Although herpes zoster has been known as a disease of the spinal ganglia due to virus infection it has been considered similar to a skin disease since its diagnosis is dependent on the cutaneous changes. Following are the results obtained in the comparative study of the amount of protein, sugar, Cl, NPN, and globulin reaction of the spinal fluid in 32 cases of herpes zoster on one hand and 42 cases of Japanese encephalitis, 10 cases of acute poliomyelitis, one case of polyneuritis. and 2 cases of intercostal neuralgia on the other.
1) Herpes Zoster: Intraspinal pressure was found slightly higher than normal in most of the cases. In all cases the fluid was found clear but zamthochromia was found in several cases. Cell count was increased in almost all cases and mononuclear cells were increased. In some cases the amount of protein is slightly increased. Pandy's reaction was positive in almost all cases. Nonne's reaction was positive in about half of the cases. The amount of NPN and triptophan reaction was normal. Cl was found to be increased in 13 cases but its significance is obscure. These changes were independent of the severity of the skin changes and pain. The spinal fluid was found entirely normal in several cases. In 8 cases in which the course of the disease was followed the recovery of the skin condition was not rapid in spite of only slight changes of spinal fluid were noted.
2) Japanese Encephalitis: The changes were almost similar to those of herpes zoster. However, the decrease of the amount of Cl and increase of mononuclear cells as noted in herpes zoster were not observed.
3) Acute Poliomyelitis and Polyneuritis: No difference of the changes of the fluid was noted between herpes zoster and these conditions.
4) Intercostal Neuralgia: Spinal fluid was found quite normal.
On the basis of above results, namely the changes of the spinal fluid, it is assumed the presence of certain changes also occur in the meninges and in the central nervous system. Furthermore as found in the literature that certain cases of facial paralysis, Landry's paralysis, encephalitis and Parkinson's syndrome being caused by herpes zoster virus, it is difficult to differentiate herpes zoster from these conditions by the spinal fluid alone, and only by the skin conditions the diagnosis is possible.
There were cases in which no pain was accompanied. It is possible to assume that there may even be cases in which no skin changes occur. These cases may be considered as nonmanifest infection. From these facts it is considered that there may be cases of peripheral paralysis, neuralgia, Guillain-Barre's syndrome, acute poliomyelitis, transverse myelitis, Parkinson's syndrome, polyneuritis, disseminated encephalomyelitis, multiple sclerosis and serous meningitis which are also due to herpes zoster virus.
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