Neurological deterioration in the treatment of Herpes zoster: encephalitis or neurotoxic effect of acyclovir?
Herpes zoster (VZV) infections have an annual incidence of approximately 1.5–3/1000 inhabitants. For Belgium, this means an annual incidence of about 20,000 cases. VZV affects mainly the elderly population .
Known complications of VZV at the level of the central nervous system (CNS) are vasculitic encephalitis, aseptic meningitis, myelitis, acute cerebellar ataxia, and Ramsay Hunt syndrome. Vasculitis is the main cause of all of these clinical presentations. The incidence of CNS disorders is estimated at around 5.5 % .
Other cases have been reported after trigeminal rash. Afferent trigeminal ganglionic fibres innervating both intracranial and extracranial arteries provide a pathway for viral spread .
A rapid diagnosis of VZV CNS infection is crucial and is primarily based on CSF analysis: pleocytosis (mostly mild (<100 cells/µl), detection of viral DNA (mostly during the first 7 days), whereas specific antibodies appear later .
There are pitfalls though in the diagnosis of...
KeywordsValproate Status Epilepticus Tramadol Herpes Zoster Acyclovir
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Conflict of interest
All the authors report no disclosure nor conflict of interest relevant to the manuscript. All authors report no financial disclosure.
This manuscript does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
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