|Year : 1965 | Volume
| Issue : 2 | Page : 73-74
Meningo-encephalitis and herpes zoster-varicella
E. N. T. Dept. Sir Jamshedji Jeejeebhoy Hospital, Bombay, India
|Date of Web Publication||21-Feb-2008|
E. N. T. Dept. Sir Jamshedji Jeejeebhoy Hospital, Bombay
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kerawala S. Meningo-encephalitis and herpes zoster-varicella. Indian J Ophthalmol 1965;13:73-4
Since Von Bokay of Budapest suggested the probable relation of Herpes Zoster and a Varicella-like generalised skin eruption over half a century ago, there have been innumerable reports in the literature discussing the various implications.
It was considered worthwhile to submit this case report particularly because of the rare finding of clinically evident meningo-encephalitis with herpes zoster which is rare - Brian (1931, 1962).
Only 17 cases have been reported in the literature in the English language [Martin and others (1962)]. Clinical findings in our patient appear to fit into a set pattern as have been reported in the other 17 cases.
| Case Report|| |
G. D. aged 68 had developed a culopapular eruption interspersed by maculopapular eruption interspersed by vesicles on the right auricle and enternal canal of the ear and in the distribution of the ophthalmic division of the right trigeminal nerve for ten days, when his doctor first noticed a generalised varicella-like eruption. There was no history of contact with Herpes Zoster or chickenpox. He showed signs of listlessness and apathy. There was a gradually deepening drowsiness and a rise of temperature for the next 8 hours. He had three generalised convulsion in rapid succession. On hospitalization he was found deeply comatosed with a stertorous respiration and neck rigidity. His temperature was 102°F.
His ankle and knee jerks were absent as were his plantar and flexor reflexes. There was no facial palsy. He regained consciousness within the next 8 hours without any loss of motor power or any residual sensory disturbances. His CSF. showed increased pressure, and was slightly turbid with a white cell count of 1500.
Examination of C.S.F. showed :
Protein 800 mg %.
Globulins in excess.
Chlorides 640 mg %.
Sugar 95 mg %.
No organisms on microscopy.
No growth on culture.
He had no personality changes, nor difficulty in speaking. However he was left with a right ptosis and a total ophthalmoplegia. His hearing on discharge was clinically normal.
| Discussion|| |
Meningo-Encelphalitis seems to occur most often in middle aged and elderly patients and invariably the patient is a male. The time of occurrence of encephalopathy is from 1 to 6 weeks after the onset of skin lesions.
CSF. changes are found in approximately 50% of zoster cases reported in the literature. These changes may persist for several weeks but very few develop manifest clinical signs of encephalitis: such as, altered state of consciousness, personality changes, speech difficulties and paresis. [Brown, W. H. (1919), Denny Brown and others (1944)].
As in many conditions caused by neurotropic or allied viruses a Meningo-Encephalitis of a variable degree, perhaps subclinical in most cases, invariably occurs. It is possible that minimal cerebral symptoms do occur which may not be noticed. In fact Welbaum E. and others (1962)
discussed their series of the Herpes Zoster cases under the heading "Herpes Zoster Encephalitis". They noticed clinical evidence of Meningeal irritation, delirium and psychoses, cranial nerve involvement, lid ptosis and facial palsy, hemiparesis and paraesthesia. They had no patients with coma or convulsions.
The majority of patients who develop clinical signs of encephalitis have Herpes Zoster involving the Ophthalmic division of the Trigeminal Nerve as compared to the other Nerve distributions of the Head and Neck. [Cope and Jones (1954) Krumshots and Lukon (1959)].
In the pathogenesis of the Encelphalitis it has been suggested that the hippocampal area can be affected by local spread of viruses from the corneal lesions, Fields and Blather, (1958).
It is generally believed that the encephalitis is transient and carries no mortality but this does not appear to be so since a fatal outcome has been reported in four cases. Thalmer (1924), Schiff & Brain (1930).
| Summary|| |
A case of Herpes Zoster Ophthalmicus et oticus in coma is described. Evidence of Meningoencephalitis is rare in a case of herpes zoster. When found in the region of the head and neck, the herpes zoster is invariably found in the distribution of the ophthalmic division of the Trigeminal Nerve although the patient had in addition vesicles on the auricle and in the external canal of the ear on the same side. Of the 17 cases with manifest meningoencephalitis reported, 4 proved fatal contrary to the general belief.
| Acknowledgement|| |
T am indebted to Dr. A. G. Emslie under whose care this patient was treated, for his encouragement and advice in the preparation of this case report.
| References|| |
Appelbaum. E., Krepps, S. I., Sunshine, A. (1961). Amer. J. of Med. 32: 25-31.
Brain, W. R. (1931), B. M. J. 1: 81.
Brain, W. R. (1962), Disease of the Nervous System. London. p. 428.
Cope, S., Jones, A. T. (1954), Lancet ii. 898.
Denny Brown, D., Adams, R. D., Fitzerald, P. J. (1944). Arch. Neurol and Psychiat. 51: 216.
Fields, W. S., and Blattner, R. J. (1958). Symposium on Convulsive Disorder. p. 313-6.
Ludsky, M. D., Kiass, D. W., McKenzie, B. F., and OLDSTEIN, N. P. (1962), Ann. of Int. Med. 56: 779.
Madonick, M. J., (1946) Ibid. 56: 4.34.
Martin, D., Ludsky, M. D., Donald, W., Klass, B. F. (1962). Ann. of Int. Med. 56: 779-84.
Schiff, C. L., Brain, W. R. (1930), Lancet 2: 70.
Thalimer, W. (1924). Arch. Neurol. Psychiat. 12: 73.
Von Bokay (1909). Wien. Klin. Wochnschr. 22: 1323.