CEREBELITIS POST VARICELA PDF

Acute cerebellitis AC is the most common neurological complication of varicella. Nevertheless, it has been scarcely studied. The objective of this study were to asses the occurrence of AC among children hospitalized for varicella and to analyze its specific clinical picture and outcome. We retrospectively reviewed the medical records of children admitted to the hospital for varicella between 1 st October and 1 st June and we compared our results with literature. Children were all unvaccinated for varicella.

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The varicella zoster virus VZV is a neurotropic virus that becomes latent in the sensory ganglia, but later causes various neurologic complications such as meningitis, encephalitis, myelitis, meningoencephalitis, cranial neuropathy, and peripheral neuropathy [ 1 ]. While acute cerebellitis is one of the most frequent acute cerebellar diseases associated with VZV in childhood, VZV rarely causes cerebellitis in adults, with or without skin manifestations, and only a few isolated cases of adult VZV cerebellitis have been reported.

We report a case of acute cerebellitis associated with VZV infection after a herpetic rash in an year-old male. Functional imaging of his cerebellum showed high blood perfusion during the acute stage of the disease, though perfusion decreased in the subacute stage.

An year-old man who complained of a rash in his left occipital area around the neck also had cervicodynia. He had a mild left deviation when walking beginning on June 1, day 1. He visited a dermatology clinic on June 14 and was prescribed valacyclovir. He visited our hospital on day 23 and was admitted on the same day due to neuralgic pain from the left side of the back of the head and neck.

Neurological examination upon admission revealed alert consciousness, no herpetic skin rash, no meningeal irritation signs, mild truncal ataxia, inability to walk with tandem gait, slight limb ataxia and nystagmus, and no slurred speech. Laboratory findings revealed normal cell blood counts and biochemical results, with the exception of renal dysfunction creatinine, 1. Brain magnetic resonance imaging MRI revealed age-matched brain atrophy and no Gd enhancement of T1-weighted images on day The patient's balance disorder and cervicodynia began improving three days after the first CSF tap day There was gradual improvement of the trunacal ataxia.

We calculated the ratio between the cerebellar and thalamic domains. The ratio was 1. We believed that the hyperperfusion of the cerebellum may be correlated with cerebellar inflammatory changes. We diagnosed the patient with acute cerebellitis. Here we report a case of adult acute cerebellitis alone as a complication post-VZV infection. Neurological examination revealed truncal ataxia after development of a skin rash at the left occipital area and neck. Though the herpetic exanthema healed, truncal ataxia developed without hearing loss.

Metastasis of primary cancer may have caused the cerebellitis. However, CSF cell cytology performed twice did not support the above conclusion and the administration of intravenous acyclovir was very effective.

There are only few reports of adult acute cerebellitis on functional imaging. Cerebellar ataxia is generally viewed as a partial sign co-existing with encephalitis and brainstem encephalitis due to VZV infection [ 1 ]. However, there are few reports of proven cerebellitis alone associated with VZV in adults confirmed by CSF viral examinations [ [2] , [3] , [4] , [5] , [6] ], none of which have been accompanied by a rash.

Other herpetic neurological complications such as encephalitis, meningitis, optic neuritis, cranial neuropathy, myelitis, and vasculopathy have been reported in several adult cases [ 7 ]. There are two types of adult acute cerebellitis associated with VZV infection: with and without skin rash.

When the appearance of skin lesions due to VZV is inhibited by immunomodulation of the host in spite of reactivation of VZV, herpetic skin rash may not occur [ 8 ].

The patient in this case had a skin rash. The pathophysiology of VZV encephalitis or meningitis differs between patients with and without skin rash [ 1 ]. In patients with skin rash due to prior replication of the virus, large amounts of virus cause encephalitis with a short latency period through axonal transport or via the bloodstream.

In patients without skin rash, it is thought that the virus is reactivated within spinal sensory ganglia and spreads to the central nervous system centrifugally through axonal transport. In such cases, the viral load should be low and there would be a long latency period. Although it was thought that large numbers of virus had replicated through axonal transport in our patient due to the presence of the skin lesion, we believe that selective inflammation in the central nervous system is extremely rare.

Acute cerebellitis as determined using neuroimaging in children and adults has been reported, although they are controversial. T2-weighted MRI and fluid-attenuated inversion recovery have revealed hyperintensity in the cerebellar gray matter [ 9 ], and hyperintensity as determined using T2-weighted sequences has been reported in the pons [ 10 ].

