic interventions. ..
  10. Gilden D, Nagel M, Ransohoff R, Cohrs R, Mahalingam R, Tanabe J. Recurrent varicella zoster virus myelopathy. J Neurol Sci. 2009;276:196-8 pubmed publisher
    ..In contrast to earlier cases of recurrent VZV myelopathy in immunocompetent adults that developed weeks to months after the first episode of myelopathy, this is the first instance of recurrence years later. ..
  11. Karauzum S, Hazar V, Acikbas I, Gelen T, Yessilipek M, Luleci G. Existence of acute lymphoblastic leukemia and osteosarcoma in a child. J Pediatr Hematol Oncol. 2002;24:572-4 pubmed
    ..To show the possibility of the existence of the genetic susceptibility caused by gene rearrangements, we used molecular technique. But we could not determine any association between gene and genetic susceptibility. ..
  12. Archuleta S. Neurologic complications of varicella-zoster virus reactivation in a person with HIV/AIDS. AIDS Read. 2007;17:58, 64-6 pubmed
  13. Bennett L, Iqbal J. A 68-year-old with cranial nerve neuropathies and a troponin rise. Clin Med (Lond). 2017;17:575-577 pubmed publisher
    ..investigations and management of a 68-year-old woman with Takotsubo cardiomyopathy secondary to a Varicella zoster encephalitis and the difficulties inherent with making this diagnosis...
  14. Toledo P, Pellegrino L, Cunha C. Varicella-zoster virus encephalitis in an AIDS patient. Braz J Infect Dis. 2004;8:255-8 pubmed
    ..VZV encephalitis is a rare opportunistic infection, occurring in 0.1 to 4% of AIDS patients with neurological disease; it is related to severe immunodeficiency and has a high mortality...
  15. Mpaka M, Karantanas A, Zakynthinos E. Atypical presentation of varicella-zoster virus encephalitis in an immunocompetent adult. Heart Lung. 2008;37:61-6 pubmed publisher
    ..Varicella-zoster virus encephalitis is uncommon, but not rare, in immunocompetent adults. Typically, patients develop stroke with hemiplegia caused by large vessel vasculopathy days to weeks after herpes zoster ophthalmicus...
  16. Kopyta I, Wojaczńska Stanek K, Marszał E. [Chickenpox--neurological complications in children]. Wiad Lek. 2007;60:470-4 pubmed
    ..The neurological complications of chickenpox did not result in permanent sequel but the cost of hospitalization and the exclusion of the child from everyday activity seem to justify the idea of the routine vaccination...
  17. Koskiniemi M, Rantalaiho T, Piiparinen H, von Bonsdorff C, Farkkila M, Jarvinen A, et al. Infections of the central nervous system of suspected viral origin: a collaborative study from Finland. J Neurovirol. 2001;7:400-8 pubmed
    ..The increase in VZV findings may in part be a pseudophenomenon due to improved diagnostic methods, however, a true increase may have occurred and the pathogenetic mechanisms behind this should be elucidated...
  18. Koskiniemi M, Piiparinen H, Rantalaiho T, Eränkö P, Farkkila M, Räihä K, et al. Acute central nervous system complications in varicella zoster virus infections. J Clin Virol. 2002;25:293-301 pubmed
    ..In a previous multicenter study on central nervous system (CNS) viral infections varicella zoster virus (VZV) appeared the most frequent etiologic agent and appeared often without rash...
  19. Rantalaiho T, Farkkila M, Vaheri A, Koskiniemi M. Acute encephalitis from 1967 to 1991. J Neurol Sci. 2001;184:169-77 pubmed
    ..6%) died. It appears that the etiology of encephalitis changes with age and with time. It is important to establish the etiological pattern, as this assists in prompt diagnosis, which is a prerequisite for successful therapy...
  20. Gilden D, Cohrs R, Mahalingam R, Nagel M. Varicella zoster virus vasculopathies: diverse clinical manifestations, laboratory features, pathogenesis, and treatment. Lancet Neurol. 2009;8:731-40 pubmed publisher
    ..In recent years, the number of recognised VZV vasculopathies has grown, and accurate diagnosis is important for the effective treatment of these disorders...
