Andersen B
Neuromedicinsk afdeling, Københavns Amts Sygehus i Glostrup.
Ugeskr Laeger. 1993 Feb 22;155(8):536-40.
The Varicella zoster virus may affect the central nervous system (CNS) as a complication of herpes zoster (HZ). A series of neurological syndromes are described and, on the basis of a review of the literature and two illustrative case histories, the symptomatology, pathogenesis, therapeutic possibilities and the diagnostic difficulties in HZ-associated cerebral vasculitis and HZ-associated encephalitis are reviewed. Progressive multifocal encephalopathy in immune-insufficient individuals is briefly mentioned. The diagnosis is most frequently established on the basis of the clinical picture when the characteristic symptoms develop in connection with cutaneous HZ. A long latent period may result in defective recognition of the connection. Immuno-suppression and dissemination are critical determinants for the course of the condition but, in immune-competent individuals, the morbidity and mortality are low. Treatment with acyclovir is employed to an increasing extent with good results but the conditions are rare and clinically controlled investigations are not available. It is important that the possibility of HZ-associated CNS-disease is borne in mind, in view of the therapeutic possibilities. The pathogeneses of these complications is little understood but there is increasing evidence that a direct viral invasion is the mechanism responsible. A post-infectious immune-mediate mechanism is also another popular opinion.
水痘带状疱疹病毒可能作为带状疱疹（HZ）的并发症影响中枢神经系统（CNS）。本文描述了一系列神经综合征，并在回顾文献及两个典型病例的基础上，对HZ相关的脑血管炎和HZ相关的脑炎的症状学、发病机制、治疗可能性及诊断难点进行了综述。简要提及了免疫功能不全个体中的进行性多灶性脑病。当特征性症状与皮肤HZ相关联出现时，诊断通常基于临床表现确立。较长的潜伏期可能导致对这种关联的识别不足。免疫抑制和病毒播散是病情发展的关键决定因素，但在免疫功能正常的个体中，发病率和死亡率较低。越来越多地使用阿昔洛韦进行治疗，效果良好，但这些病症较为罕见，且缺乏临床对照研究。鉴于治疗可能性，牢记HZ相关中枢神经系统疾病的可能性很重要。这些并发症的发病机制尚不清楚，但越来越多的证据表明，直接病毒入侵是其发病机制。感染后免疫介导机制也是另一种普遍观点。
