Haanpää M, Dastidar P, Weinberg A, Levin M, Miettinen A, Lapinlampi A, Laippala P, Nurmikko T
Department of Neurology, Tampere University Hospital, Finland.
Neurology. 1998 Nov;51(5):1405-11. doi: 10.1212/wnl.51.5.1405.
To explore MRI and CSF findings in patients with herpes zoster (HZ) and to correlate the findings with clinical manifestations of the disease.
Fifty immunocompetent patients (mean age, 59 years; range, 17 to 84 years) with HZ of fewer than 18 days duration participated. None had clinical signs of meningeal irritation, encephalitis, or myelitis. In 42 patients (84%), the symptoms constituted pain and rash only. Six patients (12%) had motor paresis, and three patients (6%) had ocular complications. One to three CSF samples were obtained from 46 patients (the first sampling taken 1 to 18 days from onset of rash), and 16 patients (all with either trigeminal or cervical HZ) underwent MRI of the brain. The clinical follow-up continued at least 3 months.
CSF was abnormal in 28/46 patients (61%): pleocytosis (range, 5 to 1,440 microL) was detected in 21, elevated protein concentration in 12, varicella zoster virus (VZV) DNA in 10, and immunoglobulin G antibody to VZV in 10. These changes were more common in patients with acute complications, although they did not predict development of postherpetic neuralgia (PHN). In 9/16 patients (56%), MRI lesions attributable to HZ were seen in the brainstem and cervical cord. At 3 months, 5/9 patients (56%) with abnormal MRI had PHN, whereas none of the 7 patients with no HZ-related lesions on MRI had any remaining pain.
Subclinical extension of viral inflammation into the CNS occurs commonly in HZ. This finding may have implications for treatment of HZ and prevention of various associated complications.
探讨带状疱疹（HZ）患者的MRI及脑脊液检查结果，并将这些结果与疾病的临床表现相关联。
纳入50例免疫功能正常、HZ病程少于18天的患者（平均年龄59岁；范围17至84岁）。所有患者均无脑膜刺激、脑炎或脊髓炎的临床体征。42例患者（84%）仅有疼痛和皮疹症状。6例患者（12%）有运动性轻瘫，3例患者（6%）有眼部并发症。46例患者采集了1至3份脑脊液样本（首次采样在出疹后1至18天），16例患者（均为三叉神经或颈部HZ患者）接受了脑部MRI检查。临床随访至少持续3个月。
46例患者中有28例（61%）脑脊液异常：21例检测到细胞增多（范围为5至1440/μL），12例蛋白质浓度升高，10例检测到水痘带状疱疹病毒（VZV）DNA，10例检测到VZV免疫球蛋白G抗体。这些变化在有急性并发症的患者中更常见，尽管它们不能预测带状疱疹后神经痛（PHN）的发生。16例患者中有9例（56%）在脑干和颈髓发现与HZ相关的MRI病变。3个月时，9例MRI异常的患者中有5例（56%）发生了PHN，而7例MRI无HZ相关病变的患者均无残留疼痛。
病毒炎症向中枢神经系统的亚临床扩展在HZ中很常见。这一发现可能对HZ的治疗及预防各种相关并发症有重要意义。
