Gilden Donald
Department of Neurology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
Herpes. 2004 Jun;11 Suppl 2:89A-94A.
Varicella zoster virus (VZV) causes chicken pox (varicella) after which it establishes latency and can subsequently reactivate to cause herpes zoster. Central nervous system (CNS) complications can follow both primary infection and reactivation of VZV. The more serious manifestations arise when VZV invades the spinal cord or cerebral arteries after reactivation of the virus, causing diseases such as myelitis and focal vasculopathies. The International Herpes Management Forum (IHMF) has developed guidelines to aid in the diagnosis and management of CNS syndromes associated with VZV and these have focused on VZV vasculopathy. The new guidelines recommend that where VZV vasculopathy is suspected, cerebrospinal fluid (CSF) should be analysed by polymerase chain reaction (PCR) for VZV DNA. As VZV antibodies may be present in the CSF in the presence or absence of detectable VZV DNA, CSF should also be analysed for VZV-specific antibody if there is a high likelihood of CNS disease. Early diagnosis of these serious complications is important, as aggressive antiviral treatment can be effective. Patients with VZV focal vasculopathy should be treated with intravenous aciclovir (10 mg/kg every 8 h for adults, 500 mg/m2 body surface area for children) for 7 days. The immunocompromised patient may require longer treatment. However, treatment should be discontinued if negative results are obtained for both VZV DNA and anti-VZV antibody in CSF. Steroid therapy (prednisone 60-80 mg/day for 3-5 days) should be considered in VZV vasculopathy to reduce inflammation.
水痘带状疱疹病毒（VZV）引起水痘，之后该病毒建立潜伏状态，并随后可能重新激活引发带状疱疹。中枢神经系统（CNS）并发症可发生在VZV的原发性感染和重新激活之后。当VZV在病毒重新激活后侵入脊髓或脑动脉时，会出现更严重的表现，导致诸如脊髓炎和局灶性血管病变等疾病。国际疱疹管理论坛（IHMF）制定了指南，以协助诊断和管理与VZV相关的中枢神经系统综合征，这些指南主要关注VZV血管病变。新指南建议，在怀疑有VZV血管病变的情况下，应通过聚合酶链反应（PCR）分析脑脊液（CSF）中的VZV DNA。由于无论是否可检测到VZV DNA，CSF中都可能存在VZV抗体，因此如果中枢神经系统疾病可能性很高，也应对CSF进行VZV特异性抗体分析。早期诊断这些严重并发症很重要，因为积极的抗病毒治疗可能有效。VZV局灶性血管病变患者应接受静脉注射阿昔洛韦治疗（成人每8小时10 mg/kg，儿童每平方米体表面积500 mg），持续7天。免疫功能低下的患者可能需要更长时间的治疗。然而，如果脑脊液中VZV DNA和抗VZV抗体检测结果均为阴性，则应停止治疗。对于VZV血管病变，应考虑使用类固醇疗法（泼尼松60 - 80 mg/天，持续3 - 5天）以减轻炎症。
