@article {1638569,
	title = {Clinical and neuroradiologic characteristics in varicella zoster virus reactivation with central nervous system involvement},
	journal = {J Neurol Sci},
	volume = {437},
	year = {2022},
	month = {2022 Jun 15},
	pages = {120262},
	abstract = {OBJECTIVE: To investigate the clinical and magnetic resonance imaging (MRI) characteristics of patients with varicella zoster virus (VZV) reactivation involving the cranial nerves and central nervous system (CNS). METHODS: This is a retrospective, multi-center case-series of 37 patients with VZV infection affecting the cranial nerves and CNS. RESULTS: The median age was 71\&nbsp;years [IQR 51.5-76]; 21 (57\%) were men. Cerebrospinal fluid (CSF) was available in 24/37 (65\%); median CSF white blood cell count was 11 [IQR 2-23] cells/μL and protein was 45.5 [IQR 34.5-75.5] mg/dL. VZV polymerase chain reaction (PCR) assays were positive in 6/21 (29\%) CSF and 8/9 (89\%) ocular samples. Clinical involvement included the optic nerve in 12 (32\%), other cranial nerves in 20 (54\%), brain parenchyma in 12 (32\%) and spinal cord or nerve roots in 4 (11\%). Twenty-seven/28 immunocompetent patients{\textquoteright} MRIs were available for review (96\%). Of the 27, 18 had T1 postcontrast fat saturated sequences without motion artifact to evaluate for cranial nerve enhancement and optic perineuritis (OPN). Eight/18 (44\%) demonstrated OPN. All 8 experienced vision loss: 3 optic neuritis, 1 acute retinal necrosis, and 3 CNS vasculitis with 1 central and 1 branch retinal artery occlusion and 1 uveitis. Diplopic patients had cranial nerve and cavernous sinus enhancement. All immunosuppressed patients were imaged. Seven/9 (88\%) had extensive neuraxis involvement, including encephalitis, vasculitis and transverse myelitis; one case had OPN. CONCLUSION: OPN is a frequent manifestation in VZV-associated vision loss among immunocompetent patients. Immunosuppressed patients had greater neuraxis involvement. Optimizing MRI protocols may improve early diagnosis in VZV reactivation.},
	keywords = {Aged, Central Nervous System, Encephalitis, Encephalitis, Varicella Zoster, Female, Herpes Zoster, Herpesvirus 3, Human, Humans, Male, Polymerase Chain Reaction, Retrospective Studies},
	issn = {1878-5883},
	doi = {10.1016/j.jns.2022.120262},
	author = {Maher, Mary D and Douglas, Vivian Paraskevi and Douglas, Konstantinos Aa and Collens, Sarah I and Gilbert, Aubrey L and Torun, Nurhan and Klein, Joshua P and Sobrin, Lucia and Buchbinder, Bradley R and Rajiv Gupta and Mukerji, Shibani S and Chwalisz, Bart K}
}
