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Complications of Varicella Zoster Virus Reactivation

  • NEUROLOGIC MANIFESTATIONS OF SYSTEMIC DISEASE (A PRUITT, SECTION EDITOR)
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Opinion statement

Varicella zoster virus (VZV) is an exclusively human neurotropic alphaherpesvirus. Primary infection causes varicella (chickenpox), after which virus becomes latent in ganglionic neurons along the entire neuraxis. With advancing age or immunosuppression, cell-mediated immunity to VZV declines and virus reactivates to cause zoster (shingles), which can occur anywhere on the body. Skin lesions resolve within 1–2 weeks, while complete cessation of pain usually takes 4–6 weeks. Zoster can be followed by chronic pain (postherpetic neuralgia), cranial nerve palsies, zoster paresis, meningoencephalitis, cerebellitis, myelopathy, multiple ocular disorders and vasculopathy that can mimic giant cell arteritis. All of the neurological and ocular disorders listed above may also develop without rash. Diagnosis of VZV-induced neurological disease may require examination of cerebrospinal fluid (CSF), serum and/ or ocular fluids. In the absence of rash in a patient with neurological disease potentially due to VZV, CSF should be examined for VZV DNA by PCR and for anti-VZV IgG and IgM. Detection of VZV IgG antibody in CSF is superior to detection of VZV DNA in CSF to diagnose vasculopathy, recurrent myelopathy, and brainstem encephalitis. Oral antiviral drugs speed healing of rash and shorten acute pain. Immunocompromised patients require intravenous acyclovir. First-line treatments for post-herpetic neuralgia include tricyclic antidepressants, gabapentin, pregabalin, and topical lidocaine patches. VZV vasculopathy, meningoencephalitis, and myelitis are all treated with intravenous acyclovir.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance•• Of major importance

  1. Gilden DH, Dueland AN, Cohrs R, et al. Preherpetic neuralgia. Neurology. 1991;41:1215–8.

    Article  CAS  PubMed  Google Scholar 

  2. Insinga RP, Itzler RF, Pellissier JM, et al. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. 2005;20:748–53.

    Article  PubMed  Google Scholar 

  3. Harnisch JP. Zoster in the elderly: clinical, immunologic and therapeutic considerations. J Am Geriatr Soc. 1984;32:789–93.

    CAS  PubMed  Google Scholar 

  4. Gilden DH, Cohrs RJ, Mahalingam R. Clinical and molecular pathogenesis of varicella virus infection. Viral Immunol. 2003;16:243–58.

    Article  CAS  PubMed  Google Scholar 

  5. Leppard B, Naburi AE. Herpes zoster: an early manifestation of HIV infection. Afr Health. 1998;21:5–6.

    CAS  PubMed  Google Scholar 

  6. Tyndall MW, Nasio J, Agoki E, et al. Herpes zoster as the initial presentation of human immunodeficiency virus type 1 infection in Kenya. Clin Infect Dis. 1995;21:1035–7.

    Article  CAS  PubMed  Google Scholar 

  7. Kakourou T, Theodoridou M, Mostrou G, et al. Herpes zoster in children. J Am Acad Dermatol. 1998;39:207–10.

    Article  CAS  PubMed  Google Scholar 

  8. Selbst RG, Selhorst JB, Harbison JW, et al. Parainfectious optic neuritis report and review following varicella. Arch Neurol. 1983;40:347–50.

    Article  CAS  PubMed  Google Scholar 

  9. Kurimoto T, Tonari M, Ishizaki N, et al. Orbital apex syndrome associated with herpes zoster ophthalmicus. Clin Ophthalmo. 2011;5:1603–8.

    Article  Google Scholar 

  10. Lambade P, Lambade D, Saha TK, et al. Maxillary osteonecrosis and spontaneous teeth exfoliation following herpes zoster. Oral Maxillofac Surg. 2012;16:369–72.

