scholarly journals Varicella-Zoster-Mediated Radiculitis Reactivation following Cervical Spine Surgery: Case Report and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Doniel Drazin ◽  
George Hanna ◽  
Faris Shweikeh ◽  
Sunil Jeswani ◽  
Leah Lovely ◽  
...  
Keyword(s):  
Rare Complication ◽  
Cervical Spine Surgery ◽  
Varicella Zoster ◽  
Epidural Steroid Injections ◽  
Arm Pain ◽  
Neurotropic Viruses ◽  
Vesicular Rash ◽  
History Of ◽  
Simplex Virus ◽  
Epidural Steroid

Varicella-zoster virus and herpes simplex virus types 1 and 2 are neurotropic viruses that can be reactivated after a surgical or stressful intervention. Although such cases are uncommon, consequences can be debilitating, and variable treatment responses merit consideration. We describe a 41-year-old male with a history of varicella-mediated skin eruptions, who presented with continuing right arm pain, burning, and numbness in a C6 dermatomal distribution following a C5-6 anterior cervical discectomy and fusion and epidural steroid injections. The operative course was uncomplicated and he was discharged home on postoperative day 1. Approximately ten days after surgery, the patient presented to the emergency department complaining of severe pain in his right upper extremity and a vesicular rash from his elbow to his second digit. He was started on Acyclovir and discharged home. On outpatient follow-up, his rash had resolved though his pain continued. The patient was started on a neuromodulating agent for chronic pain. This case adds to the limited literature regarding this rare complication, brings attention to the symptoms for proper diagnosis and treatment, and emphasizes the importance of prompt antiviral therapy. We suggest adding a neuromodulating agent to prevent long-term sequelae and resolve acute symptoms.

Herpes zoster-encefalitis: een diagnostische uitdaging bij de geriatrische patiënt

2022 ◽  
Author(s):  
L. Carmans ◽  
C. Van Dessel
Keyword(s):  
Herpes Zoster ◽  
Rare Complication ◽  
Diagnostic Process ◽  
Herpes Encephalitis ◽  
Diagnostic Challenge ◽  
Varicella Zoster ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome ◽  
Prevalent Disease ◽  
Vesicular Rash

Herpes zoster encephalitis: a diagnostic challenge in a geriatric patient Reactivation of the varicella zoster virus (VZV) is a prevalent disease and is - in addition to the typical vesicular rash - responsible for rare neurological conditions. Older people form a major group of concern, given the increasing risk of VZV reactivation at a higher age together with a higher risk of complications. Herpes zoster encephalitis is a rare but serious complication which often presents atypically, delaying the diagnostic process. In this article, the medical history of a patient with herpes encephalitis without the typical clinical and biochemical signs of infection is presented. This patient also suffered from Ramsay Hunt syndrome, another rare complication of VZV, characterized by vesicular rash in the ear and ipsilateral peripheral facial paralysis. Both diseases are briefly reviewed and the potential benefits of vaccination are discussed.

Repeat epidural steroid injections for radicular pain due to lumbar or cervical disc herniation

2018 ◽  
Vol 100-B (10) ◽  
pp. 1364-1371 ◽  
Author(s):  
H. Joswig ◽  
A. Neff ◽  
C. Ruppert ◽  
G. Hildebrandt ◽  
M. N. Stienen
Keyword(s):  
Functional Outcome ◽  
Disc Herniation ◽  
Radicular Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Arm Pain ◽  
One Year ◽  
Epidural Steroid

AimsThe aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation.Patients and MethodsA cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12).ResultsA second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days (sd 46.5) and 47 days (sd 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm (sd 10.3) and a mean VAS for arm pain of 6.3 mm (sd 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (sd 12.4; p < 0.001); mean NPAD, 19.3 (sd 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (sd 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (sd 6.8; p = 0.103).ConclusionRepeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364–71.

scholarly journals Influence of thyroid hormone disruption on the incidence of shingles

2015 ◽  
Vol 143 (16) ◽  
pp. 3557-3571 ◽  
Author(s):  
A. AJAVON ◽  
D. KILLIAN ◽  
R. ODOM ◽  
R. W. FIGLIOZZI ◽  
F. CHEN ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Age Groups ◽  
Human Herpesvirus ◽  
Incidence Rates ◽  
Retrospective Case ◽  
Varicella Zoster ◽  
Its Gene ◽  
History Of ◽  
Simplex Virus ◽  
Hsv 1

