IMR Press / JIN / Volume 22 / Issue 2 / DOI: 10.31083/j.jin2202036
Open Access Original Research
Next-Generation Sequencing of Cerebrospinal Fluid for the Diagnosis of VZV-Associated Rhombencephalitis
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1 Department of Neurology, Hengshui People’s Hospital, 050000 Hengshui, Hebei, China
2 Department of Neurological Function Examination, Hengshui People's Hospital, 050000 Hengshui, Hebei, China
3 Department of MRI, Hengshui People’s Hospital, 050000 Hengshui, Hebei, China
*Correspondence: (Jianguo Zhu)
These authors contributed equally.
J. Integr. Neurosci. 2023, 22(2), 36;
Submitted: 11 August 2022 | Revised: 3 September 2022 | Accepted: 8 September 2022 | Published: 16 February 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Rhombencephalitis (RE) is a general term for a group of inflammatory diseases of the rhombencephalon caused by different etiologies. Patients of RE caused by the varicella-zoster virus (VZV) are sporadic in medical practice. The VZV-RE is easily misdiagnosed and causes a poor prognosis for patients. Methods: In this study, we analyzed the clinical symptoms and imaging features of five patients with VZV-RE diagnosed by the next-generation sequencing (NGS) technique of cerebrospinal fluid. Magnetic resonance imaging (MRI) examination was used to characterize the imaging of the patients. The McNemar test was used to analyze the cerebrospinal fluid testing (CSF) values and MRI test of the 5 patients. Results: We finally used NGS technology to confirm the diagnosis in 5 patients with VZV-RE. MRI revealed T2/FLAIR high signal lesions in the patients’ medulla oblongata, pons, and cerebellum. All patients had early signs of cranial nerve palsy; some had herpes or pain in the corresponding cranial nerve distribution areas. The patients develop headaches, fever, nausea, vomiting, and other signs and symptoms of brainstem cerebellar involvement. McNemar’s test showed no statistical difference between multi-mode MRI and CSF values for diagnosing VZV-RE (p = 0.513). Conclusions: This study showed that patients with herpes in the skin and mucous membranes at the distribution area of the cranial nerves and with the underlying disease were prone to RE. We suggest that the NGS analysis should be considered and selected based on the level of parameters, such as MRI lesion characteristics.

varicella-zoster virus
cerebrospinal fluid
next-generation sequencing
magnetic resonance imaging
2019014078Z/Projects in Science and Technique Plans of Hengshui City
Fig. 1.
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