    Article  PubMed  Google Scholar 

  11. Payten RJ, Dawes JDK. Herpes zoster of the head and neck. J Laryngol Otol. 1972;86:1031–55.

    Article  CAS  PubMed  Google Scholar 

  12. Robillard RB, Hilsinger Jr RL, Adour KK. Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg. 1986;95:292–7.

    CAS  PubMed  Google Scholar 

  13. Steffen R, Selby G. ‘Atypical’ Ramsay Hunt syndrome. Med J Aust. 1972;1:227–30.

    CAS  PubMed  Google Scholar 

  14. Asnis DS, Micic L, Giaccio D. Ramsay Hunt syndrome presenting as a cranial polyneuropathy. Cutis. 1996;57:421–4.

    CAS  PubMed  Google Scholar 

  15. Lapresle J, Lasjaunias P. Cranial nerve ischaemic arterial syndromes. Brain. 1986;109:207–15.

    Article  PubMed  Google Scholar 

  16. Easton HG. Zoster sine herpete causing acute trigeminal neuralgia. Lancet. 1970;2:1065–6.

    Article  CAS  PubMed  Google Scholar 

  17. Hevner R, Vilela M, Rostomily R, et al. An unusual cause of trigeminal- distribution pain and tumour. Lancet Neurol. 2003;2:567–72.

    Article  PubMed  Google Scholar 

  18. Murakami S, Honda N, Mizobuchi M, et al. Rapid diagnosis of varicella zoster virus infection in acute facial palsy. Neurology. 1998;51:1202–5.

    Article  CAS  PubMed  Google Scholar 

  19. Osaki Y, Matsubayashi K, Okumiya K, et al. Polyneuritis cranialis due to varicella-zoster virus in the absence of rash. Neurology. 1995;45:2293–4.

    Article  CAS  PubMed  Google Scholar 

  20. Murata K, Miwa H, Kondo T. Polyneuritis cranialis caused by varicella zoster virus in the absence of rash. Neurology. 2010;74:85–6.

    Article  PubMed  Google Scholar 

  21. Brostoff J. Diaphragmatic paralysis after herpes zoster. Br Med J. 1966;2:1571–2.

    Article  CAS  PubMed  Google Scholar 

  22. Stowasser M, Cameron J, Oliver WA. Diaphragmatic paralysis following cervical herpes zoster. Med J Aust. 1990;153:555–6.

    CAS  PubMed  Google Scholar 

  23. Tjandra J, Mansel RE. Segmental abdominal herpes zoster paresis. Aust N Z J Surg. 1986;56:807–8.

    Article  CAS  PubMed  Google Scholar 

  24. Molinero J, Nagore E, Obón L, et al. Metameric motor paresis following abdominal herpes zoster. Cutis. 2002;69:143–4.

    PubMed  Google Scholar 

  25. Izumi AK, Edwards Jr J. Herpes zoster and neurogenic bladder dysfunction. JAMA. 1973;224:1748–9.

    Article  CAS  PubMed  Google Scholar 

  26. Jellinek EH, Tulloch WS. Herpes zoster with dysfunction of bladder and anus. Lancet. 1976;2:1219–22.

    Article  CAS  PubMed  Google Scholar 

  27. Umehara T, Sengoku R, Mitsumura H, et al. Findings of segmental zoster paresis on MRI. J Neurol Neurosurg Psychiatry. 2011;82:694.

    Article  PubMed  Google Scholar 

  28. Choi JY, Kang CH, Kim BJ, et al. Brachial plexopathy following herpes zoster infection: two cases with MRI findings. J Neurol Sci. 2009;285:224–6.

