Details

Autor(en) / Beteiligte

• Maher, Mary D.
• Douglas, Vivian Paraskevi
• Douglas, Konstantinos A.A.
• Collens, Sarah I.
• Gilbert, Aubrey L.
• Torun, Nurhan
• Klein, Joshua P.
• Sobrin, Lucia
• Buchbinder, Bradley R.
• Gupta, Rajiv
• Mukerji, Shibani S.
• Chwalisz, Bart K.

Titel

Clinical and neuroradiologic characteristics in varicella zoster virus reactivation with central nervous system involvement

Ist Teil von

• Journal of the neurological sciences, 2022-06, Vol.437, p.120262-120262, Article 120262

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2022

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• To investigate the clinical and magnetic resonance imaging (MRI) characteristics of patients with varicella zoster virus (VZV) reactivation involving the cranial nerves and central nervous system (CNS). This is a retrospective, multi-center case-series of 37 patients with VZV infection affecting the cranial nerves and CNS. The median age was 71 years [IQR 51.5-76]; 21 (57%) were men. Cerebrospinal fluid (CSF) was available in 24/37 (65%); median CSF white blood cell count was 11 [IQR 2-23] cells/μL and protein was 45.5 [IQR 34.5-75.5] mg/dL. VZV polymerase chain reaction (PCR) assays were positive in 6/21 (29%) CSF and 8/9 (89%) ocular samples. Clinical involvement included the optic nerve in 12 (32%), other cranial nerves in 20 (54%), brain parenchyma in 12 (32%) and spinal cord or nerve roots in 4 (11%). Twenty-seven/28 immunocompetent patients' MRIs were available for review (96%). Of the 27, 18 had T1 postcontrast fat saturated sequences without motion artifact to evaluate for cranial nerve enhancement and optic perineuritis (OPN). Eight/18 (44%) demonstrated OPN. All 8 experienced vision loss: 3 optic neuritis, 1 acute retinal necrosis, and 3 CNS vasculitis with 1 central and 1 branch retinal artery occlusion and 1 uveitis. Diplopic patients had cranial nerve and cavernous sinus enhancement. All immunosuppressed patients were imaged. Seven/9 (88%) had extensive neuraxis involvement, including encephalitis, vasculitis and transverse myelitis; one case had OPN. OPN is a frequent manifestation in VZV-associated vision loss among immunocompetent patients. Immunosuppressed patients had greater neuraxis involvement. Optimizing MRI protocols may improve early diagnosis in VZV reactivation. •OPN is a frequent manifestation in VZV-associated vision loss among immunocompetent patients.•Immunosuppressed patients had greater neuraxis involvement, including the spinal cord and vasculitis.•Optimizing MRI protocols may improve early diagnosis in VZV reactivation.