1/62. Impact of cerebrospinal fluid PCR on the management of hiv-infected patients with varicella-zoster virus infection of the central nervous system.Over a 2 year period, we identified five hiv-infected patients who presented with central nervous system infection caused by varicella-zoster virus, three with myelitits, and two with meningoencephalitis. All five patients were profoundly immunocompromised. Clinical presentation of these patients overlapped to a significant extent with diseases caused by other viruses, e.g. CMV. Indeed, in one case, a dual infection with CMV was diagnosed, but the respective role of each virus was ascertained by in situ hybridisation. At the time of CNS involvement, only one patient had active VZV cutaneous lesions, which were instrumental in diagnosing her condition. In contrast, PCR for VZV dna in the CSF was helpful in making a diagnosis in the four other cases, one of which was confirmed by a post mortem. Of these five patients, two patients developed VZV disease while receiving oral acyclovir and had foscarnet treatment initiated when MRI demonstrated widespread lesions. They did not respond to antiviral therapy. The three other patients had intravenous acyclovir initiated at a time when no or limited parenchymal lesions were observed by MRI. Two of these three patients had VZV infection diagnosed solely on the basis of PCR: all three responded to treatment. Our data show that reactivation of VZV involving the central nervous system occurs frequently in the absence of cutaneous lesions. PCR of cerebrospinal fluid may help in making an early diagnosis which is probably a prerequisite for successful treatment of VZV infection of the CNS.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
2/62. Varicella zoster meningitis preceeded by thrombophlebitis in a patient with Hodgkin's disease.Varicella zoster (V-Z) infections are common among patients with hematological malignancies, particularly Hodgkin's disease (HD). The common denominator in both HD and V-Z infections is immunosuppression. Most of V-Z infections occur in patients with HD during the remission period, who have mixed cellularity sub-type, with stage III disease and who have received combined chemo-radiation therapy. Involvement of the central nervous system usually manifests as post-herpetic neuralgia or encephalitis. Angiitis has also been found in association with V-Z infections. The authors describe a case of HD who developed V-Z meningitis preceeded by superficial thrombophlebitis of upper extremities during the period of active chemotherapy.- - - - - - - - - - ranking = 0.16666666666667keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/62. Concurrent herpes simplex type 1 and varicella-zoster in the V2 dermatome in an immunocompetent patient.A unique feature of herpesviruses is their ability to establish latent infection within the nervous system by colonizing peripheral sensory ganglia, which results in subsequent episodic outbreaks of infection triggered by precipitating events. Despite the latent nature of both herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) within these sensory ganglia, simultaneous outbreaks of these viruses are uncommon. This is generally attributed to the differing reactivation features of these 2 viruses. Four cases of concurrent HSV-1 and VZV infection are described in the literature. We report concurrent infection of HSV-1 and VZV within the same V2 dermatome in an immunocompetent patient.- - - - - - - - - - ranking = 0.055458376865792keywords = nervous system (Clic here for more details about this article) |
4/62. Unilateral occlusion of the middle cerebral artery after varicella-zoster virus infection.We report a 4-year-old child who developed hemiplegia 6 months after varicella-zoster virus (VZV) infection. cerebral angiography showed complete occlusion of the right middle cerebral artery with basal moyamoya vessels. Elevation of anti-VZV antibody in the cerebrospinal fluid indicated central nervous system involvement. The association between VZV cerebral angitis and unilateral occlusion of right middle cerebral artery is discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = central nervous system, nervous system (Clic here for more details about this article) |
5/62. Intractable postherpetic itch and cutaneous deafferentation after facial shingles.Some patients develop chronic itch from neurological injuries, and shingles may be a common cause. Neuropathic itch can lead to self-injury from scratching desensate skin. A 39-year-old woman experienced severe postherpetic itch, but no postherpetic neuralgia, after ophthalmic zoster. Within 1 year, she had painlessly scratched through her frontal skull into her brain. Sensory testing and skin biopsies were performed on itchy and normal scalp to generate preliminary hypotheses about mechanisms of neuropathic itch. Quantitation of epidermal neurites in PGP9.5-immunolabeled skin biopsies demonstrated loss of 96% of epidermal innervation in the itchy area. Quantitative sensory testing indicated severe damage to most sensory modalities except itch. These data indicate that in this patient, severe postherpetic itch was associated with loss of peripheral sensory neurons. Possible mechanisms include electrical hyperactivity of hypo-afferented central itch-specific neurons, selective preservation of peripheral itch-fibers from neighboring unaffected dermatomes, and/or imbalance between excitation and inhibition of second-order sensory neurons.- - - - - - - - - - ranking = 0.0034602040386058keywords = brain (Clic here for more details about this article) |
