What Is Post-Shingles Encephalitis? Dianne Feinstein’s Recent Illness

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

For Ms. Feinstein, 89, the virus also brought on a previously unreported case of encephalitis, 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 more lasting problems. Those include memory or language trouble, sleep disorders, mood disorders, walking difficulty and other cognitive problems. Older patients tend to have the most trouble recovering.

It is not entirely clear why some shingles patients who develop encephalitis fare better or worse with the condition. Older age appears to put people at greater risk for more serious problems.

But published case studies have described even younger patients who show signs of retrieving their cognitive functions, only to deteriorate again.

“You may have some symptoms that last after the encephalitis,” Dr. Mirouse said of patients. “It’s not sure you will be able to recover completely. That’s true at 89, it’s also true at 30 or 20.”

Ms. Feinstein may have been at higher risk for developing encephalitis because her shingles had spread to her face and neck, which is known to put patients at risk of brain inflammation.

Inflammation alone can damage cells in the brain.

But shingles can also contribute to cognitive decline in other ways, including by damaging blood vessels of the brain, said Dr. Sharon E. Curhan, a physician and epidemiologist at Brigham and Women’s Hospital and Harvard Medical School, who is studying the link between shingles and changes in cognition.

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