Varicella-Zoster Virus: One Pathogen With Multifaceted Imaging and Clinical Manifestations Influenced by Varied Pathophysiologic Mechanisms of Dissemination

R.J. Bert; M.A. Nagel; R.P. Friedland; E.M. Hattab; D.H. Gilden

View Article on Neurographics Website

Date of Activity Release: Feb. 1, 2017
Date of Activity Expiration: Feb. 1, 2020

Target Audience:
Intended for neuroradiologists and neuroradiology trainees with varying degrees of experience.

Learning Objectives:
Describe the epidemiology and pathologic processes responsible for the multifaceted imaging findings and affected clinical populations associated with VZV reactivation.

Varicella-zoster virus is a ubiquitous, exclusively human, neurotropic virus. Primary infection causes varicella (chickenpox), after which the virus becomes latent in cranial nerve ganglia, dorsal root ganglia, and autonomic ganglia along the entire neuraxis. Varicella-zoster virus reactivation, primarily in elderly individuals and individuals who are immunocompromised, produces herpes zoster. During their lifetime, up to one-third of people will develop zoster, often complicated by diverse neurologic and ocular disorders. Imaging is helpful, particularly because these manifestations can occur without a rash. Live attenuated varicella-zoster virus vaccine prevents varicella, although the vaccine virus becomes latent and reactivates to cause zoster just as wild-type varicella-zoster virus does. To prevent zoster, a more potent preparation of live attenuated virus was created, which boosts cell-mediated immunity to varicella-zoster virus and reduces the incidence of zoster and postherpetic neuralgia for years after immunization. But the long-term effectiveness of immunization after age 60 years is unknown. This review discusses varicella-zoster virus epidemiology and pathophysiology, and vaccines to prevent varicella and zoster, and provides a foundation for understanding when the disease is likely to occur and what imaging features predominate. An organizational chart is presented with selected illustrative imaging cases that demonstrate the protean neurologic manifestations of varicella-zoster virus infection of the nervous system.

Commercial Support
No commercial support was received for this activity.

Credit Designation Statement

The American Society of Neuroradiology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Neuroradiology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Physician Participation:
Each participant will review the corresponding Neurographics article located at Upon completion, each physician will complete and pass a post-test with a score of at least 80% to receive a CME certificate.

All individuals in control of content have disclosed the following relevant financial relationships. All of these relationships were treated as a conflict of interest, and have been resolved (C7 SCS 6.1-6.2, 6.5)

Authors have no relevant financial relationships.





Barton Branstetter 

Editor in Chief

None, N/A

Adam Flanders

Deputy Editor

Royalties, Lippincott Williams and Wilkins

Robert Quencer 

Consulting Editor

None, N/A

Mark Mullins

Associate Editor

Non-remunerative position, AUR6

Meng Law

Associate Editor

Stockholder, Clinical Imaging

Michele Johnson

Associate Editor

Consultant, Boston Scientific, Inc.

Edward Escott

Associate Editor

Grant, Atherysys, Inc.; Royalties, Thieme Medical Publishers

Scott Faro

Associate Editor

None, N/A

Tina Young Poussaint

Associate Editor

None, N/A

Dheeraj Ghandi

Associate Editor

Grant, Arstasis, Axera Inc.; Consultant, Covidien, EV3

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