  21. Matsumoto J, Nakajima A, Suwa A, Yasuki Y, Yasui T, Inada S. [Successfully treated case with microscopic polyangiitis complicated severe varicella zoster virus infection including encephalitis and disseminated varicella zoster]. Ryumachi. 2003;43:703-9 pubmed
    We report a case with microscopic polyangiitis (MPA) complicated by varicella zoster encephalitis. A 60-year-old woman caught a common cold and had acute otitis media in April 1998...
  22. Heni M, Henninger C, Ludescher B, Müssig K, Bux C, Beck R, et al. [Rare differential diagnosis of left brachial pain - Case 6/2010]. Dtsch Med Wochenschr. 2010;135:1497 pubmed publisher
    ..Subsequently, herpes zoster developed on the left arm. The next day, the patient got confused and was agitated. Furthermore, paresis of both legs and the left arm occurred...
  23. Thiry N, Beutels P, Tancredi F, Romano L, Zanetti A, Bonanni P, et al. An economic evaluation of varicella vaccination in Italian adolescents. Vaccine. 2004;22:3546-62 pubmed
    ..For practical considerations, "anamnestic screening" seems to be the most convenient option...
  24. Newsome S, Nath A. Varicella-zoster virus vasculopathy and central nervous system immune reconstitution inflammatory syndrome with human immunodeficiency virus infection treated with steroids. J Neurovirol. 2009;15:288-91 pubmed publisher
    ..Similar to our patient, severe cases of CNS-IRIS may benefit from high-dose intravenous corticosteroid treatment followed by an oral prednisone taper...
  25. Bonno S, Raschilas F, Mari I, Pigne E, Pouchot J, de Broucker F, et al. [Klüver-Bucy syndrome in herpetic meningoencephalitis]. Presse Med. 2001;30:115-8 pubmed
    ..Anatomic lesions in KBS involve the temporal lobe cortex bilaterally, and the amygdala as well as temporal white matter...
  26. Chouliaras G, Spoulou V, Quinlivan M, Breuer J, Theodoridou M. Vaccine-associated herpes zoster ophthalmicus [correction of opthalmicus] and encephalitis in an immunocompetent child. Pediatrics. 2010;125:e969-72 pubmed publisher
    ..Molecular analysis confirmed the vaccine strain as the causative agent. After an intravenous course with acyclovir, the child made a full recovery with no neurologic sequelae...
  27. Casadevall Codina T, Pascual Millan L, Fernandez Turrado T, Escalza Cortina I, Navas Vinagre I, Fanlo Meroño C, et al. [Pharmacological treatment of Korsakoff's psychosis: a review of the literature and experience in two cases]. Rev Neurol. 2002;35:341-5 pubmed
    ..The lack of thiamine entails an alteration in the synthesis of neurotransmitters, which provides the neurochemical foundation for the specific cognitive impairment that defines the syndrome...
  28. Spiegel R, Miron D, Lumelsky D, Horovitz Y. Severe meningoencephalitis due to late reactivation of Varicella-Zoster virus in an immunocompetent child. J Child Neurol. 2010;25:87-90 pubmed publisher
    ..Characteristic lesions on MRI and the presence of Varicella-Zoster virus DNA in cerebrospinal fluid are key findings for the correct diagnosis...
  29. Robinson Agramonte M, Reiber H, Cabrera Gomez J, Galvizu R. Intrathecal polyspecific immune response to neurotropic viruses in multiple sclerosis: a comparative report from Cuban patients. Acta Neurol Scand. 2007;115:312-8 pubmed
    ..Intrathecal measles(M)- rubella(R)- and varicella zoster(Z)-antibody synthesis in German and Cuban multiple sclerosis (MS) patients are compared considering the different rubella epidemiology in the tropics...
  30. Leahy T, Webb D, Hoey H, Butler K. Varicella zoster virus associated acute aseptic meningitis without exanthem in an immunocompetent 14-year-old boy. Pediatr Infect Dis J. 2008;27:362-3 pubmed publisher
    ..Diagnosis was made by detection of VZV-DNA in cerebrospinal fluid. VZV should be considered in cases of aseptic meningitis, even without a history of exanthem or immune compromise...