SUMMARYThe reactivation of dormant alpha-human herpesvirus (αHHV) has been attributed to various causes often referred to as stressors. However, no clinical study investigating the relationship between stressors and reactivation exists in humans at this time. Herpes simplex virus type-1 (HSV-1), an important αHHV, was shown to have its gene expression and replication regulated by thyroid hormone (TH) using molecular biology approaches. Varicella zoster virus (VZV) is categorized in αHHV superfamily and shares similar homology with HSV-1. We hypothesize that a history of TH imbalance may be associated with the incidence of shingles (VZV reactivation). This current pilot study, based on a hospital medical claims database, was conducted as a retrospective case-controlled investigation to determine if a putative link between TH imbalance and incidence of shingles is present. An odds ratio of 2·95 with a χ2 value of 51·74 was calculated for the total population diagnosed with TH disruption and shingles. Further analyses indicated that African American males exhibited a much higher chance of simultaneous diagnoses. These results show that a TH imbalance history may affect VZV reactivation at different incidence rates in different races and age groups.

scholarly journals Ramsay hunt syndrome- expect the unexpected: A case report

2021 ◽  
Vol 7 (3) ◽  
pp. 172-175
Author(s):  
Poorva Saxena ◽  
G. V. Ramachandra Reddy ◽  
Hina Handa ◽  
Ajita Singh
Keyword(s):  
Case Report ◽  
Herpes Zoster ◽  
Neurological Diseases ◽  
Rare Complication ◽  
Varicella Zoster Virus Infection ◽  
Post Herpetic Neuralgia ◽  
Varicella Zoster ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome ◽  
Vesicular Rash

Herpes zoster represents a latent reactivation of the varicella zoster virus infection with a dermatomal pattern of eruption and complicated by post-herpetic neuralgia. Ramsay hunt syndrome is a rare complication of herpes zoster and it is not just a syndrome but it's rather an infectious disease. This syndrome is characterized by peripheral facial nerve palsy associated with an erythematous vesicular rash on the ear. It is characterized by unilateral pattern of facial involvement and presence of vesicles helps in early diagnosis and distinguish the syndrome with diseases mimicking other severe neurological diseases. This article reports a case of 56-year-old male patient who reported with a complaint of severe toothache, which serves as severe prodrome for reactivation of herpes zoster virus which later leads to Ramsay Hunt syndrome. This case report highlights about the management of herpes zoster and its complication and emphasizes on prevention of post herpetic neuralgia complication.

scholarly journals Iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases

2021 ◽  
Vol 1 (19) ◽  
Author(s):  
Lisa B. E. Shields ◽  
Vasudeva G. Iyer ◽  
Yi Ping Zhang ◽  
Christopher B. Shields
Keyword(s):  
Radiofrequency Ablation ◽  
Neck Pain ◽  
Facet Joint ◽  
Chronic Neck Pain ◽  
Neurological Injury ◽  
Left Shoulder ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Arm Pain ◽  
Epidural Steroid

BACKGROUND Neck pain is often chronic and disabling. Cervical facet joint injections and epidural steroid injections are frequently used to manage chronic neck pain and cervicogenic headaches. While minimal side effects are commonly associated with these treatments, severe complications are exceedingly rare. OBSERVATIONS The authors report 4 cases of iatrogenic neurological injury after radiofrequency ablation (RFA) and epidural steroid injections. One patient experienced left shoulder, scapular, and arm pain with left arm and hand weakness that developed immediately after RFA for chronic neck pain. Electromyography/nerve conduction velocity (EMG/NCV) studies confirmed denervation changes in the left C8–T1 distribution. Three patients complained of numbness and weakness of the hands immediately after an interlaminar cervical epidural block. One of these patients underwent EMG/NCV that confirmed denervation changes occurring in the left C8–T1 distribution. LESSONS Spine surgeons and pain management specialists should be aware of neurological injuries that may occur after cervical RFA and epidural steroid injections, especially after a multilevel cervical procedure and with severe cervical spinal stenosis. EMG/NCV studies plays an important role in detecting and localizing neurological injury and in differentiating from conditions that mimic cervical root injuries, including brachial plexus trauma due to positioning and Parsonage-Turner syndrome.

scholarly journals Case Report: When Shingles Disrupts Bladder Function

2020 ◽  
Vol 3 (1) ◽  
pp. 95-97
Author(s):  
Aaron Campeas ◽  
◽  
Eric J. Basile ◽  
◽  
◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Dorsal Root ◽  
Rare Complication ◽  
Bladder Function ◽  
Buttock Pain ◽  
Varicella Zoster ◽  
Chicken Pox ◽  
Double Stranded Dna ◽  
Left Buttock ◽  
Vesicular Rash

Varicella Zoster (shingles) virus is a double stranded DNA in the Herpesviridae family that can present as both chicken pox and as shingles. The virus enters through the respiratory system, replicating in the nasopharynx, and causes a viremia upon primary infection. Varicella Zoster spreads to other organs and often lies dormant in the dorsal root ganglion. Reactivation of the virus is more common in older or immunocompromised patients and often presents as a painful vesicular rash in a unilateral dermatomal distribution with possible concurrent radiculopathy. A rare complication of herpes zoster is urinary dysfunction. We report a case of a 42-year-old patient diagnosed with herpes zoster whose primary complaint was left buttock pain and a maculovesicular rash in the S2-S4 dermatomal distribution. She was prescribed Valacyclovir and began to experience urinary retention two days after starting the medication.

