CSF AND MRI FINDINGS IN PATIENTS WITH ACUTE HERPES-ZOSTER

Objective: To explore MRI and CSF findings in patients with herpes tes ter (HZ) and to correlate the findings with clinical manifestations of the disease. Methods: Fifty immunocompetent patients (mean age, 59 ye ars; range, 17 to 84 years) with HZ of fewer than 18 days duration par ticipated. None had clinical signs of meningeal irritation, encephalit is, or myelitis. In 42 patients (84%), the symptoms constituted pain a nd rash only. Six patients (12%) had motor paresis, and three patients (6%) had ocular complications. One to three CSF samples were obtained from 46 patients (the first sampling taken 1 to 18 days from onset of rash), and 16 patients (all with either trigeminal or cervical HZ) un derwent MRI of the brain. The clinical follow-up continued at least 3 months. Results: CSF was abnormal in 28/46 patients (61%): pleocytosis (range, 5 to 1,440 mu L) was detected in 21, elevated protein concent ration in 12, varicella tester virus (VZV) DNA in 10, and immunoglobul in G antibody to VZV in 10. These changes were more common in patients with acute complications, although they did not predict development o f postherpetic neuralgia (PHN). In 9/16 patients (56%), MRI lesions at tributable to HZ were seen in the brainstem and cervical cord. At 3 mo nths, 5/9 patients (56%) with abnormal MRI had PHN, whereas none of th e 7 patients with no HZ-related lesions on MRI had any remaining pain. Conclusions: Subclinical extension of viral inflammation into the CNS occurs commonly in HZ. This finding may have implications for treatme nt of KZ and prevention of various associated complications.