    Article  PubMed  Google Scholar 

  29. Gupta SK, Helal BH, Kiely P. The prognosis in zoster paralysis. J Bone Joint Surg Br. 1969;51:593–603.

    CAS  PubMed  Google Scholar 

  30. Thomas EJ, Howard Jr FM. Segmental zoster paresis – a disease profile. Neurology. 1972;22:459–66.

    Article  CAS  PubMed  Google Scholar 

  31. Head H, Campbell AW. The pathology of herpes zoster and its bearing on sensory localization. Brain. 1900;23:353–523.

    Article  Google Scholar 

  32. Denny-Brown D, Adams RD, Fitzgerald PJ. Pathologic features of herpes zoster: A note on "geniculate herpes.". Arch Neurol Psychiatry. 1944;51:216–31.

    Article  Google Scholar 

  33. Cheatham WJ, Dolan Jr TF, Dower JC, et al. Varicella: report on two fatal cases with necropsy, virus isolation, and serologic studies. Am J Pathol. 1956;32:1015–35.

    CAS  PubMed  Google Scholar 

  34. Esiri MM, Tomlinson AH. Herpes zoster: demonstration of virus in trigeminal nerve and ganglion by immunofluorescence and electron microscopy. J Neurol Sci. 1972;15:35–48.

    Article  CAS  PubMed  Google Scholar 

  35. Ghatak NR, Zimmerman HM. Spinal ganglion in herpes zoster. Arch Pathol. 1973;95:411–5.

    CAS  PubMed  Google Scholar 

  36. Hope-Simpson RE. Postherpetic neuralgia. J R Coll Gen Pract. 1975;25:571–5.

    CAS  PubMed  Google Scholar 

  37. de Moragas JM, Kierland RR. The outcome of patients with herpes zoster. Arch Dermatol. 1957;75:193–6.

    Article  Google Scholar 

  38. Rogers III RS, Tindall JP. Herpes zoster in the elderly. Postgrad Med. 1971;50:153–7.

    PubMed  Google Scholar 

  39. Smith FP. Pathological studies of spinal nerve ganglia in relation to intractable intercostal pain. Surg Neurol. 1978;10:50–3.

    CAS  PubMed  Google Scholar 

  40. Watson CPN, Deck JH, Morshead C, et al. Postherpetic neuralgia: further post-mortem studies of cases with and without pain. Pain. 1991;44:105–17.

    Article  CAS  PubMed  Google Scholar 

  41. Vafai A, Wellish M, Gilden DH. Expression of varicella-zoster virus in blood mononuclear cells of patients with postherpetic neuralgia. Proc Natl Acad Sci USA. 1988;85:2767–70.

    Article  CAS  PubMed  Google Scholar 

  42. Devlin ME, Gilden DH, Mahalingam R, et al. Peripheral blood mononuclear cells of the elderly contain varicella-zoster virus DNA. J Infect Dis. 1992;165:619–22.

    Article  CAS  PubMed  Google Scholar 

  43. Mahalingam R, Wellish M, Brucklier J, et al. Persistence of varicella-zoster virus DNA in elderly patients with postherpetic neuralgia. J NeuroVirol. 1995;1:130–3.

    Article  CAS  PubMed  Google Scholar 

  44. Terada K, Niizuma T, Kawano S, et al. Detection of varicella-zoster virus DNA in peripheral mononuclear cells from patients with Ramsay Hunt syndrome or zoster sine herpete. J Med Virol. 1998;56:359–63.

    Article  CAS  PubMed  Google Scholar 

  45. Attal N, Cruccu G, Baron R, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain. Eur J Neurol. 2010;17:1113–88.

    Article  CAS  PubMed  Google Scholar 

  46. Hans G, Sabatowski R, Binder A, et al. Efficacy and tolerability of a 5 % lidocaine medicated plaster for the topical treatment of post-herpetic neuralgia: results of a long-term study. Curr Med Res Opin. 2009;25:1295–305.

    Article  CAS  PubMed  Google Scholar 

  47. Dubinsky RM, Kabbani H, El-Chami Z, et al. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004;63:959–65.

    Article  CAS  PubMed  Google Scholar 

  48. Backonja M, Wallace MS, Blonsky ER, et al. NGX-4010 C116 Study Group. NGX-4010, a high-concentration capsaicin patch, for the treatment of postherpetic neuralgia: a randomised, double-blind study. Lancet Neurol. 2008;7:1106–12.