6/62. Aseptic meningitis and optic neuritis preceding varicella-zoster progressive outer retinal necrosis in a patient with AIDS.Varicella-Zoster Virus (VZV) is the second most common ocular pathogen in patients with hiv infection. VZV retinitis is estimated to occur in 0.6% of patients with hiv infection and may occur in one of two clinical syndromes. The first is the acute retinal necrosis syndrome, which also may be seen in immunocompetent hosts. The second clinical syndrome occurs in patients with CD4 cell counts typically < 50 x 10(6)/l and is termed progressive outer retinal necrosis. VZV retinitis has been reported to occur simultaneously with other VZV central nervous system manifestations such as encephalitis and myelitis in hiv-infected patients. In addition, VZV retrobulbar optic neuritis heralding VZV retinitis has recently been described in hiv-infected patients who had suffered a recent episode of dermatomal herpes zoster. Herein we report the case of an hiv-infected individual who presented with VZV meningitis and retrobulbar optic neuritis that preceded the onset of progressive outer retinal necrosis. We also review of the literature of seven additional reported cases of retrobulbar optic neuritis preceding the onset of VZV retinitis.- - - - - - - - - - ranking = 0.16666666666667keywords = central nervous system, nervous system (Clic here for more details about this article) |
7/62. Laryngeal herpes: a case report.Herpetic laryngitis is a rare inflammatory disease caused by herpes simplex or herpes zoster virus. The propensity for spreading along peripheral nerves and within the central nervous system, with frank herpetic meningoencephalitis, is a rare complication. We present one case of herpetic laryngitis by reactivation of varicella zoster, with central nervous system spreading, and discuss the relevant literature on the pathophysiology, diagnosis, evaluation, and management of this disease.- - - - - - - - - - ranking = 0.33333333333333keywords = central nervous system, nervous system (Clic here for more details about this article) |
8/62. 2-Chlorodeoxyadenosine therapy for disseminated Langerhans cell histiocytosis.OBJECTIVE: To evaluate the efficacy of 2-chlorodeoxyadenosine (2-CDA), a purine nucleoside analogue, in treating disseminated Langerhans cell histiocytosis (LCH). patients AND methods: We retrospectively reviewed the clinical records of 5 patients who were seen at our institution for histologically confirmed disseminated LCH, including 1 patient with central nervous system parenchymal involvement. These patients were treated consecutively with 2-CDA chemotherapy between December 1994 and January 2001. The patients ranged in age from 19 to 81 years, and the median pretreatment duration of disease was 23 months. Median follow-up after initiation of 2-CDA treatment was 33 months. 2-Chlorodeoxyadenosine was used as frontline therapy for 1 patient and as salvage therapy for the other patients. patients generally received 0.7 mg/kg over 5 or 7 days; the median number of courses was 4. RESULTS: Complete responses were achieved in 3 patients, including the patient with central nervous system disease, which, to our knowledge, has not been described previously. Two other patients achieved partial responses. The overall response rate was 100%. Toxic effects consisted mainly of myelosuppression; 1 patient developed dermatomal herpes zoster infection. CONCLUSION: Our experience confirms the reported efficacy of 2-CDA in the treatment of LCH; however, the optimal timing and schedule of therapy remain to be determined.- - - - - - - - - - ranking = 0.33333333333333keywords = central nervous system, nervous system (Clic here for more details about this article) |
9/62. Presence, distribution and spread of productive varicella zoster virus infection in nervous tissues.Nervous tissue lesions were retrospectively studied for detection of productive varicella zoster virus (VZV) infection in 33 autopsied cases, including 19 herpes zoster (HZ) (10 trigeminal, nine spinal) and 14 cases of nodular brainstem encephalitis without HZ. Immunocytochemistry for VZV antigens and in situ hybridization with a biotinylated VZV dna probe were used on formol-fixed paraffin sections. Peripheral and central nervous system, skin and striated muscle were investigated in serial sections; available tissue blocks, however, varied between cases. Varicella zoster virus production (both antigen and dna) in nervous tissue was found in HZ cases but only of short survival after a rash of up to 7 wks (eight out of 12 patients). Varicella zoster virus was visualized in nerve cells, glial cells, schwann cells and blood vessels. In the central nervous system (CNS), VZV was detected in trigeminal nuclei (one out of 10 brains) or disseminated nodular brainstem lesions (one out of 10 brains), in subependymal microvessels (one out of 10 brains) or vasculitic arteries (two out of 19 brains or spinal cords). In the peripheral nervous system (PNS), VZV (dna and antigen) was found in neurons and satellite cells of sensory ganglia (four out of seven cases with sampling of ganglia), and in damaged nerve fibres including a muscle nerve in one case; myositis with VZV in affected muscle fibres was found in the latter case. In nodular brainstem encephalitis, one case contained VZV within nodular lesions. We conclude that (i) VZV neural spread is suggested by detectable virus in ganglia, nerve fibres and CNS target nuclei; (ii) haematogenous spread of VZV is suggested by detection of virus in CNS microvessels and in disseminated brainstem encephalitis; (iii) VZV myositis may occur in zosteric myotomes; and (iv) VZV is a possible agent in nodular brainstem encephalitis.- - - - - - - - - - ranking = 0.41993354654658keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
10/62. Multifocal varicella-zoster virus vasculopathy without rash.A 51-year-old woman with crest syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) developed stepwise progressive focal neurological deficits without zoster rash. Multifocal ischemic infarcts were seen on magnetic resonance imaging, and cerebral angiography revealed focal stenosis of arteries affecting the intracranial circulation. A brain biopsy was nondiagnostic. Virological etiology of the disease was verified by the detection of varicella-zoster virus antibody in cerebrospinal fluid and by reduced serum-cerebrospinal fluid varicella-zoster virus IgG ratios (compared with normally high ratios of total IgG and albumin). Treatment with intravenous acyclovir stabilized but did not significantly improve her neurological deficits.- - - - - - - - - - ranking = 0.0034602040386058keywords = brain (Clic here for more details about this article) |
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