A Clinical Study on Herpes Zoster Meningoencephalitis

Byun, Ji Won; Song, Hee Jin; Choi, Gwang Seong; Shin, Jeong Hyun

Abstract

BACKGROUND
Herpes zoster meningoencephalitis is a rare neurological complication and the known risk factors include an immunocompromised status, infiltration into the trigeminal ganglion, disseminated herpes zoster and elderly patients. Serious complications may develop, including cerebral hemorrhage.
OBJECTIVE
As early diagnostic detection is mandatory to prevent long-term sequelae, we wanted to determine what signs and symptoms we should focus on for diagnosing zoster meningoencephalitis at an early stage. We also investigated the descriptive statistics of the patients and compared them with the patients who had non-complicated herpes zoster.
METHODS
We examined the medical records of 5114 herpes zoster patients who had visited our clinic from 1996 through 2009. Among them, 18 patients who were diagnosed with herpes zoster meningoencephalitis by cerebrospinal fluid tests were subject to examinations to assess the incidence rates, the age distribution, the ganglion distribution, the clinical aspects, the underlying diseases and the presence of complications.
RESULTS
The ages of the patients with herpes zoster meningoencephalitis showed that 50% of the patients were under 30 years old. Infiltration into the trigeminal ganglion and immunocompromising underlying diseases accounted for 50% and 16.7% of the total patients, respectively. In the case of disseminated herpes zoster patients, no meningoencephalitis developed. The rates of neck stiffness and fever, which are the most common symptoms of meningoencephalitis, were lower in the patients with herpes zoster meningoencephalitis (33.3% and 11.1%, respectively). However, headaches accompanied with nausea or vomiting showed high sensitivity (88.9%), and a high positive predictive value (69.6%) (p<0.001). All the patients were treated with acyclovir for 10~14 days, and cerebral hemorrhage occurred in 1 of them (5.5%) after treatment.
CONCLUSION
When a patient with herpes zoster has symptoms of headache and nausea or vomiting then herpes zoster meningoencephalitis should be considered even if neck stiffness and fever are not present.