The most frequent Meningitis-induced complications encountered in decreasing order of frequency were infarcts (31.25%), obstructive hydrocephalus (25%), cerebritis (9.37%), ependymitis (6.25%) and choroid plexitis (3.1%) (Table/Fig.
(6,11,17) The reactive inflammatory process can cause arteritis, arachnoiditis, and ependymitis. (6,10) The granular-nodular stage involves progressive degenerative changes with increased larval decay, vesicle involution, and thickening of the vesicle wall.
In the brain, VZV involvement of small blood vessels or ependymal cells results in small-vessel vasculopathy (Figure 11, B, D, and E) (multifocal leukoencephalopathy) or ependymitis (ventriculitis), respectively.[4-6,45-49] Both MRI (Figure 11, B) and PCR of the CSF for VZV DNA (Figure 11, C) are helpful in the diagnosis.