1/14. Meningoencephalomyelitis with vasculitis due to varicella zoster virus: a case report and review of the literature.Varicella zoster virus (VZV) encephalitis is associated with large or small vessel vasculopathy. We report the case of a 67-year-old woman with a history of non-Hodgkin's lymphoma and cancers of the breast and colon, who presented with a zosteriform rash and brown-sequard syndrome. Despite 10 days therapy with intravenous acyclovir, meningoencephalitis developed and the patient died 15 days after onset of neurological symptoms. autopsy showed meningoencephalomyelitis with necrotising vasculitis of leptomeningeal vessels, which is a rare complication of VZV, and we review the literature of the nine similar published cases. polymerase chain reaction of cerebrospinal fluid for VZV was negative 6 days after onset of neurological symptoms, but became positive by day 10. Only one multinucleated giant cell with intranuclear Cowdry type A inclusions was seen within an endothelial cell in a leptomeningeal vessel involved by vasculitis.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/14. MR and CT imaging patterns in post-varicella encephalitis.The aim of the investigation was to determine the patterns of cerebral involvement on computed tomography (CT) and magnetic resonance (MR) imaging in post-varicella encephalitis. Four children between the ages of 2 and 11 years presented over a 5-year period with a diagnosis of post-varicella encephalitis. Their imaging studies and clinical data were reviewed retrospectively. The medical histories of all four children were noncontributory except for recent bouts of chickenpox 1 week to 3 months prior to hospitalization. Three children presented with parkinsonian manifestations. Bilateral, symmetric hypodense, nonenhancing basal ganglia lesions were found on CT. These areas showed nonenhancing low signal intensity on T1-weighted images and high signal intensity on T2-weighted images on MR. One child presented with diffuse, multiple gray and white matter lesions of similar imaging characteristics; some lesions, however, did enhance. This child had no gait disturbances. Post-varicella encephalitis can produce two patterns of dramatic CT and MR findings. With an appropriate history and clinical findings, varicella as a cause of bilateral basal ganglia or diffuse cerebral lesions can be differentiated from other possible etiologies which include trauma, anoxia, metabolic disorders and demyelinating diseases.- - - - - - - - - - ranking = 2keywords = varicella (Clic here for more details about this article) |
3/14. Pre-eruptive varicella cerebellitis confirmed by PCR.The diagnosis of pre-eruptive varicella cerebellitis is usually based on a history of exposure and thus depends on a subjective clinical assessment. The confirmation of the diagnosis has traditionally depended on the development of skin manifestations of varicella and on varicella-zoster antibody seroconversion. Confirming the diagnosis of pre-eruptive cerebellar ataxia or encephalitis early in the course of a viral infection may save the patient unnecessary tests, procedures, or attempts at therapeutic intervention. A patient is reported in whom, after clinically suspecting a diagnosis of pre-eruptive varicella cerebellitis, the diagnosis was confirmed by performing polymerase chain reaction analysis of varicella-zoster virus dna in peripheral blood leukocytes and cerebrospinal fluid. The patient developed skin manifestations of varicella 5 days after the onset of neurologic symptoms and 15 days after known exposure. In some patients with preeruptive varicella cerebellitis, polymerase chain reaction may be extremely useful for rapid confirmation of the diagnosis.- - - - - - - - - - ranking = 2.75keywords = varicella (Clic here for more details about this article) |
4/14. brain stem encephalitis due to varicella-zoster virus in a patient with AIDS.We describe a patient infected with human immunodeficiency virus (hiv) who had localized brain stem encephalitis due to varicella-zoster virus (VZV) and no cutaneous eruption. diagnosis of the infection was based on the presence of Cowdry type A intranuclear inclusions in neurons, astrocytes, and oligodendrocytes positive for VZV (as shown by immunochemical staining). Although this infection is rare, we demonstrate the need for clinicians to include VZV infection in the differential diagnosis of rapidly progressive multiple cranial nerve palsies in hiv-infected patients, particularly because specific treatment for VZV infection is effective and relatively safe.- - - - - - - - - - ranking = 1.25keywords = varicella (Clic here for more details about this article) |
5/14. Postvaricella basal ganglia infarction in children.Two patients presented with acute neurologic deficits attributable to contralateral basal ganglia infarction 1 to 3 months after episodes of chickenpox. Both presented with hemiparesis with one patient also demonstrating ipsilateral choreoathetosis. In both patients MR revealed unilateral basal ganglia infarction. cerebral angiography findings in one patient were normal; in the second, there was unilateral narrowing of the common carotid artery and of proximal branches of the anterior and middle cerebral artery.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
6/14. Periorbital varicella gangrenosa necessitating orbital exenteration in a previously healthy adult.A previously healthy 31-year-old man had profound neurologic compromise and necrotizing periorbital infection due to a complication of varicella infection. Despite aggressive treatment, he required orbital exenteration and radical debridement of the involved tissues. He survived in a vegetative state for almost 1 year before succumbing to progressive neurologic deterioration. We present and discuss this complicated case of varicella gangrenosa to show the devastating nature of complications that can occur from varicella infection in the unsensitized adult.- - - - - - - - - - ranking = 1.75keywords = varicella (Clic here for more details about this article) |
