CSF and MRI findings in patients with acute herpes zoster
CSF and MRI findings in patients with acute herpes zoster
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DOI：
10.1212/wnl.51.5.1405
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发表时间：
1998-11-01
期刊：
影响因子：
9.9
通讯作者：
Nurmikko, T
中科院分区：
文献类型：
--
作者：
Haanpää, M;Dastidar, P;Nurmikko, T
目的：探讨疱疹试验（HZ）患者的MRI及脑脊液表现，并探讨其与临床表现的关系。方法：50例免疫功能正常、HZ持续时间小于18天的患者（平均年龄59岁，范围17 ~ 84岁）参与研究。没有人有脑膜刺激、脑炎或脊髓炎的临床症状。42例（84%）患者的症状仅为疼痛和皮疹。6例（12%）患者有运动轻瘫，3例（6%）患者有眼部并发症。从46例患者中获得1 - 3份脑脊液样本（第一次取样于皮疹发病后1 - 18天），并对16例患者（均为三叉神经或颈椎HZ）进行脑MRI检查。临床随访至少3个月。结果：脑脊液异常28/46例（61%），细胞增多21例（范围5 ~ 1440 μ L），蛋白浓度升高12例，水痘病毒（VZV） DNA 10例，VZV免疫球蛋白G抗体10例。这些变化在急性并发症患者中更为常见，尽管它们不能预测带状疱疹后神经痛（PHN）的发展。在9/16（56%）的患者中，脑干和颈髓可见HZ的MRI病变。3个月时，9例MRI异常患者中有5例（56%）出现PHN，而7例MRI上没有hz相关病变的患者中没有任何疼痛。结论：病毒性炎症亚临床扩展到中枢神经系统常见于HZ。这一发现可能对KZ的治疗和各种相关并发症的预防具有启示意义。
Objective: To explore MRI and CSF findings in patients with herpes tester (HZ) and to correlate the findings with clinical manifestations of the disease. Methods: Fifty immunocompetent patients (mean age, 59 years; range, 17 to 84 years) with HZ of fewer than 18 days duration participated. None had clinical signs of meningeal irritation, encephalitis, or myelitis. In 42 patients (84%), the symptoms constituted pain and 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) underwent 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 concentration in 12, varicella tester virus (VZV) DNA in 10, and immunoglobulin G antibody to VZV in 10. These changes were more common in patients with acute complications, although they did not predict development of postherpetic neuralgia (PHN). In 9/16 patients (56%), MRI lesions attributable to HZ were seen in the brainstem and cervical cord. At 3 months, 5/9 patients (56%) with abnormal MRI had PHN, whereas none of the 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 treatment of KZ and prevention of various associated complications.