Changes of the central nervous system in herpes zoster

Abstract

Postmortem examination was conducted in eight cases of neurocutaneous herpes zoster. One generalized case with diffuse and focal meningoencephalomyelitis showed numerous infiltrates in the subarachnoid space and along the cerebral ventricles. Intranuclear inclusion bodies could be demonstrated for the first time in ependymal and in arachnoidal cells, and viral capsids were found in the latter. The parenchymal lesions, lying predominantly in the white matter, were characterized by inflammation, hemorrhage, axonal swellings, demyelination, and intranuclear inclusions in oligodendrocytes. In the second generalized case there was a granulomatous giant cell angiitis with intranuclear inclusion bodies in the vessel walls. Out of four cases with localized damage of the central nervous system (CNS), three showed demyelination as the main alteration. In another case there was a hitherto undescribed calcifying coagulation necrosis of a spinal ganglion.