Herpes neuropathy

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Genetic testing

NCV/EMG

Laboratory

Imaging

Biopsy

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Herpes virus remains in a latent state in the dorsal root ganglion or trigeminal ganglion.

Sensory disturbances occur with cutaneous eruptions. Post-herpetic neuralgia can involve three distinct pain situations: lancinating, shock-like pain, a continuous burning or aching pain, or pain caused by innocuous stimuli (allodynia). All of these occur in a dermatomal distribution.

Motor signs are infrequent (herpes zoster), and are caused by radiculopathy. Motor impairment occurs in the corresponding myotome to the sensory distribution. Long standing radicular pain that resembles diabetic neuropathy or infiltrative radiculopathy may be caused by herpes reactivation without the distinctive rash (zoster sine herpete). Cranial nerve palsies are also common, include oculomotor and facial nerve palsies, and optic neuritis or vestibulocochlear impairment (Ramsay-Hunt syndrome).

Herpes simplex or Herpes zoster (chicken pox) infection can come out of latency in a sensory ganglion. Herpes zoster occurs frequently in HIV patients and patients recovering from chemotherapy. The virus migrates down the sensory nerve fibers to the skin, causing tissue damage and inflammation. The pain syndromes associated with post-herpetic neuralgia may result from altered CNS pain pathways, aberrant reinnervation following infection, or changes in receptor sensitivity.

Vesicle smear and PCR may be used to confirm infection.

Acyclovir and other antivirals may be used both acutely and prophylactically. Pain can be managed by tricyclic antidepressants or opiates. Nerve block or lidocaine treatment may also be used.

Herpes simplex is recurrent and may be implicated in Bell's palsy. Herpes zoster neuropathy increases in frequency with age and may lead to residual neuralgia, although recovery is generally good.

Collins SL, Moore RA, McQuay HJ, et al (2000) Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. J Pain Symptom Manage 20: 449-458

Fox RJ, Galetta SL, Mahalingam R, et al (2001) Acute, chronic, and recurrent varicella zoster virus neuropathy without zoster rash. Neurology 57: 351-354

Anatomy/distribution

Symptoms

Clinical syndrome/ signs

Pathogenesis

Diagnosis Therapy

Prognosis

References

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