    Article  CAS  PubMed  Google Scholar 

  49. Backonja MM, Malan TP, Vanhove GF, et al. NGX-4010, a high-concentration capsaicin patch, for the treatment of postherpetic neuralgia: a randomized, double-blind, controlled study with an open-label extension. Pain Med. 2010;11:600–8.

    Article  PubMed  Google Scholar 

  50. Gilron I, Bailey JM, Tu D. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial. Lancet. 2009;374:1252–61.

    Article  CAS  PubMed  Google Scholar 

  51. Gilron I, Bailey JM, Tu D, et al. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005;352:132–1334.

    Article  Google Scholar 

  52. Rehm S, Binder A, Baron R. Post-herpetic neuralgia: 5 % lidocaine medicated plaster, pregabalin, or a combination of both? A randomized, open, clinical effectiveness study. Curr Med Res Opin. 2010;26:1607–19.

    Article  CAS  PubMed  Google Scholar 

  53. Ruiz Huete C, Bermejo PE. Botulinum toxin type A in the treatment of neuropathic pain in a case of postherpetic neuralgia [in Spanish]. Neurologia. 2008;23:259–62.

    CAS  PubMed  Google Scholar 

  54. Sotiriou E, Apalla Z, Panagiotidou D, et al. Severe post-herpetic neuralgia successfully treated with botulinum toxin A: three case reports. Acta Derm Venereol. 2009;89:214–5.

    PubMed  Google Scholar 

  55. Xiao L, Mackey S, Hui H, et al. Subcutaneous injection of botulinum toxin a is beneficial in postherpetic neuralgia. Pain Med. 2010;11:1827–33.

    Article  PubMed  Google Scholar 

  56. van Wijck AJ, Opstelten W, Moons KG, et al. The PINE study of epidural steroids and local anaesthetics to prevent postherpetic neuralgia: a randomized controlled trial. Lancet. 2006;367:219–24.

    Article  PubMed  CAS  Google Scholar 

  57. Harke H, Gretenkort P, Ladleif HU, et al. Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain. Anesth Analg. 2002;94:694–700.

    Article  PubMed  Google Scholar 

  58. Surjya PU, Shiv PR, Mishra S, et al. Successful treatment of an intractable postherpetic neuralgia (PHN) using peripheral nerve field stimulation (PNFS). Am J Hosp Palliat Care. 2010;27:59–62.

    Article  Google Scholar 

  59. Lynch PJ, McJunkin T, Eross E, et al. Case report: successful epiradicular peripheral nerve stimulation of the C2 dorsal root ganglion for postherpetic neuralgia. Neuromodulation. 2011;14:58–61.

    Article  PubMed  Google Scholar 

  60. Yakovlev AE, Peterson AT.: Peripheral nerve stimulation in treatment of intractable postherpetic neuralgia. Neuromodulation 2007, 373-375.

  61. Kouroukli I, Neofytos D, Panaretou V, et al. Peripheral subcutaneous stimulation for the treatment of intractable postherpetic neuralgia: two case reports and literature review. Pain Prac. 2009;9:225–9.

    Article  Google Scholar 

  62. Kang JH, Ho JD, Chen YH, et al. Increased risk of stroke after a herpes zoster attack: a population-based follow-up study. Stroke. 2009;40:3443–8.

    Article  CAS  PubMed  Google Scholar 

  63. Lin HC, Chien CW, Ho JD. Herpes zoster ophthalmicus and the risk of stroke: a population-based follow-up study. Neurology. 2010;74:792–7.

    Article  PubMed  Google Scholar 

  64. Amlie-Lefond C, Bernard TJ, Sébire G, et al. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation. 2009;119:1417–23.

