Herpesvirus Infections of the Nervous System

Kelly J. Baldwin, MD; Christopher L. Cummings, MD Neuroinfectious Disease p. 1349-1369 October 2018, Vol.24, No.5 doi: 10.1212/CON.0000000000000661
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PURPOSE OF REVIEW: This article reviews the spectrum of neurologic disease associated with human herpesvirus infections.

RECENT FINDINGS: As more patients are becoming therapeutically immunosuppressed, human herpesvirus infections are increasingly common. Historically, infections with human herpesviruses were described as temporal lobe encephalitis caused by herpes simplex virus type 1 or type 2. More recently, however, additional pathogens, such as varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6 have been identified to cause serious neurologic infections. As literature emerges, clinical presentations of herpesvirus infections have taken on many new forms, becoming heterogeneous and involving nearly every location along the neuraxis. Advanced diagnostic methods are now available for each specific pathogen in the herpesvirus family. As data emerge on viral resistance to conventional therapies, newer antiviral medications must be considered.

SUMMARY: Infections from the herpesvirus family can have devastating neurologic outcomes without prompt and appropriate treatment. Clinical recognition of symptoms and appropriate advanced testing are necessary to correctly identify the infectious etiology. Knowledge of secondary neurologic complications of disease is equally important to prevent additional morbidity and mortality. This article discusses infections of the central and peripheral nervous systems caused by herpes simplex virus type 1 and type 2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6. The pathophysiology, epidemiology, clinical presentations of disease, diagnostic investigations, imaging characteristics, and treatment for each infectious etiology are discussed in detail.

Address correspondence to Dr Kelly J. Baldwin, Department of Neurology MC 14-03, 100 North Academy Ave, Danville, PA 17822, kjbaldwin@geisinger.edu.

RELATIONSHIP DISCLOSURE: Drs Baldwin and Cummings report no disclosures.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Baldwin and Cummings discuss the unlabeled/investigational use of acyclovir, aloe vera, amitriptyline, controlled-release morphine, controlled-release oxycodone, diazepam, divalproex sodium, ganciclovir, foscarnet, levetiracetam, lidocaine, lorazepam, methylprednisolone, nortriptyline, oxcarbazepine, prednisone, tramadol, and trolamine salicylate, for the treatment of herpesvirus infections.

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© 2018 American Academy of Neurology