Shingles, according to the National Institute of Neurological Disorders and Stroke, is the common name for herpes zoster, the disease that results from reactivation of the virus that causes chicken pox within the roots of spinal or cranial nerves. Most people recognize the one-sided, blistering skin rash that characterizes shingles' external manifestations. However, the disease also produces internal symptoms such as fever, fatigue, malaise and poor appetite. While complications of external shingles are limited to scarring and secondary bacterial infections, complications of internal shingles affect the central nervous system., reflecting the virus' localization within the nerves.
Encephalitis
Encephalitis, or inflammation of the brain, results when the virus that causes shingles attacks nerves or blood vessels in the brain. In some cases, according to Medical College of Wisconsin neurologist Catherine Amlie-Lefond, M.D. in a 2009 review published in the journal "Current Neurology and Neuroscience Reports," symptoms of encephalitis develop slowly and don't become apparent until weeks or months after other symptoms of shingles have resolved. Symptoms, according to Amlie-Lefond, include low-grade fever, headache, irritability, mental confusion and drowsiness. Although more specific neurological symptoms such as speech problems, double vision and loss of sensation or motor function in a part of the body also occur with encephalitis, these are late signs, says Amlie-Lefond, and 85 percent of patients seek help before they develop.
Meningitis
Doctors use the term meningitis to describe inflammation of the outer protective covering of the spinal cord. Meningitis due to shingles, according to pathologist Patrick Harris, M.D. in a 2010 report in the medical journal "Infection," usually presents within three to five days of the appearance of the skin rash. Symptoms include stiff neck, headache, sensitivity to light, fever, nausea and vomiting and, like encephalitis, irritability, mental confusion and drowsiness. Although encephalitis can result in permanent neurological problems and even death, viral meningitis, according to NINDS, usually causes mild, non-lethal symptoms that responds quickly to intravenous antiviral drugs and steroids.
Myelitis
Myelitis occurs when shingles causes inflammation of the spinal cord itself. Symptoms, according to NINDS, typically begin with lower back pain, muscle weakness and tingling in the feet and toes. Later symptoms depend on the level of the spinal cord that is involved and may include muscle weakness or paralysis and loss of bladder or bowel control. Muscle problems, notes Amlie-Lefond, can affect the same side of the body as skin symptoms, or both. When both ides are affected, Amlie-Lefond notes,s the skin symptom side is usually hardest hit. Bladder problems occur more often than bowel problems, Amlie-Lefond continues. Some patients--particularly those with immune system problems--experience an exacerbating-remitting course, similar to what is seen with multiple sclerosis.
References
- National Institute of Neurological Disorders and Stroke: Shingles: Hope Through Research
- "Current Neurology and Neuroscience Reports;" Neurologic Manifestations of Varicella Zoster Virus Infections; C. Amlie-Lefond and B. Jubelt; 2009
- "Infection;" Herpes Zoster Meningoencephalitis; P. Harris et al.; 2010
- National Institute of Neurological Disorders and Stroke: Meningitis and Encephalitis
- National Institute of Neurological Disorders and Stroke: Transverse Myelitis
