Clinical features analysis of varicella zoster virus myeloradiculitis
Objective To investigate the clinical features of varicella-zoster virus myeloradiculitis(VZVM).Methods Eight cases of VZVM diagnosed in our hospital from June 2016 to June 2021 were selected,and their clinical manifestations,imaging,electromyography,etiological gene detection of cerebrospinal fluid,treatment and prognosis were analyzed.Results Among the 8 cases,5 were males and 3 were females.The age of onset was 56-80 years old,with a median(quartile)of 59.5(57.0,60.0)years.All patients had acute onset and duration of disease ranging from 5 to 90 days,with a median(quartile)duration of 15.5(14.0,17.0)days.All the 8 patients had a history of skin herpes before onset,and the incubation period from skin herpes to myelopathy was 1-36 days,with a median(quartile)of 11.5(10.0,13.0)days.The onset symptom of the disease was pain in 7 patients,limb weakness in 8 cases,limb numbness in 6 cases,urinary and fecal incontinence in 6 cases;There were 6 cases of transverse spinal cord injury and 2 cases of focal spinal cord injury.Electromyography was performed in 7 patients,and electromyography spontaneous potential was found in the corresponding innervation area of myelopathy in 4 of them.Cerebrospinal fluid(CSF)and/or blood virus gene detection was performed in 5 patients,of which 3 patients underwent PCR herpesvirus gene detection in CSF and blood,2 cases were positive and 1 case was negative.Cerebrospinal fluid microorganism next-generation sequencing(mNGS)was performed in 2 cases,and VZV gene was detected in 1 case.All patients showed abnormal enhancement of spinal cord,nerve root and ganglion in spinal MRI.The lesions involved only the neck segment in 3 cases and the chest segment in 2 cases,and the neck and chest segment in 2 cases,and the chest and waist segment in 1 case.All 8 cases had intramedullary enhancement,4 cases had intramedullary ring enhancement,2 cases had intramedullary lamellar enhancement,and 2 cases had intramedullary nodular enhancement.There were 4 cases of intramedullary long segment lesions,including 1 case involving the neck,1 case involving the thoracic segment,1 case involving the cervico-thoracic segment and 1 case involving the thoracolumbar segment.All 8 cases were treated with acyclovir and glucocorticoid.Five cases improved,2 cases had paraplegia,and 1 case died after the lesion developed to the medulla oblongata.Conclusions The onset of VZVM is often characterized by pain.Abnormal enhancement of nerve roots and spinal cord can be detected by enhanced MRI.Spontaneous muscle potential in the innervation area of spinal nerve roots can be detected by electromyography.Diagnosis of VZV virus can be confirmed by cerebrospinal fluid virus gene sequencing.Early diagnosis through various methods,early antiviral and appropriate hormone therapy are very important to improve the prognosis.
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