Neurological and Ophthalmological Manifestations of Varicella Zoster Virus

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Title Neurological and Ophthalmological Manifestations of Varicella Zoster Virus
Creator Sachin Kedar; Lakshman N. Jayagopal; Joseph R. Berger
Affiliation Department of Neurological Sciences (SK, LNJ), University of Nebraska Medical Center, Omaha, Nebraska; Stanley M Truhlsen Eye Institute (SK), University of Nebraska Medical Center, Omaha, Nebraska; and Department of Neurology (JRB), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Abstract Background: Approximately 1 million new cases of herpes zoster (HZ) occur in the United States annually, including 10%-20% with herpes zoster ophthalmicus (HZO). Postherpetic neuralgia, a debilitating pain syndrome occurs in 30% HZ, whereas 50% HZO develop ophthalmic complications. Diplopia from cranial nerve palsy occurs in less than 30% HZO, whereas optic neuropathy is seen in less than 1% HZO. We reviewed recent developments in the diagnosis, treatment, and prevention of HZ as well as neurological and ophthalmological complications of relevance to the neuro-ophthalmologist. Evidence acquisition: We searched the English language literature on Pubmed and Google scholar for articles relevant to the various sections of this review. Results: Antiviral treatment should be initiated within 48-72 hours of onset of HZ and HZO to decrease pain and reduce complications. We recommend neuroimaging in all patients with neuro-ophthalmic manifestations such as diplopia and acute vision loss. Diagnostic confirmation using polymerase chain reaction and serology on paired serum and cerebrospinal fluid samples should be obtained in those with neurological signs and symptoms or abnormal imaging. Patients with neurological and/or retinal varicella zoster virus (VZV) infection should be treated promptly with intravenous acyclovir. Patients with isolated optic neuropathy or cranial nerve palsy can be managed with oral antivirals. The prognosis for visual recovery is good for patients with isolated optic neuropathy and excellent for patients with isolated ocular motor cranial nerve palsy. Conclusions: HZ produces a spectrum of potentially blinding and life-threatening complications that adversely affect quality of life and increase health care costs. Individuals at risk for HZ, such as the elderly and immunocompromised, should be encouraged to receive the highly effective VZV vaccine to prevent HZ and its complications.
Subject Antiviral Agents / therapeutic use; Herpes Zoster Ophthalmicus / diagnosis; Herpes Zoster Ophthalmicus / drug therapy; Humans; Immunocompromised Host; Nervous System Diseases / diagnosis; Nervous System Diseases / drug therapy; Polymerase Chain Reaction; Quality of Life; Serologic Tests
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Date 2019-06
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, June 2019, Volume 39, Issue 2
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6jh99n9
Setname ehsl_novel_jno
ID 1595800
Reference URL https://collections.lib.utah.edu/ark:/87278/s6jh99n9
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