Background:. Quantitative polymerase chain reaction (PCR) has improved the diagnosis of VZV-infection of the CNS. The correlation between the viral load and symptoms, prognosis and effect of treatment is not yet known. The main aim of this study was to describe the clinical manifestations of patients with VZV DNA positivity in the CSF.

Patients and methods: Patients in the Västra Götaland region in Sweden with VZV-infection of the CNS during 1995-2006 were identified. The diagnoses, laboratory tests (including virus amount), x-ray examinations, antiviral treatment and neurological sequelae have been studied.

Results: 97 of the 100 charts have been obtained. 28% had the diagnosis encephalitis or meningoencephalitis and 34% meningitis, 20% Ramsay Hunt’s syndrome and the remaining had infarction or bleeding, encephalopathy or other neurological complications. In 66 patients PCR levels were measured, there is a significant difference between the Ramsay-Hunt group and the encephalitis group and between the Ramsay-Hunt group and the meningitis group. In 37% there were no skin manifestations observed. 62% had CT scan or MRI of the brain performed and of these, 40% had pathological findings. Of the 45% who were followed-up, approximately ¾ had neurological complications one month after discharge.

Conclusions: A considerable number of the patients with VZV-infection in CNS had serious neurological symptoms and sequelae. Less than half of the patients had skin manifestations before onset of neurological complications, which might delay diagnosis and start of antiviral treatment. Quantitative PCR in cerebrospinal fluid (CSF) is a sensitive method to detect VZV-infection of the CNS.