%0 Journal Article %J J Neurol Sci %D 2022 %T Clinical and neuroradiologic characteristics in varicella zoster virus reactivation with central nervous system involvement %A Maher, Mary D %A Douglas, Vivian Paraskevi %A Douglas, Konstantinos Aa %A Collens, Sarah I %A Gilbert, Aubrey L %A Torun, Nurhan %A Klein, Joshua P %A Sobrin, Lucia %A Buchbinder, Bradley R %A Rajiv Gupta %A Mukerji, Shibani S %A Chwalisz, Bart K %K Aged %K Central Nervous System %K Encephalitis %K Encephalitis, Varicella Zoster %K Female %K Herpes Zoster %K Herpesvirus 3, Human %K Humans %K Male %K Polymerase Chain Reaction %K Retrospective Studies %X 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 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' 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. %B J Neurol Sci %V 437 %P 120262 %8 2022 Jun 15 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/35489173?dopt=Abstract %R 10.1016/j.jns.2022.120262