Cervical Herpes Zoster Research Articles

Ultrasound‐Guided Cervical Nerve Root Block for the Treatment of Acute Cervical Herpes Zoster: A Randomized Controlled Clinical Study

To evaluate the efficacy and safety of ultrasound-guided cervical nerve root block (CRB) on acute pain and its preventive effects on post-herpetic neuralgia (PHN) in patients with cervical herpes zoster (HZ). 140 recruited participants were randomized 1:1 to receive ultrasound-guided CRB with either mixed drug liquid (treatment group) or similar looking placebo (placebo group). All patients received a 7-day course of oral antiviral treatment, pregabalin, and analgesics as needed. The primary efficacy was assessed on the basis of HZ burden of illness (HZ-BOI) scores over 30days (BOI-30AUC ). Secondary outcomes included HZ-BOI scores through 30 to 90days (BOI-30-90AUC ) and 90 to 180days (BOI-90-180AUC ), quality of life (QoL) outcomes, concomitant analgesic consumption, and the incidence of PHN. Adverse events were recorded to evaluate safety. The BOI-30AUC values were 92.55 and 112.72 for the treatment and placebo groups, respectively (P<0.01). Both the BOI-30-90AUC and BOI-90-180AUC in the treatment group were lower than those in the placebo group (P<0.01). The incidence of PHN at 90days was significantly less than that at 180days in the treatment group (P=0.036). A better improvement in QoL was found in the treatment group (P<0.05). There was a greater decrease in analgesic use in the treatment group as compared to the placebo group (P<0.05). No serious adverse events were observed. Ultrasound-guided CRB represented an early intervention and preventive strategy to reduce the BOI due to acute HZ in the cervical dermatome region, and might be feasible to reduce the incidence of PHN.

Mumps, Cervical Zoster, and Facial Paralysis: Coincidence or Association?

The association of mumps with peripheral facial paralysis has been suggested, but its pathogenesis remains unclear. An 8-year-old girl simultaneously developed left peripheral facial paralysis, ipsilateral cervical herpes zoster, and bilateral mumps sialadenitis. Elevated anti-mumps and anti-varicella zoster virus IgM antibodies in serological testing indicated recent infection of mumps and reactivation of VZV. Molecular studies have provided mounting evidence that the mumps virus dysregulates the host's immune system and enables the virus to proliferate in the infected host cells. This dysregulation of the immune system by mumps virus may have occurred in our patient, enabling the latent VZV infection to reactivate.

Ramsay Hunt syndrome

Ramsay Hunt syndrome is defined as herpes zoster oticus associated with an acute peripheral facial nerve paresis and quite often with other cranial nerve lesions. The combination of motor, sensory and autonomic involvement leads to a variety of neurological damage patterns, i. e. facial muscle paresis, hearing and balance disorders, sensory problems and disturbances of taste as well as lacrimal and nasal secretion. Additional variability of the clinical picture of Ramsay Hunt syndrome is produced by varying patterns of skin involvement explained by individual anastomoses between cranial and cervical nerves. Knowledge of these findings and an early diagnosis of Ramsay Hunt syndrome are important as prognosis of cranial nerve damage depends on the time at which acyclovir-corticosteroid therapy is started.

An unusual cause of dyspnea in a patient with cervical herpes zoster

Motor involvement in acute herpes zoster does occur,but is rare. Most causes of zoster paresis are due to the extension of the inflammation to the anterior horn and/or anterior motor roots. We report a female patient with an unusual diaphragmatic paralysis caused by cervical herpes zoster. The lesion, diagnosed by MRI, involved the anterior horn of the cervical spinal cord.

Ramsay Hunt Syndrome: An Unusual Variant After Dental Infection

Ramsay Hunt Syndrome: An Unusual Variant After Dental Infection

CSF and MRI findings in patients with acute herpes zoster.

To explore MRI and CSF findings in patients with herpes zoster (HZ) and to correlate the findings with clinical manifestations of the disease. Fifty immunocompetent patients (mean age, 59 years; range, 17 to 84 years) with HZ of fewer than 18 days duration participated. None had clinical signs of meningeal irritation, encephalitis, or myelitis. In 42 patients (84%), the symptoms constituted pain and rash only. Six patients (12%) had motor paresis, and three patients (6%) had ocular complications. One to three CSF samples were obtained from 46 patients (the first sampling taken 1 to 18 days from onset of rash), and 16 patients (all with either trigeminal or cervical HZ) underwent MRI of the brain. The clinical follow-up continued at least 3 months. CSF was abnormal in 28/46 patients (61%): pleocytosis (range, 5 to 1,440 microL) was detected in 21, elevated protein concentration in 12, varicella zoster virus (VZV) DNA in 10, and immunoglobulin G antibody to VZV in 10. These changes were more common in patients with acute complications, although they did not predict development of postherpetic neuralgia (PHN). In 9/16 patients (56%), MRI lesions attributable to HZ were seen in the brainstem and cervical cord. At 3 months, 5/9 patients (56%) with abnormal MRI had PHN, whereas none of the 7 patients with no HZ-related lesions on MRI had any remaining pain. Subclinical extension of viral inflammation into the CNS occurs commonly in HZ. This finding may have implications for treatment of HZ and prevention of various associated complications.

Diaphragmatic Paralysis Following Cervical Herpes Zoster – A Rarely Recognized Association

An 83-year-old woman was found to have a paralyzed hemidiaphragm less than three weeks after developing cervical herpes zoster. The diaphragm was radiographically normal the day before the skin rash appeared. The relatively short time frame and lack of evidence to indicate other etiologies suggests herpes zoster as the likely cause of the paralysis. Diaphragmatic paralysis following cervical herpes zoster is probably underrecognized and the association between the two conditions can be easily missed, especially if the interval between their detection is long.

Otolaryngology problems in the immune compromised patient—An evolving natural history

As the human immunodeficiency virus is being detected in increasing numbers of asymptomatic individuals at risk, newer earlier patterns of disease have become apparent--including cranial and cervical herpes zoster, oral hairy leukoplakia, and oral candidiasis--thus linking viral and other disease to the development of acquired immunodeficiency disease (AIDS). Many similarities between patients with AIDS and other immunosuppressed patients have emerged. As immunosuppressed patients survive longer, they begin to manifest cancers such as lymphomas and squamous cell cancers in addition to Kaposi's sarcoma. Otolaryngologists can learn to identify and treat otitis and sinusitis in the immunosuppressed patient, to identify predictive early signs such as oral hairy leukoplakia, herpes simplex virus, and oral candidiasis, and to diagnose and treat Kaposi's sarcomas of the head and neck, lymphomas, squamous cell cancers, and opportunistic infections as the immunodeficiency disease progresses.

Cervical herpes zoster and delayed brainstem infarction

Varicella-zoster (VZ) virus is a rare cause of CNS angiitis, which commonly presents as herpes zoster ophthalmicus with contralateral hemiplegia due to hemispheric infarction. We report the first case of VZ-angiitis with infarction in the ventral pons, following cervical herpes zoster.

Cervical herpes zoster and diaphragmatic paralysis

Summary Four further cases of diaphragmatic paralysis due to cervical herpes zoster are added to the 11 cases previously reported. Though clearly an uncommon association circumstantial evidence suggests that zoster may be a commoner cause of lone diaphragmatic paralysis than is at present recognized, and evidence of previous or concomitant herpes should be sought in every case.