Neurologic complications of varicella-zoster virus infection still occur

Abstract

Investigators from the Hospital for Sick Children in Toronto collected a series of 84 children 1-18 years of age with central nervous system (CNS) complications associated with varicella-zoster virus (VZV) infection between 1999 and 2012. Cases occurred after recommendation by Canada's National Advisory Committee on Immunization for use of VZV vaccine in children 1 year of age and older in 1999, and public funding for universal vaccination in 2004. Only four of 84 patients had a history of VZV immunization. The series serves as an excellent modern compendium of the variety of neurologic syndromes occurring around the time of VZV rash onset (median 5 days, range 6 days before onset to 42 days after onset, and occasionally in absence of rash): cerebellar ataxia, encephalitis, isolated seizures, meningitis, Guillain-Barré syndrome, acute disseminated encephalomyelitis, and Ramsay Hunt syndrome. Additionally, an under-appreciated complication, stroke, occurred in 10 patients at a median 16 weeks (range 2-26 weeks) after rash onset; typical neuroimaging findings were focal ischemia or infarction, with angiographic evidence of characteristic vasculopathy (ie, narrowing or beading in cerebral arteries). Three important reminders from this study, which hopefully would be the last series possible in the era of widespread availability of VZV vaccine, are: (1) neurologic complications of VZV often are severe and continue to occur, not because of ineffective vaccine, but because of its suboptimal uptake; (2) vaccination of the majority of children has lessened circulation of VZV but has not eliminated exposure; and (3) the role of VZV should be considered for many neurologic conditions, especially in unimmunized individuals and even in the absence of a history of rash. Article page 779▶ Central Nervous System Complications of Varicella-Zoster VirusThe Journal of PediatricsVol. 165Issue 4PreviewTo describe the spectrum of central nervous system complications of varicella-zoster virus (VZV) in children admitted to The Hospital for Sick Children between January 1999 and December 2012. Full-Text PDF