Acta Neurologica Belgica

, Volume 117, Issue 1, pp 395–397 | Cite as

Neurological deterioration in the treatment of Herpes zoster: encephalitis or neurotoxic effect of acyclovir?

  • H. De Cauwer
  • Jan Maes
  • M. Viaene
  • L. Janssen
  • L. Belmans
Letter to the Editor

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 [1].

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 % [2].

Other cases have been reported after trigeminal rash. Afferent trigeminal ganglionic fibres innervating both intracranial and extracranial arteries provide a pathway for viral spread [1].

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 [1].

There are pitfalls though in the diagnosis of...


Valproate Status Epilepticus Tramadol Herpes Zoster Acyclovir 
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Compliance with ethical standards

Conflict of interest

All the authors report no disclosure nor conflict of interest relevant to the manuscript. All authors report no financial disclosure.

Ethical approval

This manuscript does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

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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Copyright information

© Belgian Neurological Society 2016

Authors and Affiliations

  1. 1.Department of NeurologyDimpna Regional HospitalGeelBelgium
  2. 2.General PractitionerVeerle-LaakdalBelgium
  3. 3.Department of Anaesthesiology-Intensive CareAZ St DimpnaGeelBelgium

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