The National Institute of Neurological Disorders and Strokes estimates that 25 percent of Americans will eventually develop shingles, the disease that results from reactivation of the virus that causes chicken pox within the roots of the nerves. Symptoms, according to NINDS, typically include a mild, flu-like illness and a painful, one-sided, blistering skin rash. In rare cases, shingles attacks the lungs, spine or brain. Symptoms of internal shingles vary by the anatomic site involved.
Sensory Deficits
When shingles attacks the cranial nerves, the result is a deficit in taste, hearing or vision, depending on the specific cranial nerve involved. In the 2009 edition of "Hazzard's Geriatric Medicine and Gerontology," Duke University Professor of Medicine Dr. Jack I. Twersky explains that involvement of the fifth or ninth cranial nerves decreases the ability to taste since the fifth nerve supplies the front two-thirds of the tongue while the ninth supplies the back two-thirds. Involvement of cranial nerves seven and eight, says Twersky, produces a spectrum of symptoms including ringing in the ears, balance problems, dizziness and deafness.
Involvement of five, seven or eight can lead to vision problems. With the ophthalmic division of cranial nerve five, symptoms such as severe eye pain, inflammation and changes in visual field or visual acuity usually present immediately. With cranial nerves seven and eight, vision problems develop later, as a result of inability to completely close the eye. Without careful attention to eye protection and lubrication, vision loss ensues from mechanical trauma and drying of the cornea.
Mental Status Changes
Doctors use the term "mental status changes" to refer to changes in personality, behavior, mood or cognition. In the case of shingles, sleepiness, irritability, abnormal behavior and mental confusion often signal involvement of the brain tissue or outer protective covering of the spinal cord, conditions called, respectively, encephalitis and meningitis, according to University of Melbourne pathologist Dr. Patrick Harris in a 2010 case series published in the journal "Infection." Patients may also complain of headache behind the temples or at the base of the skull, neck stiffness or difficulty moving the neck, sensitivity to light or problems moving the eyes, says Harris. These patients need to be seen by their doctors without delay. Since they may not be able to make this decision for themselves, friends and family members may need to step in.
Breathing Problems
In the 2008 edition of "Harrison's Principles of Internal Medicine," University of Alabama Professor of Infectious Diseases Richard J. Whitley explains that pneumonia is the most common complication of the varicella-zoster virus that causes shingles. In addition to breathing problems, patients typically report fever, chills, cough and pain with the intake of breath. All patients with breathing problems due to shingles should be seen by a doctor. Patients who show signs of inadequate oxygenation such as blue coloration around the mouth or fingertips, fast breathing or shortness of breath and those who stop breathing need to be taken to the emergency department of the nearest hospital.
References
- National Institute of Neurological Disorders and Stroke: Shingles: Hope Through Research
- "Hazzard's Geriatric Medicine and Gerontology, 6th edition"; J.B. Halter et al.; 2009
- "Infection"; Herpes Zoster Meningoencephalitis; P. Harris et al.; 2010
- "Harrison's Principles of Internal Medicine, 23rd Edition"; A.S. Fauci et al.; 2008