    Article  PubMed  Google Scholar 

  65. Nagel MA, Cohrs RJ, Mahalingam R, et al. The varicella zoster vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008;70:853–60.

    Article  CAS  PubMed  Google Scholar 

  66. Nagel MA, Choe A, Khmeleva N, et al.: Search for varicella zoster virus and herpes simplex virus-1 in normal human cerebral arteries. J NeuroVirol. 2013;19:181–85.

    Google Scholar 

  67. Kleinschmidt-DeMasters BK, Gilden DH. Varicella-zoster virus infections of the nervous system: clinical and pathologic correlates. Arch Pathol Lab Med. 2001;125:770–80.

    CAS  PubMed  Google Scholar 

  68. Nagel MA, Traktinskiy I, Azarkh Y, et al. Varicella zoster virus vasculopathy: analysis of virus-infected arteries. Neurology. 2011;77:364–70. Correlative analysis of viral and muscle cell markers in cerebral arteries from patients with VZV vasculopathy.

    Article  CAS  PubMed  Google Scholar 

  69. Nagel MA, Traktinskiy I, Stenmark KR, et al. Varicella-zoster virus vasculopathy: immune characteristics of virus-infected arteries. Neurology. 2013;80:62–8. Analysis of the immune repertoire in arteries of patients with VZV vasculopathy.

    Article  CAS  PubMed  Google Scholar 

  70. Lee RM. Morphology of cerebral arteries. Pharmacol Ther. 1995;66:149–73.

    Article  CAS  PubMed  Google Scholar 

  71. Mayberg MR, Langer RS, Zervas NT, et al. Perivascular meningeal projections from cat trigeminal ganglia: possible pathway for vascular headaches in man. Science. 1981;213:228–30.

    Article  CAS  PubMed  Google Scholar 

  72. Mayberg MR, Zervas NT, Moscowitz MA. Trigeminal projections to supratentorial pial and dural blood vessels in cats demonstrated by horseradish peroxidase histochemistry. J Comp Neurol. 1984;223:46–56.

    Article  CAS  PubMed  Google Scholar 

  73. Salazar R, Russman AN, Nagel MA, et al. VZV ischemic optic neuropathy and subclinical temporal artery involvement. Arch Neurol. 2011;68:517–20.

    Article  PubMed  Google Scholar 

  74. Nagel MA, Russman AN, Feit DO, et al. VZV ischemic optic neuropathy andsubclinical temporal artery infection without rash. Neurology. 2013;80:220–2.

    Article  PubMed  Google Scholar 

  75. Mathias M, Nagel MA, Khmeleva N, et al. VZV multifocal vasculopathy withischemic optic neuropathy, acute retinal necrosis and temporal artery infection in the absence of zoster rash. J Neurol Sci. 2013;325:180–2.

    Article  PubMed  Google Scholar 

  76. Nagel MA, Bennett JL, Khmeleva N, et al.: Multifocal VZV vasculopathy withtemporal artery infection mimics giant cell arteritis. Neurology 2013, (in press). Exciting new study indicating that the clinical features of multifocal VZV vasculopathy with temporal artery infection can be the same as seen in classic giant cell arteritis.

  77. Habib AA, Gilden D, Schmid DS, et al. Varicella zoster virus meningitis with hypoglycorrhachia in the absence of rash and in an immunocompetent woman. J Neurovirol. 2009;15:206–8.

    Article  PubMed  Google Scholar 

  78. Gunson RN, Aitken C, Gilden D. A woman with acute headache and sacral dermatomal numbness. J Clin Virol. 2011;50:191–3.

    Article  CAS  PubMed  Google Scholar 

  79. Moses H, Nagel MA, Gilden DH. Acute cerebellar ataxia in a 41 year old woman. Lancet Neurol. 2006;5:984–8.

    Article  PubMed  Google Scholar 

  80. Ratzka P, Schlachetzki JC, Bähr M, et al. Varicella zoster virus cerebellitis in a 66-year-old patient without herpes zoster. Lancet. 2006;367:182.

