Nilgun ÇINAR, Şevki ŞAHİN, Sibel KARŞIDAĞ, Tuğba OKLUOĞLU, Kübra BATUM

Is herpes zoster merely a simple neuralgia syndrome?

Amaç: Herpes zoster sıklıkla tek dermatomu tutan postherpetik nevralji (PHN) tablosu ile kliniğe yansımasına rağmen, nadiren farklı klinik görünümler ile de ortaya çıkabilmektedir. Bu nadir durumları daha net ortaya koyabilmek için kliniğimizce izlenen PHN olgularının ayrıntılı olarak incelenmesi amaçlanmıştır. Metod: 2008 2010 yılları arasında nöroloji polikliniğince PHN nedeni ile izlenen toplam 26 olgunun kart bilgileri taranmıştır. Bulgular: Olguların yaş ortalaması 61,9±16,4 yıl olup, kadın/erkek oranı 15/11di.Olguların 10unda (%38); lenfoma, solid kanser ve diyabetes mellitus, protez metal kalp kapağı, ve Parkinson hastalığı gibi kronik hastalık öyküsü saptandı. Lezyon dağılımı; olguların 8inde trigeminal sinirde (7sinde oftalmik, 1inde mandibular), 3ünde spinal servikal, 8inde spinal torakal, 7sinde spinal lomber dermatomlardaydı. Toplam üç olguda (%11,5) motor tutulum saptandı (bir olguda C7, iki olguda L4-L5 innervasyonlu kaslarda). Dört olguda (%15,3; iki olguda aynı dermatomun simetrik tarafında, 2sinde farklı dermotomlarda) birden fazla der- matomal tutulum gözlendi. Sonuç: İmmünsupresyon ve ileri yaşın varisella reaktivasyonunu kolaylaştırdığı bilinmektedir. Makalemizde kliniğimizde izlenen zona zoster olguları gözden geçirilerek eşlik eden hastalıklar, görüldüğü anatomik lokalizasyonlar, birden daha fazla dermatomal tutulumlu zoster olguları incelenerek zonanın duysal tutulum dışında motor tutuluma da sebebiyet verebileceği vurgulanmıştır. Bulgularımız zonanın multifaktöryel farklı klinik görünümleri olabilecek kompleks bir sendrom olduğuna işaret etmiştir.

Herpes zoster sadece basit bir nevralji sendromu mudur ?

Aim: Although, herpes zoster usually presents with postherpetic neu- ralgia (PHN) localized at single dermatome, it may also manifest with different clinical presentations. To clarify of these rare conditions, we aimed to examine the cases of PHN followed by our clinic in more details. Method: Medical records of 26 patients in total monitored by the neurology outpatient clinic for PHN between 2008 and 2010 were re- viewed. Result: The mean age of the patients was 61.9±16.4 years, with a female-male ratio of 15/11. Ten of the patients (38 %) had a chronic illness history such as solid cancer, lymphoma, diabetes mellitus, car- diac valve prosthesis and Parkinson s disease. Eight of the patients had trigeminal nerve lesions (ophthalmic in 7 and mandibular in 1), 3 had spinal cervical lesions, 8 had spinal thoracic lesions and 7 had spinal lumbar dermatomic lesions. Three (11.5%) patients had motor involvement (C7 in one and L4-L5 innervated muscles in two). Four patients (15.3%; symmetric sides of the same dermatome in two and at different dermatomes in another two) had multiple dermatomal involvements. Conclusion: Immunosuppression and advanced ages are known to fa- cilitate varicella reactivation. By reviewing patients with zona zoster monitored by our clinic for accompanying conditions, anatomical lo- calizations and presence of multiple dermatomal involvements, the present study emphasizes that zona may also cause motor involve- ment besides sensory involvement. Our findings demonstrate that zona is a complex syndrome which may manifest as varying clinical presentations.

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