aDepartment of Neurology bDepartment of Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA.
Curr Opin Neurol. 2014 Jun;27(3):356-60. doi: 10.1097/WCO.0000000000000092.
Varicella zoster virus (VZV) reactivation results in zoster, which may be complicated by postherpetic neuralgia, myelitis, meningoencephalitis, and VZV vasculopathy. This review highlights the clinical features, laboratory abnormalities, imaging changes, and optimal treatment of each of those conditions. Because all of these neurological disorders produced by VZV reactivation can occur in the absence of rash, the virological tests proving that VZV caused disease are discussed.
After primary infection, VZV becomes latent in ganglionic neurons along the entire neuraxis. With a decline in VZV-specific cell-mediated immunity, VZV reactivates from ganglia and travels anterograde to the skin to cause zoster, which is often complicated by postherpetic neuralgia. VZV can also travel retrograde to produce meningoencephalitis, myelitis, and stroke. When these complications occur without rash, VZV-induced disease can be diagnosed by detection of VZV DNA or anti-VZV antibody in cerebrospinal fluid and treated with intravenous acyclovir.
Awareness of the expanding spectrum of neurological complications caused by VZV reactivation with and without rash will improve diagnosis and treatment.
水痘带状疱疹病毒（VZV）再激活可导致带状疱疹，其可能并发带状疱疹后神经痛、脊髓炎、脑膜脑炎和 VZV 血管病变。本综述重点介绍了这些疾病的临床特征、实验室异常、影像学改变和最佳治疗方法。由于 VZV 再激活引起的所有这些神经障碍都可在无皮疹的情况下发生，因此讨论了证明 VZV 引起疾病的病毒学检测。
初次感染后，VZV 在沿整个脊神经节的神经节神经元中潜伏。随着 VZV 特异性细胞介导免疫的下降，VZV 从神经节中重新激活并逆行传播到皮肤，引起带状疱疹，常并发带状疱疹后神经痛。VZV 也可逆行传播，导致脑膜脑炎、脊髓炎和中风。当这些并发症在无皮疹的情况下发生时，可以通过检测脑脊液中的 VZV DNA 或抗 VZV 抗体来诊断 VZV 引起的疾病，并采用静脉用阿昔洛韦进行治疗。
认识到 VZV 再激活引起的、有和无皮疹的神经并发症的范围正在扩大，这将改善诊断和治疗。