    Article  PubMed  Google Scholar 

  81. Gilden DH, Beinlich BR, Rubinstien EM, et al. Varicella-zoster virus myelitis: an expanding spectrum. Neurology. 1994a;44:1818–23.

    Article  CAS  Google Scholar 

  82. Devinsky O, Cho ES, Petito CK, et al. Herpes zoster myelitis. Brain. 1991;114:1181–96.

    Article  PubMed  Google Scholar 

  83. de Silva SM, Mark AS, Gilden DH, et al. Zoster myelitis: improvement with antiviral therapy in two cases. Neurology. 1996;47:929–31.

    Article  PubMed  Google Scholar 

  84. Orme HT, Smith G, Nagel MA, et al. VZV spinal cord infarction identified bydiffusion-weighted magnetic resonance imaging (DWI). Neurology. 2007;69:398–400.

    Article  CAS  PubMed  Google Scholar 

  85. Bonfioli AA, Eller AW. Acute retinal necrosis. Semin Ophthalmol. 2005;20:155–60.

    Article  PubMed  Google Scholar 

  86. Guex-Crosier Y, Rochat C, Herbort CP. Necrotizing herpetic retinopathies. A spectrum of herpes virus-induced diseases determined by the immune state of the host. Ocul Immunol Inflamm. 1997;5:259–65.

    Article  CAS  PubMed  Google Scholar 

  87. Lewis JM, Nagae Y, Tano Y. Progressive outer retinal necrosis after bone marrow transplantation. Am J Ophthalmol. 1996;122:892–5.

    CAS  PubMed  Google Scholar 

  88. Franco-Paredes C, Bellehemeur T, Merchant A, et al. Aseptic meningitis and optic neuritis preceding varicella-zoster progressive outer retinal necrosis in a patient with AIDS. AIDS. 2002;16:1045–9.

    Article  PubMed  Google Scholar 

  89. Menerath JM, Gerard M, Laurichesse H, et al. Bilateral acute retinal necrosis in a patient with acquired immunodeficiency syndrome. J Fr Ophtalmol. 1995;18:625–33.

    CAS  PubMed  Google Scholar 

  90. Johnston WH, Holland GN, Engstrom Jr RE, et al. Recurrence of presumed varicella-zoster virus retinopathy in patients with acquired immunodeficiency syndrome. Am J Ophthalmol. 1993;116:42–50.

    CAS  PubMed  Google Scholar 

  91. Moorthy RS, Weinberg DV, Teich SA, et al. Management of varicella zoster virus retinitis in AIDS. Br J Ophthalmol. 1997;81:189–94.

    Article  CAS  PubMed  Google Scholar 

  92. Austin RB. Progressive outer retinal necrosis syndrome: a comprehensive review of its clinical presentation, relationship to immune system status, and management. Clin Eye Vis Care. 2000;12:119–29.

    Article  PubMed  Google Scholar 

  93. Friedman SM, Mames RN, Sleasman JW, et al. Acute retinal necrosis after chickenpox in a patient with acquired immunodeficiency syndrome. Arch Ophthalmol. 1993;111:1607–8.

    Article  CAS  PubMed  Google Scholar 

  94. Galindez OA, Sabates NR, Whitacre MM, et al. Rapidly progressive outer retinal necrosis caused by varicella zoster virus in a patient infected with humanimmunodeficiency virus. Clin Infect Dis. 1996;22:149–51.

    Article  CAS  PubMed  Google Scholar 

  95. Goon P, Wright M, Fink C. Ophthalmic zoster sine herpete. J R Soc Med. 2000;93:191–2.

    CAS  PubMed  Google Scholar 

  96. Hon C, Au WY, Cheng VC. Ophthalmic zoster sine herpete presenting as oculomotor palsy after marrow transplantation for acute myeloid leukemia. Haematologica. 2005;90:12. EIM04.