  31. Kobayashi H, Ueno M, Sumi M, Shimizu I, Yotsumoto M, Tanozaki R, et al. [Varicella-zoster virus meningoencephalitis without skin manifestation in an allogeneic bone marrow transplantation patient successfully treated with aciclovir]. Rinsho Ketsueki. 2007;48:1511-3 pubmed
    ..Meningoencephalitis was diagnosed and the patient was successfully treated with aciclovir administered at a dose of 30 mg/kg/day for four weeks...
  32. Hayashi T, Murayama S, Sakurai M, Kanazawa I. Jugular foramen syndrome caused by varicella zoster virus infection in a patient with ipsilateral hypoplasia of the jugular foramen. J Neurol Sci. 2000;172:70-2 pubmed
    ..Anatomical narrowing of the jugular foramen in this patient may have contributed to entrapment of the affected nerves at their passage through the foramen...
  33. Kubota M, Kawamura M. [Dramatic improvement of urinary retention and the left lower limb paresis with methylprednisolone in a case of regional encephalitis following varicella zoster infection]. No To Shinkei. 2004;56:339-43 pubmed
    ..Dramatic response to steroid, rapid recovery on MRI and good prognosis supported that the underlying pathology was mainly vasogenic edema rather than cytotoxic edema...
  34. Morris P, Davies N, Keir G. A screening assay to detect antigen-specific antibodies within cerebrospinal fluid. J Immunol Methods. 2006;311:81-6 pubmed
    ..The assay provides a simple, cheap assay to screen for microbial-specific antibody in the cerebrospinal fluid samples of patients with suspected neurological infections...
  35. Bianchi M, Dworetzky B, Bromfield E. Auditory auras in patients with postencephalitic epilepsy: case series. Epilepsy Behav. 2009;14:250-2 pubmed publisher
  36. Schiller D. [Herpes zoster generalisatus in diabetes mellitus]. Dtsch Med Wochenschr. 2006;131:1290; author reply 1290 pubmed
  37. Kin T, Hirano M, Tonomura Y, Ueno S. Coexistence of Ramsay Hunt syndrome and varicella-zoster virus encephalitis. Infection. 2006;34:352-4 pubmed
    ..Although concomitant diseases such as diabetes and chronic renal failure may lead to an aggressive course, all patients described in detail have had good outcomes...
  38. Wetzel K, Asholt I, Herrmann E, Kratzer C, Masuhr F, Schielke E. Good cognitive outcome of patients with herpes zoster encephalitis: a follow-up study. J Neurol. 2002;249:1612-4 pubmed
  39. Saji N, Taniguchi K, Tadano M, Shimizu H, Kawarai T, Kita Y. [A case of brainstem encephalitis following multiple cranial neuropathy in a hepatocellular carcinoma patient--association with cytomegalovirus and varicella-zoster virus infection]. Brain Nerve. 2007;59:1273-9 pubmed
  40. Hsu C, Lai T, Lien W, Chen W, Fang C. Emergent hemodialysis for acyclovir toxicity. Am J Emerg Med. 2005;23:899-900 pubmed
  41. Mailles A, Vaillant V, Stahl J. [Infectious encephalitis in France from 2000 to 2002: the hospital database is a valuable but limited source of information for epidemiological studies]. Med Mal Infect. 2007;37:95-102 pubmed
    ..The study will be implemented in mainland France in 2007 and will last one year. We invite all voluntary hospitals to include their encephalitic patients in our study...
  42. Hevner R, Vilela M, Rostomily R, Cohrs R, Mahalingam R, Wellish M, et al. An unusual cause of trigeminal-distribution pain and tumour. Lancet Neurol. 2003;2:567-71 pubmed
  43. Losurdo G, Giacchino R, Castagnola E, Gattorno M, Costabel S, Rossi A, et al. Cerebrovascular disease and varicella in children. Brain Dev. 2006;28:366-70 pubmed
    ..On the basis of our experience and of literature data on varicella-associated stroke, we recommend that VZV infection be taken into account in every episode of stroke in children...
  44. García Bardeci D, Pena M, Suárez Bordón P, Aladro Y, Pérez González C, Lafarga B. [Value of the polymerase chain reaction in the diagnosis of herpes infections of the nervous system]. Enferm Infecc Microbiol Clin. 2004;22:150-5 pubmed
  45. Gilden D. Varicella zoster virus vasculopathy and disseminated encephalomyelitis. J Neurol Sci. 2002;195:99-101 pubmed
  46. Dale R, Church A, Heyman I. Striatal encephalitis after varicella zoster infection complicated by Tourettism. Mov Disord. 2003;18:1554-6 pubmed
    ..The patient subsequently developed a chronic tic disorder with attention deficit disorder. This case furthers the proposed association between Tourettism and the basal ganglia...
