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Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicusShankar Lal, Savannah Gracie Moore, Harsha Vedantam, Shahnawaz Notta, Beesham Kumar. Abstract |  Download PDF | |  Post | Background:
Varicella-zoster virus (VZV) reactivation can rarely involve the central nervous system, leading to meningitis even in otherwise healthy elderly patients. Clinical presentation may be subtle, occasionally mimicking transient ischemic attacks or strokes, which can delay diagnosis.
Case Description:
We report an 85-year-old man with multiple vascular risk factors who experienced a brief episode of expressive aphasia. Neuroimaging showed no acute ischemia. Examination revealed a healing unilateral vesicular rash in the ophthalmic (V1) dermatome. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis and elevated protein, and polymerase chain reaction testing confirmed VZV DNA. The patient was treated with a 14-day course of intravenous acyclovir, resulting in complete neurologic recovery.
Conclusion:
This case emphasizes the need to consider VZV meningitis in elderly patients presenting with transient neurological deficits, even without classic meningeal signs.
Key words: Acyclovir; Cerebrospinal fluid; Expressive aphasia; Varicella-zoster virus; VZV meningitis.
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