Multiple Enhancing Brain Mass as Initial Presentation of Varicella Zoster Virus Encephalitis

Case Report

Austin J Clin Neurol 2016; 3(1): 1088.

Multiple Enhancing Brain Mass as Initial Presentation of Varicella Zoster Virus Encephalitis

Schmidt E, Yonaty SA, Jubelt B and Latorre JG*

Department of Neurology, SUNY Upstate Medical University Hospital, USA

*Corresponding author: Latorre JG, Department of Neurology and Neurosurgery, Neurocritical Care Service, SUNY Upstate Medical University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA

Received: July 01, 2016; Accepted: August 06, 2016; Published: August 08, 2016


Viral encephalitis causes a myriad of neurologic symptoms that can mimic many acute central nervous system disorders. The clinical manifestation is dependent on a number of factors including the predominant cell types affected by the virus or viral tissue tropism, the virulence of the virus and the localization of the infection to a particular brain region. For instance, Herpes simplex virus (HSV) tends to localize to the mesial temporal and orbitofrontal lobes and presents with characteristic clinico-pathologic and imaging findings. Varicella Zoster Virus (VZV) is an exclusively neurotropic human virus which produces an initial infection typically in childhood– chickenpox, followed by dormant persistence in the ganglionic neurons. Reactivation of the virus, most commonly in immunocompromised patients but also in immunocompetent individuals typically produces “shingles”, a painful vesicular rash in a dermatomal area. Most recently, the entity of neurological complications of VZV reactivation, in absence of a skin rash has been recognized. What makes this virus stand out is its unique ability of replication in the arteries, with resultant vasculopathy, affecting both large and small vessels, manifesting clinically and radiologically as acute ischemic or hemorrhagic infarction. We present an atypical manifestation of VZV encephalitis mimicking a metastatic brain tumor, with unusual pathological findings.

Keywords: Varicella; Encephalitis; Tumor; Metastatic; PCR


VZV: Varicella Zoster Virus; HSV: Herpes Simplex Virus; CSF: Cerebral Spinal Fluid; CMV: Cytomegalo Virus; EBV: Epstein Barr Virus; HHV 6: Human Herpes Virus 6; WNV: West Nile Virus; EEEV: Eastern Equine Encephalitis Virus; SLE: St. Louis Encephalitis; IgG: Immunoglobulin G; PCR: Polymerase Chain Reaction

Case Presentation

A 42 year old African American woman with history of hypertension presented with 1-week complaints of nausea and vomiting. She later developed headache, photophobia, vertigo, diplopia and neck stiffness prompting admission to a local hospital. Initial brain imaging showed multiple enhancing brain lesions within the right periventricular region, the bilateral cerebellar peduncles and the right lateral medulla (Figure 1). The patient was transferred to our hospital in August 2010 for an elective brain biopsy after a negative metastatic tumor work-up.