    Google Scholar 

  97. Noda Y, Nakazawa M, Takahashi D, et al. Retinal periphlebitis as zoster sine herpete. Arch Ophthalmol. 2001;119:1550–2.

    CAS  PubMed  Google Scholar 

  98. Yamamoto S, Tada R, Shimomura Y, et al. Detecting varicella-zoster virus DNA in iridocyclitis using polymerase chain reaction: a case of zoster sine herpete. Arch Ophthalmol. 1995;113:1358–9.

    Article  CAS  PubMed  Google Scholar 

  99. Silverstein BE, Chandler D, Neger R, et al. Disciform keratitis: a case of herpes zoster sine herpete. Am J Ophthalmol. 1997;123:254–5.

    CAS  PubMed  Google Scholar 

  100. Lewis GW. Zoster sine herpete. Br Med. 1958;J 2:418–42.

    Article  Google Scholar 

  101. Gilden DH, Wright RR, Schneck SA, et al. Zoster sine herpete, a clinical variant. Ann Neurol. 1994;35:530–3.

    Article  CAS  PubMed  Google Scholar 

  102. Amlie-Lefond C, Mackin GA, Ferguson M, et al. Another case of virologically confirmed zoster sine herpete with electrophysiologic correlation. J Neurovirol. 1996;2:136–8.

    Article  CAS  PubMed  Google Scholar 

  103. Blumenthal DT, Shacham-Shmueli E, Bokstein F, et al. Zoster sine herpete: virological verification by detection of anti-VZV IgG antibody in CSF. Neurology. 2011;76:484–5.

    Article  CAS  PubMed  Google Scholar 

  104. Nagel MA, Forghani B, Mahalingam R, et al. The value of detecting anti-VZV IgG antibody in CSF to diagnose VZV vasculopathy. Neurology. 2007;68:1069–73.

    Article  CAS  PubMed  Google Scholar 

  105. Haug A, Mahalingam R, Cohrs RJ, et al. Recurrent polymorphonuclear pleocytosis with increased red blood cells caused by varicella zoster virus infection of the central nervous system. J Neurol Sci. 2010;292:85–8.

    Article  PubMed  Google Scholar 

  106. Gilden D, Mahalingam R, Nagel MA, Pugazhenthi S, Cohrs RJ. Review: The neurobiology of varicella zoster virus infection. Neuropathol Appl Neurobiol. 2011;37:441–63.

    Article  CAS  PubMed  Google Scholar 

  107. Gilden DH, Mahalingam R, Cohrs RJ, et al. The protean manifestations of varicella-zoster virus vasculopathy. J NeuroVirol. 2002;8:75–9.

    Article  CAS  PubMed  Google Scholar 

  108. Gilden D, Cohrs RJ, Mahalingam R, et al. Varicella zoster virus vasculopathies: diverse clinical manifestations, laboratory features, pathogenesis, and treatment. Lancet Neurol. 2009;8:731–40.

    Article  PubMed  Google Scholar 

  109. Gilden DH, Kleinschmidt-DeMasters BK, Wellish M, et al. Varicella zoster virus, a cause of waxing and waning vasculitis: the NEJM case 5-1995 revisited. Neurology. 1996;47:1441–6.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by National Institutes of Health grants AG006127 and AG032958 to DG and NS067070 to MAN. The authors wish to thank Marina Hoffman for editorial assistance and Lori DePriest for manuscript preparation.

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Maria A. Nagel and Don Gilden declare that they have no conflict of interest.

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  1. Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA

    Maria A. Nagel MD & Don Gilden MD

  2. Department of Microbiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Box B182, Aurora, CO, 80045, USA

    Don Gilden MD

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Correspondence to Don Gilden MD.

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Nagel, M.A., Gilden, D. Complications of Varicella Zoster Virus Reactivation. Curr Treat Options Neurol 15, 439–453 (2013). https://doi.org/10.1007/s11940-013-0246-5

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