  47. Pirounaki M, Liatsos G, Elefsiniotis I, Skounakis M, Moulakakis A. Unusual onset of varicella zoster reactivation with meningoencephalitis, followed by rhabdomyolysis and renal failure in a young, immunocompetent patient. Scand J Infect Dis. 2007;39:90-3 pubmed
    ..Herpes zoster erupted 5 d later. Rare complication of VZV-related rhabdomyolysis occurred, with subsequent ARF, in combination with acyclovir and ceftriaxone. The patient recovered fully and remained healthy...
  48. Klein N, McDermott B, Cunha B. Varicella-zoster virus meningoencephalitis in an immunocompetent patient without a rash. Scand J Infect Dis. 2010;42:631-3 pubmed publisher
    ..We report a case of VZV meningoencephalitis without a rash occurring in a normal host...
  49. López Gómez M, López Ruz M, Jiménez Alonso J. [Cerebral infarction due to varicella-zoster virus in a patient with HIV infection]. Enferm Infecc Microbiol Clin. 2003;21:532-3 pubmed
  50. Malik Z, Litman N. A 17-year-old boy with facial palsy and hyperacusis. Pediatr Infect Dis J. 2008;27:646; 674 pubmed publisher
  51. Sindic C, Van Antwerpen M, Goffette S. Clinical relevance of polymerase chain reaction (PCR) assays and antigen-driven immunoblots for the diagnosis of neurological infectious diseases. Brain Res Bull. 2003;61:299-308 pubmed
  52. Nakane S, Honda H, Hamasaki S, Shirabe S, Nakamura T. [A case of herpes zoster encephalitis with Ramsay-Hunt syndrome, herpes zoster generalisatus and acute pancreatitis]. No To Shinkei. 2000;52:43-7 pubmed
    ..We discussed the pathogenic mechanisms of these conditions, and this case was considered to have VZV encephalitis, and to be associated with right facial nerve palsy and pancreatitis, in spite of the absence of immunological deficiency...
  53. Dalton C, Jager H, Losseff N, Greenwood R. Neurological picture. Varicella zoster virus and intracranial dolichoectasia in a late adult cancer survivor. J Neurol Neurosurg Psychiatry. 2008;79:573 pubmed publisher
  54. Hartzell J, Aronson N, Nagaraja S, Whitman T, Hawkes C, Wortmann G. Varicella zoster virus meningitis complicating sodium stibogluconate treatment for cutaneous leishmaniasis. Am J Trop Med Hyg. 2006;74:591-2 pubmed
    ..We report the first known case of an immunocompetent adult who developed VZV aseptic meningitis and dermatomal herpes zoster during treatment with sodium stibogluconate...
  55. Hackanson B, Zeiser R, Bley T, Pantazis G, Huzly D, Bertz H, et al. Fatal varicella zoster virus encephalitis in two patients following allogeneic hematopoietic stem cell transplantation. Clin Transplant. 2005;19:566-70 pubmed
    ..Varicella zoster virus (VZV) reactivation in this setting most commonly manifests as dermatomal herpes zoster but in some cases life-threatening VZV encephalitis occurs...
  56. Chiappini E, Calabri G, Galli L, Salvi G, de Martino M. Varicella-zoster virus acquired at 4 months of age reactivates at 24 months and causes encephalitis. J Pediatr. 2002;140:250-1 pubmed
    ..VZV-DNA was detected in cerebrospinal fluid. Early acquisition of VZV may predispose to major neurologic complications that can occur years after the primary infection...
  57. Cohen J, Krogmann T, Pesnicak L, Ali M. Absence or overexpression of the Varicella-Zoster Virus (VZV) ORF29 latency-associated protein impairs late gene expression and reduces VZV latency in a rodent model. J Virol. 2007;81:1586-91 pubmed
    ..0044). These studies indicate that regulation of ORF29 at appropriate levels is critical for VZV latency in a rodent model...
