title: Neurological complications of varicella zoster virus reactivation.
abstract: OBJECTIVE
  Varicella zoster virus (VZV) reactivation results in zoster, which may be complicated by postherpetic neuralgia, myelitis, meningoencephalitis, and VZV vasculopathy. This review highlights the clinical features, laboratory abnormalities, imaging changes, and optimal treatment of each of those conditions. Because all of these neurological disorders produced by VZV reactivation can occur in the absence of rash, the virological tests proving that VZV caused disease are discussed.
  
  
  RESULTS
  After primary infection, VZV becomes latent in ganglionic neurons along the entire neuraxis. With a decline in VZV-specific cell-mediated immunity, VZV reactivates from ganglia and travels anterograde to the skin to cause zoster, which is often complicated by postherpetic neuralgia. VZV can also travel retrograde to produce meningoencephalitis, myelitis, and stroke. When these complications occur without rash, VZV-induced disease can be diagnosed by detection of VZV DNA or anti-VZV antibody in cerebrospinal fluid and treated with intravenous acyclovir.
  
  
  CONCLUSIONS
  Awareness of the expanding spectrum of neurological complications caused by VZV reactivation with and without rash will improve diagnosis and treatment.
authors.affiliation: aDepartment of Neurology bDepartment of Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Nagel
authors.forename: Don
authors.initials: D
authors.lastname: Gilden
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000134:cerebrospinal fluid; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D020804:Encephalitis, Varicella Zoster / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006562:Herpes Zoster / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014645:Herpesvirus 3, Human; D006801:Humans; D009187:Myelitis / Q000188:drug therapy / Q000209:etiology; D051474:Neuralgia, Postherpetic / Q000209:etiology; D014652:Vascular Diseases / Q000209:etiology; D017735:Virus Latency
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir