Facial herpes zoster infection precipitated by surgical manipulation of the trigeminal nerve during exploration of the posterior fossa: a case report

Multidermatomal Shingles Occurrence Post-therapeutic Dry Needling (TDN) in a Saudi Woman

This is a case report of the occurrence of shingles (herpes zoster) in a multidermatomal distribution following therapeutic dry needling. The patient developed acute reactivation of varicella-zoster virus two days after the third session of dry needling for the relief of long-standing pain in the hip and sacroiliac joints. The lesions initially presented with severe pain along lumbar dermatomes with later rash development. The patient was treated with oral valacyclovir 1,000 mg three times daily for seven days, and the pain was controlled with ibuprofen. The lesions resolved two weeks later without any complications or sequelae.

Post-total knee arthroplasty herpes zoster activation

Herpes zoster is a clinical manifestation of reactivation of varicella-zoster virus (VZV) that lies dormant in the dorsal root ganglia after a past primary infection. It can be associated with severe pain, a crop of vesicles in typical dermatomal distribution but the neuralgic pain persists long, making the patient uncomfortable and often disturbing patient's sleep. There are cases reported after trauma or post surgeries that are mainly related to organ transplant or malignancy. In the literature, there is a solitary report of VZV infection along the sciatic nerve post ipsilateral hip and contralateral knee joint replacement. Here, we report a VZV infection in post knee replacement setting along the L2-3 dermatomal distribution.

Factors Leading to Oro-Facial Herpetic Eruptions in Patients Undergoing Surgery for Vestibular Schwannoma

OBJECTIVE

To study factors influencing oro-facial herpetic eruptions (HEs) in patients undergoing retromastoid suboccipital craniectomy for vestibular schwannomas (VS).

METHODS

A retrospective analysis of the prospectively collected database (from July 2014 to December 2015). A total of 87 patients underwent retromastoid suboccipital craniectomy for VS at our center. For the purpose of analysis the patient subset was divided into 2 groups, HE and non-HE. Pearson χ² test or Fisher exact test were used to identify the factors.

RESULTS

The overall incidence of postoperative HE was less than 1% (0.89%, 26 patients of 2916 cases); whereas after VS surgery, it was 20.69% (18 of 87). Demographic profiles of patients in the 2 groups were comparable. Average tumor size (with HE 3.19 ± 2 × 0.67 cm, non-HE 3.38 ± 2 × 1.07 cm), consistency, and laterality also were comparable between the 2 groups. Factors favoring development of postoperative HEs were large size (12 vs. 22, P = 0.013) and preoperative trigeminal nerve (CN V) involvement (9 of 18, 50%, P = 0.046). All patients developed HE in maxillary division of trigeminal nerve (V2), whereas involvement of ophthalmic (V1) and mandibular (V3) divisions were involved less commonly in combination with V2 (V2, 72.2%; V2 + V3, 22.2%; V1 + V2 + V3, 5.6%). The majority of the patients (55.56%) developed HE on postoperative day 3 and none beyond postoperative day 5. All patients responded to empirical oral acyclovir.

CONCLUSIONS

The study highlights the relatively high incidence and factors associated with this rare but benign complication.

Postoperative Shingles Mimicking Recurrent Radiculopathy after Anterior Cervical Diskectomy and Fusion

Study Design Case report and review of literature. Objective To report the case of a 67-year-old woman who developed delayed onset (6 months) of symptomatic shingles after cervical nerve root decompression in a previously symptomatic dermatome. Methods The patient's clinic course and outcomes were retrospectively reviewed. The study required no outside funding. The study authors have no financial interest in any of the products or techniques discussed. Results The patient received definitive treatment for shingles once the zoster form rash manifested. The patient, however, developed postherpetic neuralgia and remained symptomatic at her 2-year postoperative visit. Conclusions Although shingles is a common disease state affecting patients in the fifth and sixth decades of life, it is rarely seen in the setting of cervical nerve root decompression. This case demonstrates the need to include shingles on the differential diagnosis of recurrent neurogenic pain after anterior cervical decompression and fusion.

Human herpesvirus 1 meningoencephalitis after trigeminal neuralgia surgery

We report a case of human herpesvirus 1 (HHV-1) meningoencephalitis in a patient who underwent trigeminal neuralgia surgery. Although this surgery has been reported to increase the risk of mucocutaneous HHV-1 recurrence, to our knowledge, an association between trigeminal surgery and HHV-1 encephalitis has not been previously described.