HERPES-ZOSTER MYELITIS
HERPES-ZOSTER MYELITIS
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DOI：
10.1093/brain/114.3.1181
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发表时间：
1991-06-01
期刊：
影响因子：
14.5
通讯作者：
PRICE, RW
中科院分区：
文献类型：
--
作者：
DEVINSKY, O;CHO, ES;PRICE, RW
我们研究了13例带状疱疹脊髓炎的临床(10例)和病理(9例)结果，所有患者都有与免疫抑制相关的全身性疾病。带状疱疹皮疹和骨髓病症状之间的中位间隔为12天，随后达到最大缺陷的中位间隔为10.5天。主要表现为皮疹同侧的神经系统症状，主要表现为运动功能障碍，其次是脊髓丘脑，较少出现后柱感觉障碍。受累皮肤节对应的脊髓节段的背根入口区和后角病变最为严重。脊髓在水平和垂直方向上均有不同程度的扩散。免疫组织化学染色证实水痘-带状疱疹病毒(VZV)直接感染神经外胚层细胞，尤其是少突胶质细胞(8例)和Cowry A型核内包涵体(7例)，常伴有局限性脱髓鞘(6例)。4例VZV血管炎合并软脑膜炎和出血性坏死(脊髓1例，脑干或小脑3例)。许多病例的长期演变和病理记录的脊髓直接病毒感染为使用抗病毒治疗预防或减轻演变中的脊髓病提供了合理的基础。
We studied the clinical (10 patients) and pathological (9 patients) findings in 13 patients with herpes zoster myelitis, all of whom had systemic illnesses associated with immunosuppression. The median interval between the onset of the herpes zoster rash and myelopathic symptoms was 12 days, and the subsequent median interval to maximal deficit was 10.5 days. Presenting neurological symptoms were characteristically ipsilateral to the rash, with motor dysfunction predominating, followed by a spinothalamic and, less often, posterior column sensory deficit. Pathological involvement was most severe in the dorsal root entry zone and posterior horn of the spinal cord segment corresponding to the involved dermatome. There was variable spread both horizontally and vertically in the spinal cord. Direct varicella-zoster virus (VZV) infection of neuroectodermal cells, particularly oligodendrocytes, was demonstrated by immunostaining viral antigens (8 cases), and by the presence of Cowdry type A intranuclear inclusions (7 cases) and often was associated with focal demyelination (6 cases). In 4 patients a VZV vasculitis was associated with leptomeningitis and haemorrhagic necrosis (spinal cord in 1; brainstem or cerebellum in 3). The protracted evolution in many cases and the pathologically documented direct viral infection of the spinal cord provide a rational basis for the use of antiviral therapy in preventing or attenuating the evolving myelopathy.