Nervous system complications of varicella-zoster virus infections: A tertiary center experience

Abstract

Objective: Our aim was to describe the spectrum of central nervous system complications of varicella-zoster virus (VZV) infection in a cohort of children admitted to a tertiary pediatric hospital. Methods: Children younger than 18 years-of-age admitted with neurological signs associated with characteristic rash or a positive serum IgM test were included in the study (n = 28). Study population included stroke patients within 6 months of VZV infection without any other identified etiology. Results: We assessed 28 children with neurological complications due to VZV infection. Median age at presentation was 61 (8-206) months. Median admission period was 7 (1-27) days. Median period of rash before admission and neurological signs were 7 (0-45) days, and 5 (0-43) days respectively. Nausea and vomiting were the initial symptoms for 15/28 patients (%53.5), and the number of vomits ranged between 0-20 (median=1). None of our patients had a previous neurological diagnosis, and had normal development except for 2 patients. At admission 15/28 children had cerebellar signs and 5/28 had encephalopathy. Twenty children had neuroimaging studies (14 had MRI, 5 had CT, one had both). Only 6 of the imaging tests showed abnormal signs, one being an infarct of right middle cerebral artery. Treatment strategies involved no medication (n= 6), only acyclovir (n= 13), only antibiotics (n= 1), and both acyclovir and antibiotics (n= 8). At the time of discharge nearly all patients showed an improvement with 18/28 being totally recovered. Conclusion: Neurological manifestations are a rare but a major concern for VZV infections. In our study most common neurological manifestation was cerebellar ataxia. We would like to note that nausea and vomiting may precede neurological symptoms as in the case of %53.5 of our cohort.