Jacobs A, Bamborschke S, Szelies B, Lanfermann H, Schröder R, Heiss W D
Klinik und Poliklinik für Neurologie und Psychiatrie der Universität, Köln.
Dtsch Med Wochenschr. 1996 Mar 15;121(11):331-5. doi: 10.1055/s-2008-1043009.
A 43-year-old woman was admitted with a 14-day history of general malaise, subfebrile temperature, radicular dysaesthesias in the "riding breeches" area, severe pain in the lumbar region and progressive disorders of bladder and rectal emptying. Physical examination showed a conus-cauda syndrome. Differential diagnosis was between myelitis (inflammatory or infectious), space-occupying intraspinal mass or vascular lesion.
Cerebrospinal fluid contained 1700/3 cells and there was intrathecal antibody synthesis against varicella zoster virus (VZV) and positive VZV-DNA analysis in the polymerase chain reaction. Magnetic resonance imaging of the lumbar spine revealed an inflamed enlarged conal and epiconal area with small haemorrhagic spots. There was no evidence of an underlying immune-modulated disease.
With the diagnosis of varicella zoster myelitis with cutaneous changes having been established the clinical signs and symptoms regressed almost completely with aciclovir administration (10mg/kg intravenously for 14 days).
VZV without cutaneous involvement should be considered in the differential diagnosis of the radicular pain syndrome. When clinical signs of beginning myelitis or encephalitis are present, immediate investigations and therapy are necessary.
一名43岁女性因全身不适、低热、“马裤”区域神经根感觉异常、腰部剧痛以及膀胱和直肠排空进行性障碍，病程14天而入院。体格检查显示为圆锥-马尾综合征。鉴别诊断考虑为脊髓炎（炎症性或感染性）、脊髓内占位性病变或血管病变。
脑脊液细胞数为1700/3，存在针对水痘-带状疱疹病毒（VZV）的鞘内抗体合成，聚合酶链反应中VZV-DNA分析呈阳性。腰椎磁共振成像显示圆锥和圆锥上区域发炎肿大，伴有小出血点。未发现潜在的免疫调节疾病证据。
确诊为水痘-带状疱疹脊髓炎伴皮肤改变后，使用阿昔洛韦治疗（静脉注射10mg/kg，共14天），临床体征和症状几乎完全消退。
在神经根疼痛综合征的鉴别诊断中应考虑无皮肤受累的VZV感染。当出现脊髓炎或脑炎初期临床体征时，需立即进行检查和治疗。
