Elsevier

The Lancet

Volume 367, Issue 9505, 14–20 January 2006, Page 182
The Lancet

Case Report
Varicella zoster virus cerebellitis in a 66-year-old patient without herpes zoster

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    The CNS manifestations caused by VZV can occur as a result of both primary and reactivated disease. Cerebellitis, for example, is primarily associated with childhood varicella, but rarely can also be seen in association with herpes zoster.8 Up to a third to half of patients with herpes zoster-associated CNS manifestations are reported without rash.1–4

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    The cerebellar and brainstem symptoms can postdate vesicular eruptions by several weeks and can develop while patients are receiving antiviral therapy.21 Pure cerebellitis is uncommon but has been reported in immunocompetent adults.22,23 All VZV syndromes can occur without a herpetic rash.

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    Many reported cases of VZV encephalitis may actually be VZV vasculopathy (Gilden, 2002). Recent reports of VZV meningitis (Habib et al., 2009; Klein et al., 2010), meningoradiculitis (Gunson et al., 2011), and cerebellitis (gait ataxia and tremor predominated) (Moses et al., 2006; Ratzka et al., 2006), all in the absence of rash and confirmed by the detection of VZV DNA and anti-VZV antibody in cerebrospinal fluid (CSF), revealed that VZV is not an uncommon cause of aseptic meningitis. Another serious complication of VZV reactivation is VZV infection of human cerebral arteries (VZV vasculopathy) which causes both ischemic and hemorrhagic stroke.

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