  58. Wallington T, Weir E. Varicella control and vaccine coverage: issues and challenges. CMAJ. 2002;166:631-2 pubmed
  59. Chan C, Tam K, To W, Law T, Kwan W. Hypoglycorrhachia in herpes zoster associated encephalitis of an immunocompetent young male: an unusual presentation. J Neurol. 2005;252:987-8 pubmed
  60. Stahl J, Mailles A, Vaillant V, Floret D. [Acute infectious encephalitis and pathogens coming from animals]. Medicina (Kaunas). 2008;44:821-6 pubmed
    ..Three levels of etiological tests are proposed, from the most common infections and those, which required an immediate treatment, to the rarest ones...
  61. Cakirer S, Basak M, Mutlu A, Galip G. MR imaging in epilepsy that is refractory to medical therapy. Eur Radiol. 2002;12:549-58 pubmed
    ..So MRI plays a primary role in planning of the treatment, primarily surgical therapy, by detecting structural epileptogenic lesions...
  62. Ziebold C, von Kries R, Lang R, Weigl J, Schmitt H. Severe complications of varicella in previously healthy children in Germany: a 1-year survey. Pediatrics. 2001;108:E79 pubmed
    ..The purpose of this study was to describe the epidemiology of severe varicella complications in immunologically healthy children in Germany...
  63. Schonenberg D, Hartdorff C, Hoekx J. Case 2: a 4-year old girl with photophobia and somnolence after a head trauma. Acta Paediatr. 2006;95:496; discussion 498-9 pubmed
  64. Sekiguchi K, Oishi K, Hamaguchi H, Maeda N, Nishimoto K, Ishihara H, et al. [Acute hemorrhagic encephalitis by varicella-zoster virus in a patient with SLE]. Nihon Naika Gakkai Zasshi. 2003;92:1328-30 pubmed
  65. Liu D, Chan A. Progressive outer retinal necrosis presenting with isolated optic neuropathy. Neurology. 2005;65:1682-3 pubmed
  66. Eskiizmir G, Uz U, Taşkiran E, Unlu H. Herpes zoster oticus associated with varicella zoster virus encephalitis. Laryngoscope. 2009;119:628-30 pubmed publisher
    ..Therefore, the authors discuss all the aspects of this rare entity, including clinical examination, radiological evaluation, laboratory evaluation, and treatment options...
  67. Heerlein K, Jarius S, Jacobi C, Rohde S, Storch Hagenlocher B, Wildemann B. Aquaporin-4 antibody positive longitudinally extensive transverse myelitis following varicella zoster infection. J Neurol Sci. 2009;276:184-6 pubmed publisher
    ..Our observations provide further evidence for a pathogenic role of AQP4-Ab in LETM and suggest that AQP4-Ab associated auto-immunity should be considered also in apparently infectious/parainfectious settings...
  68. Tattevin P, Schortgen F, De Broucker T, Dautheville S, Wolff M. Varicella-zoster virus limbic encephalitis in an immunocompromised patient. Scand J Infect Dis. 2001;33:786-8 pubmed
    ..When brain imaging is suggestive of limbic encephalitis in an immunocompromised patient, PCR of CSF for VZV DNA should be performed, as early antiviral treatment may improve the outcome...
  69. Sigaloff K, de Fijter C. Herpes zoster-associated encephalitis in a patient undergoing CAPD: case report and literature review. Perit Dial Int. 2007;27:391-4 pubmed
    ..The patient was treated with acyclovir and steroids and had a slow but complete return to her prior cognitive status. The available literature is reviewed and the differential diagnosis with acyclovir toxicity is discussed...
  70. Weerkamp N, Keizer K, Boel C, de Rijk M. [Meningoencephalitis caused by varicella zoster virus]. Ned Tijdschr Geneeskd. 2010;154:A1575 pubmed
    ..Since the advent of the PCR technique, VZV has been readily demonstrable. Anti-viral treatment is advised despite the lack of placebo-controlled studies, and may be combined with prednisone...
  71. Fusco D, Krawitz P, Larussa P, Steinberg S, Gershon A, Jacobs J. VZV meningitis following varicella vaccine. J Clin Virol. 2010;48:275-7 pubmed publisher
    ..We report a case of disseminated herpes zoster in a previously healthy elderly woman hours after Oka strain vaccination. PCR and restriction enzyme analysis revealed that symptoms were caused by wild type virus...