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NEUROLOGY 1994;44:1818
© 1994 American Academy of Neurology

Varicella-zoster virus myelitis

An expanding spectrum

D. H. Gilden, MD, B. R. Beinlich, MD, E. M. Rubinstien, MD, E. Stommel, MD, R. Swenson, MD, D. Rubinstein, MD and R. Mahalingam, PhD

Departments of Neurology (Drs. Gilden and Mahalingam), Microbiology (Dr. Gilden), and Radiology (Dr. Rubinstein), University of Colorado School of Medicine, Denver, CO; Department of Neurology (Dr. Beinlich), University of Wisconsin School of Medicine, Madison, WI; Department of Medicine (Dr. Rubinstien), University of Connecticut School of Medicine, Hartford, CT; and Section of Neurology (Drs. Stommel and Swenson), Dartmouth-Hitchcock Medical Center, Lebanon, NH.

We report four cases of varicella-zoster virus (VZV)-associated myelopathy in adults. Myelopathy was remitting-exacerbating in two remarkable instances, once acute and once chronic. VZV myelopathy was diagnosed based on the close temporal relationship between rash and onset of myelopathy, and for the first time, by polymerase chain reaction, which revealed VZV DNA in the cerebral spinal fluid of three patients with pleocytosis weeks to months later. Magnetic resonance imaging was abnormal in three of four patients. Although all four patients were treated at some time with intravenous acyclovir, concomitant treatment with steroids and the presence of acquired immunodeficiency syndrome in one patient prevented conclusions about a favorable response to therapy. Myelopathy after VZV infection may be remitting-exacerbating in addition to acute or chronic. Detection of VZV DNA in cerebral spinal fluid months after rash was useful for diagnosis and suggests a role for virus in the pathogenesis of myelopathy.

Address correspondence and reprint requests to Dr. Donald H. Gilden, Department of Neurology, Box B-182, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Denver, CO 80262.

Supported in part by grants NS32623 and AG06127 from the National Institutes of Health.

Received February 9, 1994. Accepted in final form April 13, 1994.




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