scholarly journals Toll-like Receptors in Viral Encephalitis

Viruses ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2065
Author(s):  
Olivia Luise Gern ◽  
Felix Mulenge ◽  
Andreas Pavlou ◽  
Luca Ghita ◽  
Imke Steffen ◽  
...  
Keyword(s):  
Viral Encephalitis ◽  
Current Knowledge ◽  
Virus Infections ◽  
Toll Like Receptors ◽  
Tlr Signaling ◽  
Varicella Zoster ◽  
Vaccine Responses ◽  
Neurotropic Viruses ◽  
Virus Rna ◽  
Simplex Virus

Viral encephalitis is a rare but serious syndrome. In addition to DNA-encoded herpes viruses, such as herpes simplex virus and varicella zoster virus, RNA-encoded viruses from the families of Flaviviridae, Rhabdoviridae and Paramyxoviridae are important neurotropic viruses. Whereas in the periphery, the role of Toll-like receptors (TLR) during immune stimulation is well understood, TLR functions within the CNS are less clear. On one hand, TLRs can affect the physiology of neurons during neuronal progenitor cell differentiation and neurite outgrowth, whereas under conditions of infection, the complex interplay between TLR stimulated neurons, astrocytes and microglia is just on the verge of being understood. In this review, we summarize the current knowledge about which TLRs are expressed by cell subsets of the CNS. Furthermore, we specifically highlight functional implications of TLR stimulation in neurons, astrocytes and microglia. After briefly illuminating some examples of viral evasion strategies from TLR signaling, we report on the current knowledge of primary immunodeficiencies in TLR signaling and their consequences for viral encephalitis. Finally, we provide an outlook with examples of TLR agonist mediated intervention strategies and potentiation of vaccine responses against neurotropic virus infections.

scholarly journals Inadvertent Discogram During Lumbar Interlaminar Epidural Steroid Injection

2020 ◽  
pp. 103-110
Author(s):  
Philip J. Koehler III
Keyword(s):  
Case Report ◽  
Rare Complication ◽  
Radicular Pain ◽  
Thrombin Inhibitors ◽  
Direct Thrombin Inhibitors ◽  
Ischemic Pain ◽  
Epidural Steroid Injections ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid ◽  
Key Words Anticoagulation

Background: Interlaminar epidural steroid injections (ILESI) are the most common injection performed for lumbosacral radicular pain. In order to continually improve the performance and safety profile of ILESI, it is imperative to report complications and inadvertent outcomes in addition to studies on efficacy in order to create guidelines to mitigate risk of potential debilitating sequelae. Case Report: Here we present a case report of a 36-year-old man who underwent a right sided ILESI for right sided lumbosacral radicular pain from a disc herniation. Following the injection, he had complete resolution of right sided symptoms. However, 4 weeks later he developed left sided lumbosacral radicular for which he underwent repeat left sided ILESI that resulted in an inadvertent discogram. Following this procedure a new magnetic resonance image was obtained that revealed a new large left L5-S1 paracentral extrusion with caudal migration of disc material abutting the ligamentum flavum in the path of the left-sided injection attempt. The patient was treated with oral antibiotics and suffered no significant sequelae from the inadvertent discogram. Conclusions: Discogram during ILESI is a highly unusual and rare complication. We discuss the management and prevention of this complication and review the limited existing literature. Key words: Anticoagulation guidelines, direct thrombin inhibitors, interventional pain, interventional spine, ischemic pain, neuromodulation

scholarly journals Varicella-zoster meningitis in an immunocompetent young man presenting with a painless erythematous rash

2020 ◽  
Vol 13 (1) ◽  
pp. e233511 ◽  
Author(s):  
Sahand Imani ◽  
Natalie C Palavra ◽  
Carly Oboudiyat ◽  
Jerome Ip
Keyword(s):  
Supportive Therapy ◽  
Immunocompetent Patient ◽  
Intermittent Fever ◽  
Significant Past Medical History ◽  
Varicella Zoster ◽  
Csf Analysis ◽  
Intravenous Acyclovir ◽  
Vesicular Rash ◽  
History Of ◽  
Enteroviral Meningitis

A 32-year-old man presented with a 7-day history of generalised headache, intermittent fever, emesis and diarrhoea. Four days after symptom onset, he developed a vesicular rash on his medial left thigh, without associated pain, paraesthesia or pruritus. He had no significant past medical history, and no HIV risk factors. He was presumed to have enteroviral meningitis and was commenced on supportive therapy. Lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed a lymphocytic pleocytosis. While awaiting CSF serology, the formation of a new vesicle was noted at the site of the rash and was swabbed. Results for both the CSF and vesicle swab returned positive for varicella-zoster virus (VZV) confirming concurrent VZV meningitis with atypical painless herpes zoster in a young immunocompetent patient. He was initiated on intravenous acyclovir and made a full recovery after 2 weeks of treatment.

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