However, in the above studies, no functional imaging was performed. Our patient had hyperperfusion in the cerebellum, as determined using brain SPECT, which we believe was due to inflammation based on our CSF study results. In conclusion, we report a case of acute cerebellitis associated with VZV infection in an adult confirmed using laboratory examination with high cerebellar perfusion at the acute stage. Adult patients with cerebellar ataxia purely due to VZV infection with rash are extremely rare.

We have no disclosures to report. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. National Center for Biotechnology Information , U. Journal List eNeurologicalSci v. Published online Apr Author information Article notes Copyright and License information Disclaimer.

Hirofumi Matsuyama: pj. Received Apr 4; Accepted Apr Abstract The varicella zoster virus VZV is a neurotropic virus that becomes latent in the sensory ganglia, but later causes various neurologic complications such as meningitis, encephalitis, myelitis, meningoencephalitis, cranial neuropathy, and peripheral neuropathy [ 1 ].

Dear Editor, An year-old man who complained of a rash in his left occipital area around the neck also had cervicodynia. Open in a separate window. Authors' disclosures We have no disclosures to report. References 1. Infections of the nervous system caused by varicella-zoster virus: a review. Suzuki Y.

Case of acutecerebellitis as a result of varicella zoster virus infection without skin manifestations. Geriatr Gerontol Int.

Ratzka P. Varicella zoster virus cerebellitis in a year-old patient without herpes zoster. Moses H. Lancet Neurol. Shilo S. Varicella zoster virus Cerebellitis without a rash in an immunocompetent year-old patient. Lubomski M. Gilden D. Review: the neurobiology of varicella zoster virusinfection. Varicella-zoster virus reactivation without rash. Montenegro M. Neuroimaging of acute Cerebellitis. Calabria F. Articles from eNeurologicalSci are provided here courtesy of Elsevier.

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Acute cerebellitis in varicella: a ten year case series and systematic review of the literature

La varicela puede tener complicaciones, pero no son comunes en personas sanas que contraen la enfermedad. Las personas que pueden contraer un caso grave de varicela y que pueden tener mayor riesgo de complicaciones incluyen las siguientes:. Algunas personas con complicaciones graves por la varicela pueden estar tan enfermas que tengan que ser hospitalizadas. Muchos de los adultos sanos que murieron por varicela contrajeron la enfermedad de sus hijos que no estaban vacunados. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation.

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Acute cerebellitis and acute cerebellar ataxia represent a spectrum of inflammatory processes characterized by sudden onset cerebellar dysfunction. It usually affects children and is related as a consequence of primary or secondary infection, or much less commonly as a result of a post-vaccination reaction. The terms acute cerebellitis and acute cerebellar ataxia are sometimes used interchangeably, as in this article, but they are considered separate by some authors 9. Acute cerebellar ataxia is a clinical diagnosis that can be made without imaging evidence of cerebellar inflammation. Acute cerebellitis may be considered a less common and more severe form of acute cerebellar ataxia 9, Usually occurring in children under six years of age, acute cerebellar ataxia and acute cerebellitis represent the most common cause of acute ataxia in the pediatric population.

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A case of cerebellar ataxia associated with VZV infection

Background: The neurological complications occur in 0. There is no universal vaccination against chicken pox in India. Most patients prefer alternate modalities of treatment. Hence these complications of chickenpox are likely to continue to occur. Study Design: A prospective study was conducted for 2 years from March on the admitted cases with neurological complications after chickenpox with rash or scar.

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The varicella zoster virus VZV is a neurotropic virus that becomes latent in the sensory ganglia, but later causes various neurologic complications such as meningitis, encephalitis, myelitis, meningoencephalitis, cranial neuropathy, and peripheral neuropathy [ 1 ]. While acute cerebellitis is one of the most frequent acute cerebellar diseases associated with VZV in childhood, VZV rarely causes cerebellitis in adults, with or without skin manifestations, and only a few isolated cases of adult VZV cerebellitis have been reported. We report a case of acute cerebellitis associated with VZV infection after a herpetic rash in an year-old male. Functional imaging of his cerebellum showed high blood perfusion during the acute stage of the disease, though perfusion decreased in the subacute stage. An year-old man who complained of a rash in his left occipital area around the neck also had cervicodynia. He had a mild left deviation when walking beginning on June 1, day 1.

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