This article describes the clinical features and laboratory and imaging abnormalities of the protean neurologic disorders produced by varicella-zoster virus (VZV) reactivation. Diseases include not only zoster, but also chronic pain (postherpetic neuralgia), meningoencephalitis and cerebellitis, single or multiple cranial nerve palsies (polyneuritis cranialis), myelopathy (myelitis and spinal cord infarction), and VZV vasculopathy of intracerebral and extracerebral arteries that causes ischemic or hemorrhagic stroke, aneurysm, subarachnoid and intracerebral hemorrhage, arterial ectasia, and dissection. The article addresses accurate diagnosis of VZV infection of the nervous system in the absence of rash, and optimal treatment.
All neurologic disorders produced by VZV can occur in the absence of rash. Diagnosis is confirmed by the presence of VZV DNA or anti-VZV antibodies in CSF. Based on evidence from recent studies, VZV has been implicated as a cause of giant cell arteritis.
Clinicians must be aware that VZV reactivation produces multiple disorders of the central nervous system (CNS) and peripheral nervous system, often without rash. Rapid virologic verification and prompt treatment with antiviral agents can lead to complete recovery, even in patients with protracted disease.
Address correspondence to Dr Don Gilden, University of Colorado School of Medicine, Department of Neurology, 12700 E 19th Avenue, Box B182, Aurora, CO 80045, firstname.lastname@example.org.
Relationship Disclosure: Dr Gilden receives research funding from the National Institutes of Health and serves on the editorial boards of In Vivo, Journal of the Neurological Sciences, Journal of Neurovirology, Journal of Virology, and Neurology.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Gilden reports no disclosure.