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NEUROLOGY 1991;41:1215
© 1991 American Academy of Neurology

Preherpetic neuralgia

D. H. Gilden, MD, A. N. Dueland, MD, R. Cohrs, PhD, J. R. Martin, MD, B. K. Kleinschmidt-DeMasters, MD and R. Mahalingam, PhD

Departments of Neurology (Drs. Gilden, Dueland, Cohrs, Kleinschmidt-DeMasters, and Mahalingam), Microbiology and Immunology (Dr. Gilden), and Pathology (Dr. Kleinschmidt-DeMasters), University of Colorado School of Medicine, Denver, CO; and the Laboratory of Experimental Neuropathology (Dr. Martin), National Institutes of Health, Bethesda, MD.

We have encountered six zoster patients whose pain preceded rash by 7 to more than 100 days. Pain was severe, burning, and radicular, and located both in dermatomes different from, as well as in, the area of eventual rash. Two patients ultimately developed disseminated zoster with neurologic complications, one of zoster paresis, and the other, a fatal zoster encephalitis; both had been taking long-term, low-dose steroids. A third case of preherpetic neuralgia developed in a patient with prior metastatic carcinoma, and another case in a patient with an earlier episode of brachial neuritis. The final two cases of preherpetic neuralgia developed in individuals with no underlying disease. An extended period of pain before the onset of zoster rash has gone largely unrecognized.

Address correspondence and reprint requests to Dr. Donald H. Gilden, Department of Neurology, 4200 East 9th Avenue, Campus Box B-182, Denver, CO 80262.

Supported in part by Public Health Service Grants NS-07321, AG-06127, AG-07347, and AI-30462 from the National Institutes of Health, and a grant from the Roy and Beatrice Backus Foundation. A.N.D. is the recipient of an advanced postdoctoral fellowship (FG 861-A-1) from the National Multiple Sclerosis Society.

Received November 9, 1990. Accepted for publication in final form January 7, 1991.




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