Varicella-Zoster Virus Infections.
Varicella-Zoster Virus Infections.
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DOI：
10.1212/con.0000000000000246
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发表时间：
2015-12-01
期刊：
影响因子：
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通讯作者：
Gilden, Don
中科院分区：
文献类型：
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作者：
Gilden, Don
综述目的：本文描述了水痘带状疱疹病毒（VZV）再激活引起的多变的神经系统疾病的临床特征以及实验室和影像学异常。疾病不仅包括带状疱疹，还包括慢性疼痛（带状疱疹后神经痛）、脑膜脑炎和小脑炎、单个或多个颅神经麻痹（颅神经炎）、脊髓病（脊髓炎和脊髓梗塞）以及导致缺血或出血的脑内和脑外动脉的 VZV 血管病 中风、动脉瘤、蛛网膜下腔和脑出血、动脉扩张和夹层。本文讨论了在没有皮疹的情况下神经系统水痘带状疱疹病毒感染的准确诊断以及最佳治疗。最新发现：所有由水痘带状疱疹病毒引起的神经系统疾病都可能在没有皮疹的情况下发生。通过脑脊液中存在 VZV DNA 或抗 VZV 抗体即可确诊。根据最近研究的证据，VZV 被认为是巨细胞动脉炎的一个原因。总结：临床医生必须意识到，VZV 重新激活会导致中枢神经系统 (CNS) 和周围神经系统的多种疾病，通常不会出现皮疹。快速病毒学验证和及时使用抗病毒药物治疗可以使患者完全康复，即使是病情迁延的患者也是如此。
PURPOSE OF REVIEW: This article describes the clinical features and laboratory and imaging abnormalities of the protean neurologic disorders produced by varicella-zoster virus (VZV) reactivation. Diseases include not only zoster, but also chronic pain (postherpetic neuralgia), meningoencephalitis and cerebellitis, single or multiple cranial nerve palsies (polyneuritis cranialis), myelopathy (myelitis and spinal cord infarction), and VZV vasculopathy of intracerebral and extracerebral arteries that causes ischemic or hemorrhagic stroke, aneurysm, subarachnoid and intracerebral hemorrhage, arterial ectasia, and dissection. The article addresses accurate diagnosis of VZV infection of the nervous system in the absence of rash, and optimal treatment.RECENT FINDINGS: All neurologic disorders produced by VZV can occur in the absence of rash. Diagnosis is confirmed by the presence of VZV DNA or anti-VZV antibodies in CSF. Based on evidence from recent studies, VZV has been implicated as a cause of giant cell arteritis.SUMMARY: Clinicians must be aware that VZV reactivation produces multiple disorders of the central nervous system (CNS) and peripheral nervous system, often without rash. Rapid virologic verification and prompt treatment with antiviral agents can lead to complete recovery, even in patients with protracted disease.