Neurological effects of herpes zoster virus underscore need for vaccination

This review article describes recent advances in the diagnosis, treatment and prevention of herpes zoster (HZ), as well as neurological and ophthalmological complications of infection.

Study design

The authors searched PubMed and Google scholar for published studies relevant to the management and complications of HZ.

Outcomes

Based on this review, the authors recommend that antiviral treatment be initiated within 48 to 72 hours of HZ or herpes zoster ophthalmicus (HZO) onset to decrease pain and reduce complications. Furthermore, they recommend neuroimaging in all patients with neuro-ophthalmic manifestations such as diplopia and acute vision loss. Diagnostic confirmation using polymerase chain reaction and serology on paired serum and cerebrospinal fluid samples should be obtained in patients with neurological signs and symptoms or abnormal imaging.

Neurological or retinal manifestations of varicella zoster virus (VZV) infection warrant immediate treatment with intravenous acyclovir, whereas oral antivirals are appropriate for isolated optic neuropathy or cranial nerve palsy. Patients with isolated optic neuropathy have a good prognosis for visual recovery, while isolated ocular motor cranial nerve palsy carries an excellent prognosis.

Limitations

This is a review article and the conclusions are limited by the available literature.

Clinical significance

Complications of HZ can adversely affect quality of life and increase health care costs. The findings underscore the importance of vaccination in elderly and immunocompromised patients.