Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America.
J Neurol Sci. 2022 Jun 15;437:120262. doi: 10.1016/j.jns.2022.120262. Epub 2022 Apr 16.
To investigate the clinical and magnetic resonance imaging (MRI) characteristics of patients with varicella zoster virus (VZV) reactivation involving the cranial nerves and central nervous system (CNS).
This is a retrospective, multi-center case-series of 37 patients with VZV infection affecting the cranial nerves and CNS.
The median age was 71 years [IQR 51.5-76]; 21 (57%) were men. Cerebrospinal fluid (CSF) was available in 24/37 (65%); median CSF white blood cell count was 11 [IQR 2-23] cells/μL and protein was 45.5 [IQR 34.5-75.5] mg/dL. VZV polymerase chain reaction (PCR) assays were positive in 6/21 (29%) CSF and 8/9 (89%) ocular samples. Clinical involvement included the optic nerve in 12 (32%), other cranial nerves in 20 (54%), brain parenchyma in 12 (32%) and spinal cord or nerve roots in 4 (11%). Twenty-seven/28 immunocompetent patients' MRIs were available for review (96%). Of the 27, 18 had T1 postcontrast fat saturated sequences without motion artifact to evaluate for cranial nerve enhancement and optic perineuritis (OPN). Eight/18 (44%) demonstrated OPN. All 8 experienced vision loss: 3 optic neuritis, 1 acute retinal necrosis, and 3 CNS vasculitis with 1 central and 1 branch retinal artery occlusion and 1 uveitis. Diplopic patients had cranial nerve and cavernous sinus enhancement. All immunosuppressed patients were imaged. Seven/9 (88%) had extensive neuraxis involvement, including encephalitis, vasculitis and transverse myelitis; one case had OPN.
OPN is a frequent manifestation in VZV-associated vision loss among immunocompetent patients. Immunosuppressed patients had greater neuraxis involvement. Optimizing MRI protocols may improve early diagnosis in VZV reactivation.
研究水痘带状疱疹病毒（VZV）再激活累及颅神经和中枢神经系统（CNS）的临床和磁共振成像（MRI）特征。
这是一项回顾性、多中心病例系列研究，共纳入 37 例 VZV 感染累及颅神经和 CNS 的患者。
中位年龄为 71 岁[IQR 51.5-76]；21 例（57%）为男性。24/37（65%）例患者有脑脊液（CSF）检查结果；CSF 白细胞计数中位数为 11[IQR 2-23]细胞/μL，蛋白为 45.5[IQR 34.5-75.5]mg/dL。6/21（29%）例 CSF 和 8/9（89%）例眼标本的 VZV 聚合酶链反应（PCR）检测为阳性。12 例（32%）患者视神经受累，20 例（54%）患者其他颅神经受累，12 例（32%）患者脑实质受累，4 例（11%）患者脊髓或神经根受累。27/28 例免疫功能正常患者的 MRI 可供回顾（96%）。27 例中，18 例有 T1 增强脂肪饱和序列，无运动伪影，可用于评估颅神经增强和视神经周围炎（OPN）。18 例中有 8 例（44%）显示 OPN。8 例均有视力丧失：3 例视神经炎，1 例急性视网膜坏死，3 例 CNS 血管炎，1 例中央和 1 例分支视网膜动脉闭塞，1 例葡萄膜炎。复视患者有颅神经和海绵窦增强。所有免疫抑制患者均进行了影像学检查。9 例中有 7 例（88%）有广泛的神经轴受累，包括脑炎、血管炎和横贯性脊髓炎；1 例有 OPN。
在免疫功能正常的 VZV 相关视力丧失患者中，OPN 是一种常见的表现。免疫抑制患者有更大的神经轴受累。优化 MRI 方案可能有助于早期诊断 VZV 再激活。
