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Deficit sciatica post varicella zooster virus infection

      BEDOUI I1,2, BEN WADDEY O1,2, RIAHI A1,2, DERBALI H1,2, MESSSELMANI M1,2, MANSOUR M1,2, ZAOUALI J1,2, M’RISSA R1,2
      1-DEPARTMENT OF NEUROLOGY, MILITARY HOSPITAL OF TUNIS, TUNISIA
      2-FACULTY OF MEDECINE OF TUNIS, UNIVERSITY MANAR II OF TUNIS
      Introduction: Neurologic complications of varicella zoster virus (VZV) are rare and they are dominated by encephalitis. Direct mechanism is implicated. Myeloradiculitis involving indirect mechanism is rarely reported. Sciatica with neurological deficit can be the first manifestation.
      Objective: Remembering through a case report the neurologic involvements of VZV infection implicated indirect mechanism.
      Case report: A. N a 64-year-old was admitted for bilateral sciatica L5 and S1 with bladder disorders progressively installed two months after intercostal zozter. The examination showed flaccid areflexic paraparesis with a sensory level D10-D11. The spinal MRI showed medullar hypersignal D11-D12 on T2 weighting with meningeal and roots contrast enhancing. CSF study was consistent with aseptic lymphocytic meningitis with negative VZV PCR. The EMG showed lower limb polyradicular lesions. The diagnosis of post herpetic meningomyeloradiculitis was made. Patient improved under aciclovir and corticosteroid. He consulted six months later for recurrence of the same symptoms concomitant to corticosteroids tapering with extension of radiologic lesions. The resumption of corticosteroids was marked by clinical and radiological improvement.
      Discussion: Neurological complications of VZV were observed in 5-10 % of cases affecting not only immunodeficient but also immunocompetent persons. Encephalitis and meningitis were the most comment involvements. Myeloradiculitis implicating indirect mechanism with immuno-allergic reaction secondary to antigenic mimetism was rarely reported. Treatment is based on corticosteroids.
      Conclusion: VZV is a rare etiology of Myeloradiculitis caused by immunoallergic mechanism and whose only manifestation may be sciatica and neurologic deficit.