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Table of Contents
LETTER TO THE EDITOR
Year : 2016  |  Volume : 19  |  Issue : 1  |  Page : 161-163
 

Neurological complications due to chicken pox in adults: A retrospective study of 20 patients


Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

Date of Submission17-Jun-2015
Date of Decision08-Sep-2015
Date of Acceptance14-Sep-2015
Date of Web Publication2-Feb-2016

Correspondence Address:
Deepak Amalnath
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.173306

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How to cite this article:
Amalnath D, Karthikeyan A, Thammishetti V, Subrahmanyam DK, Surendran D. Neurological complications due to chicken pox in adults: A retrospective study of 20 patients. Ann Indian Acad Neurol 2016;19:161-3

How to cite this URL:
Amalnath D, Karthikeyan A, Thammishetti V, Subrahmanyam DK, Surendran D. Neurological complications due to chicken pox in adults: A retrospective study of 20 patients. Ann Indian Acad Neurol [serial online] 2016 [cited 2019 Apr 19];19:161-3. Available from: http://www.annalsofian.org/text.asp?2016/19/1/161/173306


Sir,

Varicella zoster virus (VZV) causes primary infection (chicken pox) and reactivation (herpes zoster). [1] Chicken pox in children is usually self-limiting with cerebellitis as the most common neurological complication. [2] However, in adults, VZV can cause serious neurological complications. The mechanisms responsible for neurological manifestations have been attributed to direct neurological damage, immune mediated and, recently, due to infection of the blood vessels by VZV (VZV vasculopathy). [3] Published Indian data on chicken pox-associated neurological complications are very sparse, with only a few case series [4],[5],[6] mostly limited to children. Hence, we have carried out this study to specifically look for chicken pox-associated neurological complications in adults.


   Materials and Methods Top


This was a retrospective study of all patients (aged 13 years and above) admitted over 2 years. The patients with herpes zoster complications were excluded. Case records of 20 patients were included in this study. This study was carried out with after obtaining approval from the Scientific Advisory Committee and the Ethics Committee of the Institute.


   Results Top


There were 20 cases in total. The male:female ratio was 17:3. Out of the 20 patients, 13 patients had active lesions at the time of development of the neurological complications.

The neurological manifestations were as follows: Encephalitis (10), cerebellitis (4), cortical venous thrombosis, (4) and arterial stroke (2). The clinical manifestations, investigations, and outcomes of these patients are presented in [Table 1].
Table 1: Table showing the details of all the patients

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Encephalitis was seen in 10 patients. Mean duration of presentation from the onset of skin lesions was 5.8 days, and 8 patients had active skin lesions. All patients received acyclovir. The oldest patient died and the rest recovered without any significant deficit.

Ataxia was seen in four patients. All developed ataxia within 2 weeks of onset of skin lesions. One patient had persistent ataxia and the rest improved.

Cortical venous thrombosis was seen in four patients. Two patients presented 2 months after chicken pox. All the four patients had extensive sinus thrombosis and two patients died due to massive infarct.

Two patients developed arterial infarcts. The first patient presented within 4 days of skin lesions and imaging showed pontine infarct. The second patient presented 14 days after the onset of rash and computed tomography (CT) showed ganglio-capsular infarct.

We did not come across any cases of Guillain-Barré syndrome or Myelitis in our study.


   Conclusion Top


Based on our study, we conclude that encephalitis might be more common in adults as compared to cerebellitis that is predominantly seen in children. We hope that this series will be of help for clinicians who treat adults with chicken pox.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Whitley RJ. Varicella-zoster virus infection. In: Longo, editor. Harrison's Principles of Internal Medicine. 18 th ed. New York: McGraw Hill Publisher; 2008. p. 1103.   Back to cited text no. 1
    
2.
Johnson R, Milbourn PE. Central nervous system manifestations of chickenpox. Can Med Assoc J 1970;102:831-4.  Back to cited text no. 2
    
3.
Gilden D, Cohrs RJ, Mahalingam R, Nagel MA. Varicella zoster virus vasculopathies: Diverse clinical manifestations, laboratory features, pathogenesis, and treatment. Lancet Neurol 2009;8:731-40.  Back to cited text no. 3
    
4.
Paul R, Singhania P, Hashmi MA, Bandyopadhyay R, Banerjee AK. Post chicken pox neurological sequelae: Three distinct presentations. J Neurosci Rural Pract 2010;1:92-6.  Back to cited text no. 4
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5.
Murthy JM, Kishore TL. Neurological complications of chickenpox: A clinical, electrophysiological and MRI study. Neurol India 1996;44:195-201.  Back to cited text no. 5
    
6.
Girija AS, Rafeeque M, Abdurehman KP. Neurological complications of chickenpox. Ann Indian Acad Neurol 2007;10:240-6.  Back to cited text no. 6
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    Tables

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