Shingles (Herpes Zoster) occur when the varicella-zoster virus (VZV) reactivates in the body. Most adults have this virus lying dormant in their bodies, thanks to childhood chickenpox. While in most cases, shingles resolve within several weeks, some patients face complications, and shingles in the brain are one of them.
If not addressed immediately, this condition can lead to serious health consequences. Let's take a closer look at diagnosing shingles in the brain and available treatment options.
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While shingles in the brain (herpes zoster encephalitis) is a rare condition, it is a possible complication of the more common form of the disease. According to the World Health Organization, out of 33,000–50,000 cases of shingles, one ends with herpes zoster encephalitis.¹
Researchers have yet to discover why the varicella-zoster virus reactivates in the body. It often occurs when the immune system is weakened by a health condition, such as HIV or cancer.
Before the advent of the HIV pandemic, shingles encephalitis was extremely rare.
It was mainly seen in the elderly or patients with malignancies. Since HIV weakens the immune system, it facilitates the reactivation of the virus.
Studies show that people newly diagnosed with cancer, especially blood cancer, or undergoing chemotherapy treatments are at a higher risk of developing shingles than others. Immunocompromised patients are also at a higher risk of facing herpes zoster-associated encephalitis. However, VZV encephalitis can also be seen in previously healthy patients.²
When a person develops shingles encephalitis, they will most likely require hospitalization. By receiving the necessary drugs through IV, it's possible to prevent serious consequences.
Varicella zoster virus can cause encephalitis if it extends centrally from the spinal nerve distribution.
The most common nervous system problems associated with the varicella-zoster virus are:
Postherpetic neuralgia – once the shingles rash is gone, the patient continues to experience pain in the area where it used to be. This is secondary to nerve damage from shingles.
Acute encephalitis – inflammation of the brain that requires immediate medical attention. Herpes zoster-associated encephalitis typically presents with delirium surrounding the development of the vesicular rash.
Aseptic meningitis – inflammation of the lining of the brain (meninges). While most cases are mild, untreated aseptic meningitis could lead to serious health consequences.
Myelitis – inflammation of the spinal cord. Transverse myelitis from herpes zoster occurs within days to weeks after the onset of the vesicular rash.
Other nervous system complications include Guillain-Barre Syndrome, peripheral motor neuropathy, HZ oticus, and HZ ophthalmicus
The most common symptom of shingles is a rash. However, in some cases, complications can occur without an obvious manifestation on the skin. A rash may not be one of the symptoms of herpes zoster encephalitis in rare cases.
However, you may experience:
Poor muscle control
Problems with coordination
Aphasia (language disorder that causes difficulty speaking)
The same symptoms can occur when a person has other conditions, including meningitis, brain abscess, stroke, trauma, etc. A doctor can differentiate between these conditions to design an effective course of treatment.
It's important to understand that shingles in the brain and other conditions with similar symptoms are medical emergencies. You need to contact a medical professional immediately to prevent complications.
When a patient develops shingles in the brain, they need immediate treatment. A combination of the symptoms, especially those that have to do with the loss of coordination, problems with speech, and high fever, is a medical emergency.
In the hospital, the doctor diagnoses the condition by:
Reviewing medical and travel history
Asking questions about recent activities
Evaluating immune system status
Examining skin, mucous membranes, and lymph nodes
Running blood tests
Arranging electroencephalography (EEG) to check brain activity
Ordering CT and/or MRI of the head
Examining cerebrospinal fluid
Conducting a brain biopsy (in rare cases).
In most cases, doctors can diagnose shingles in the brain without running extensive tests. If symptoms are accompanied by an obvious shingles rash, the diagnosis is easier. If there isn't a rash (which is rare but possible), doctors may require further testing.
If they confirm herpes zoster-associated encephalitis, medical professionals may prescribe the following treatment:
IV acyclovir– acyclovir is an antiviral medication that works by stopping the replication and spreading of the varicella-zoster virus. The medication works faster when administered intravenously. When the patient's condition improves, a doctor may recommend switching to the oral form of this medication.
Steroids – a doctor may administer IV steroids (usually prednisone) to reduce the inflammation of the brain.
Doctors may also prescribe antiseizure medication if the patient has seizures associated with the condition.
While many cases of shingles are mild, some lead to severe complications, including brain inflammation and even death. Immunocompromised patients are more likely to experience complications of shingles. For them, prevention is especially important.
Today, U.S. citizens have access to a shingles vaccine called Shingrix. It provides strong protection against the condition and prevents shingles in up to 97% of cases. For people with a compromised immune system, the protection rate is between 68% and 91%.³
If you've never had chickenpox, you can ask your doctor about a chickenpox vaccine. While the condition is generally mild in children, it can become a serious disease in adults.
If you develop a shingles rash, it's important to contact a doctor as soon as you can. A seemingly mild rash could lead to serious complications. A doctor can run relevant tests to ensure you aren't in danger.
If you experience any of the symptoms of herpes zoster encephalitis, call your doctor or 911 immediately. You may need emergency medical treatment.
Shingles in the brain are a serious condition that can lead to severe health consequences. Thankfully, this disease is rare and affects only a very small percentage of people who get shingles. With timely treatment, it's possible to recover from the condition and lead a normal life. If you experience any symptoms of shingles in the brain, call a healthcare professional immediately.
Headaches are uncommon in uncomplicated shingles, with fewer than 20% of patients presenting with systemic symptoms. . However, just because you have a headache, it doesn't mean that you have shingles in the brain.
Nevertheless, it is important to speak to a doctor and monitor your condition. If you develop herpes zoster encephalitis, you may need immediate hospitalization.
If you have a shingles rash accompanied by headaches, vomiting, problems with concentration, speech issues, loss of coordination, or hallucinations, you may have shingles (herpes zoster-associated) encephalitis. This condition warrants immediate medical attention. In some cases, shingles encephalitis may occur without a rash.
Shingle encephalitis is rare. It happens once for every 33,000 – 50,000 cases of shingles. The condition usually affects immunocompromised people, especially those with HIV and blood cancers.
People undergoing chemotherapy are also more likely to develop this condition than others, but it can also affect previously healthy people. Risk factors also include a history of more than 2 episodes of shingles previously, as well as cranial or cervical dermatome involvement.
Shingles in the brain can occur when the varicella-zoster virus (from childhood chickenpox) reactivates in your body and extends from the spinal nerves centrally. Shingles usually cause a painful and itchy rash in a single dermatome that does not cross the midline, and that goes away in several weeks. In rare cases, it can progress to the brain and cause herpes zoster encephalitis.
While there isn't a cure for shingles yet, doctors can administer medication that keeps the virus from replicating in your nerve cells. They can also prescribe medication to alleviate the unpleasant symptoms. Timely treatment is key to preventing complications that include permanent nerve damage.
Shingles may cause brain inflammation. The condition could also cause permanent damage such as postherpetic neuralgia or peripheral motor neuropathy.
Shingles vaccination | Centers for Disease Control and Prevention
Herpes zoster encephalitis (2012)
Aseptic meningitis | Medscape