Neurological manifistations of herpes zoster virus reactivation

Abstract

Herpes zoster remains an actual problem for elderly patients and those with immunosuppression. Usually the clinic of Herpes zoster is considered as a combination of neuralgia and typical vesicular rash (sometimes with intoxication). However, the rash does not appear in all patients, and the spectrum of neurological manifestations of the virus reactivation is extremely wide. Most of them reduce the quality of life, and some may result in disability or even death. Due to polymorphic symptoms and difficulties in laboratory diagnosis, many cases of the disease may remain unrecognized, the patient will not receive the necessary etiotropic therapy, so the course of the disease will become more protracted, and the prognosis will worsen. This review is based on 62 domestic and foreign publications without limiting the depth of the search. Here we describe relatively rare forms of the disease with injury of the sensory and motor peripheral nerves, brain and cranial vessels. We offer You a detailed description of pain: herpetic and postherpetic neuralgia. Also in the article we describe examples of damage of motor neurons and give some basic information about damage to the central nervous system. A separate section is devoted to diagnostic methods. This section describes the advantages and disadvantages of diagnostic methods used in real clinical practice, indicates the materials for the study, and the markers of subclinical virus reactivation. The “treatment” section is mainly devoted to the peculiarities of etiotropic therapy for various forms of the disease (with an indication of the recommended drugs, their doses and duration of the course). At the end of the article a list of clinical indications for examination for reactivation of the herpes zoster virus is defined.

Keywords

• herpes zoster
• zoster sine herpete
• varicella zoster virus
• neuritis