7/14. The patterns of varicella zoster virus encephalitis.Varicella zoster virus (VZV) encephalitis has become increasingly prevalent in the era of acquired immunodeficiency syndrome (AIDS), and a widening spectrum of pathological lesions has defined the disease in these and other severely immunosuppressed patients. VZV produces three distinct morphological patterns of brain damage. VZV can cause bland or hemorrhagic infarctions secondary to a large or medium vessel vasculopathy. Deep white matter, ovoid mixed necrotic, and demyelinative lesions occur as a consequence of small vessel vasculopathy, with demyelination dependent on the degree of additional oligodendrocyte infection. Distinctive Cowdry A intra-nuclear viral inclusions are rare in either large or small blood vessels or near infarctions, but are commonly found in glial cells at the edge of the smaller ovoid, demyelinative lesions. Ependymal and periventricular necrosis occurs as a result of vasculopathy of subependymal vessels and secondary infection of ependymal and other glial cells in the periventricular region. To clarify these patterns of VZV encephalitis and shed light on their pathogenesis, the authors have examined all cases of VZV encephalitis seen at our institution since 1984. Additionally, the authors review the extensive literature in an attempt to classify the patterns of VZV encephalitis into (1) large/ medium vessel vasculopathy with bland or hemorrhagic infarctions, (2) small vessel vasculopathy with mixed ischemic/demyelinative lesions, and (3) ventriculitis/periventriculitis. Although one of these three patterns often predominates clinically and radiographically, careful histological examination at autopsy shows mixed features in many cases.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
8/14. association of progressive outer retinal necrosis and varicella zoster encephalitis in a patient with AIDS.BACKGROUND: A patient with AIDS who developed the clinical picture of bilateral progressive outer retinal necrosis (PORN) in combination with varicella zoster encephalitis is described. The picture developed more than 2 years after an episode of ophthalmic zoster infection, and following intermittent exposure to oral acyclovir because of recurrent episodes of cutaneous herpes simplex infection. methods: Aqueous humour, obtained by paracentesis of the anterior chamber, was analysed using immunofluorescence and polymerase chain reaction (PCR). Postmortem analysis of eye and brain tissue was performed by using conventional techniques and in situ hybridisation. RESULTS: While conventional techniques all failed to detect a causative agent, analysis of the aqueous humour using PCR, and histological examination of necropsy specimens from eyes and brain using in situ hybridisation were conclusive for the diagnosis varicella zoster virus (VZV) infection. CONCLUSION: This case documents the presumed association of PORN and VZV encephalitis in a severely immunocompromised AIDS patient.- - - - - - - - - - ranking = 1.5keywords = varicella (Clic here for more details about this article) |
9/14. Complicated varicella zoster infection in 8 paediatric patients and review of literature.BACKGROUND: This is a study of complicated varicella zoster infection in paediatric patients. AIM: To find out the number of patients with such complications, the types of complications and their outcome. METHOD: This involved a retrospective review of the case records of 8 patients who presented to our unit over a 12-month period (Jan-Dec 96). All patients were previously well without any underlying immunodeficiency. Varicella zoster (VZ) infection was confirmed by VZ immunofluorescence from vesicular fluid. RESULTS: CMS complications accounted for 6 of the 8 cases. Of these, 3 presented with encephalitis, 2 with cerebella ataxia and 1 with aseptic meningitis and cerebella ataxia. Of the non-CNS cases, 1 presented with glomerulonephritis with superimposed staphylococcus infection of skin ulcers; the other had disseminated VZ infection with haemorrhagic vesicles, hepatitis, ileus with mesenteric adenitis and disseminated intravascular coagulation. OUTCOME: The patient with disseminated VZ infection and multiple organ involvement died 5 days after a stormy course. One patient with encephalitis who had status epilepticus for 2 hours had behavioural problems and poor memory. The remaining 6 patients had no sequelae. CONCLUSION: VZ infection usually a minor illness, can result in serious life-threatening complications in previously healthy patients.- - - - - - - - - - ranking = 1.25keywords = varicella (Clic here for more details about this article) |
10/14. Response to acyclovir in two cases of herpes zoster leukoencephalitis and review of the literature.herpes zoster leukoencephalitis is a rare complication of varicella-zoster virus infection. Associated with high mortality, the majority of cases have been discovered postmortem; today, however, magnetic resonance imaging is being used successfully as an aid in the diagnosis of this disease. The first two reported cases of hiv-infected patients with herpes zoster leukoencephalitis who recovered clinically and showed complete resolution of the magnetic resonance demyelination images after acyclovir treatment are described. In addition, the cases of herpes zoster leukoencephalitis reported in the literature to date are reviewed.- - - - - - - - - - ranking = 0.25keywords = varicella (Clic here for more details about this article) |
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