Neurology: Case of the Month

Test Yourself — Patient 69

Varicella-Zoster Myelitis

  1. Neurologic sequelae of varicella-zoster virus (VZV) infection include:
    • [ A ] Neuralgia
    • [ B ] Ventriculitis
    • [ C ] Stroke
    • [ D ] Myelitis
    • [ E ] All of the above are true
  2. Which of the following statements regarding the clinical presentation of VZV myelitis is FALSE?
    • [ A ] The onset of symptoms of weakness and numbness are gradual.
    • [ B ] Weakness and sensory changes are symmetric.
    • [ C ] Sphincter dysfunction occurs in almost 50% of patients.
    • [ D ] Myelitis usually occurs days to weeks following the onset of vesicular rash.
  3. Which of the following statements about the diagnosis of VZV myelitis is TRUE?
    • [ A ] CSF PCR for VZV DNA is a highly sensitive test.
    • [ B ] Serum IgG antibodies to VZV support a diagnosis of VZV myelitis.
    • [ C ] Spinal MRI shows decreased intramedullary signal on T2-weighted images.
    • [ D ] VZ virus is rarely isolated in viral cultures.
  4. Which of the following statements are FALSE?
    • [ A ] VZV is an alpha-herpesvirus found only in human beings.
    • [ B ] From 7-15% of all VZV infections clinically involve the CNS.
    • [ C ] Cerebellitis is a common neurologic abnormality associated with chickenpox.
    • [ D ] After the rash of varicella (chickenpox) resolves, the virus becomes latent in the cranial and spinal ganglia, during which time it remains in a non-infectious state.
  5. CSF findings in VZV myelitis may include:
    • [ A ] Pleocytosis
    • [ B ] Elevated protein
    • [ C ] Increased opening pressure
    • [ D ] Normal glucose
    • [ E ] All of the above

 

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