What is postherpes zoster encephalitis? Dianne Feinstein’s recent illness


Dianne Feinstein, the Democratic senator from California, returned to the Capitol last week after spending more than two months recovering from shingles. The disease, often marked by a painful rash, is caused by the same virus that causes chickenpox, which remains in people’s bodies for life, and can reactivate years later.

For Ms. Feinstein, 89, the virus has also taken its toll A previously unreported case of encephalitisThis is a rare but potentially debilitating complication in which the brain swells. The condition is often caused by an infection or an immune response.

Post-shingles encephalitis can cause headache, fever, sensitivity to light, vomiting, confusion, a stiff neck, or even seizures.

It can also leave some patients with permanent problems. These include memory or language problems, sleep disturbances, mood disorders, difficulty walking, and other cognitive problems. Older patients tend to have more problems recovering.

There are milder and more severe cases. a French study from last year Looking at dozens of critically ill patients, it was found that about one-fifth of them became seriously disabled after a year of hospitalization, and one-third of them died.

a Separate study in Denmark from 2020 It was found that approximately half of postherpes zoster encephalitis patients admitted to hospitals were at least moderately disabled three months after discharge.

Dr. Adrien Meros, a physician and immunologist at the Sorbonne in Paris who led the French study last year, estimated that less than 1 percent of shingles patients develop encephalitis.

But he said it’s been difficult to pinpoint exact rates: Milder cases often go unreported, making it difficult to know the true number of patients with herpes zoster or subsequent encephalitis.

Historically it was thought that brain swelling affected mostly immunocompromised shingles patients. But recent studies have found that many patients are simply older and have routinely weakened immune systems. For this reason, the condition may be becoming increasingly common as the population ages, experts said.

It’s not entirely clear why some shingles patients who develop encephalitis get better or worse with the condition. Advances in age seem to put people at greater risk of more serious problems.

But published case studies describe even younger patients who show signs of their cognitive function recovering, only to deteriorate again.

“You may have some symptoms that persist after encephalitis,” Dr. Meros said of the patients. “It’s not certain that you’ll be able to fully recover. That’s true at 89, and it’s also true at 30 or 20.”

Ms. Feinstein may be at increased risk for encephalitis due to an outbreak of herpes zoster in her face and neck, which puts patients at risk for encephalitis.

Inflammation alone can damage brain cells.

Shingles can also contribute to cognitive decline in other ways, including damage to blood vessels in the brain, said Dr. Sharon E. Korhan, a physician and epidemiologist at Brigham and Women’s Hospital and Harvard Medical School. and changes in perception.

Patients with shingles also face a higher long-term risk of having a stroke, a condition that can itself lead to cognitive decline, according to Study led by Dr. Korhan published last year.

Mrs. Feinstein was Herpes zoster vaccine, which in most people provides strong protection against the virus and the complications that can follow. Federal health officials I recommend the vaccine For people 50 years of age and older and younger with a weakened immune system.


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