• Depression
  
  Clinical depression is a state of intense despair or sadness that has become disruptive to the patient’s daily life. Non-clinical depression is a feeling of sadness that does not affect the patient’s ability to function. Clinical depression is much more serious than normal depressed feelings; it can even lead to suicidal thoughts and requires immediate medical attention.
  
  
• Post Viral Fatigue
  
  Post-viral fatigue syndrome (PVFS) is a term describing the extended fatigue and weakness common after any severe viral infection. This fatigue is a severe mental and physical exhaustion or depletion which is unrelieved by rest and is often worsened by even trivial exertion. The term is not widely used, but the state of prolonged or severe fatigue after a viral illness is not uncommon. Some persons will experience fatigue of a few months to years following a severe infection or illness. Some researchers claim that post-viral fatigue results from damage to the immune system, and that it is common to many post-viral patients. In the UK, PVFS was adopted as a new name for Myalgic Encephalomyelitis (ME), while in the United States and elsewhere the syndrome is known as Chronic Fatigue Syndrome.
  
  
• PostHerpetic Neuralgia
  
  Pain following a herpes infection. Pain that persists for longer than a month after the vesicles (blisters) disappear is likely to be PHN. It is more common in patients over 50. PHN may develop as a continuation of pain that accompanies the onset of RHS or it may develop later. The pain usually resolves within 6 months but in about 1% of patients pain will continue for a year or longer.
  
  
• Vestibular Problems
  
  Symptoms of vestibular dysfunction due to RHS include vertigo, often accompanied by nausea, and dysequilibrium. Vertigo refers to an illusion of motion when there is conflicting information going to the brain from the eyes and the inner ear, and is often described as a spinning sensation. Dysequilibrium is often described as a feeling of being lightheaded, woozy, drunk, disoriented, and unsteady when walking. In RHS, vestibular problems usually result from viral injury to the 8th cranial nerve.
  
  
• Vocal Cord Paralysis
  
  Inability of one or both vocal cords (vocal folds) to move. In RHS, the paralysis is due to viral damage to the nerves leading to the vocal cords.
  
  

Cranial Nerve Syndrome Complications

• Cranial Nerve Palsies
  
  Dysfunction of cranial nerves are called cranial nerve palsies. Inflammation of CN VII, the facial nerve, is characteristic of RHS, causing facial muscle paralysis and loss of taste. The second most common CN involved is CN VIII, the vestibulocholear nerve, resulting in loss of hearing, vertigo, disequilibrium, tinnitis, and/or hyperacusis. Other nerves less commonly affected include: CNs III, IV, and VI, the oculomotor, trochlear, and abducens nerves, respectively, controlling eye movement and focusing and pupil dilation; CN V, the trigeminal nerve, controlling the senses of touch and pain in the face and head as well as the jaw muscles; and CN IX, the Glossopharyngeal Nerve, controlling swallowing and the gag reflex.
  
  
• Granulomatous Angiitis
  
  
• Meningoencephalitis
  
  Inflammation of the brain and spinal cord and their meninges (the system of membranes that envelop the central nervous system). Also called encephalomeningitis. Meningoencephalitis is most likely to be seen in immunocompromised patients.
  
  
• Myelitis
  
  Myelitis is a disease involving swelling of the spinal cord, which disrupts central nervous system functions linking the brain and limbs.
  
  

Disseminated (Systemic) Zoster

Which may lead to:

• Encephalitis
  
  Encephalitis is an acute inflammation of the brain. It can lead to brain damage and death as the inflamad brain pushes against the skull. It is a rare complication of RHS.
  
  
• Hepatitis
  
  Hepatitis is inflammation of the liver. It is a rare complication of RHS.
  
  
• Pneumonitis
  
  Pneumonitis is inflammation of lung tissue. As a complication of RHS, this may be a result of paralysis of the muscles that control swallowing, permitting foreign matter to be aspirated into the lungs. It is a rare complication of RHS.
  
  

Ear Problems

• Deafness
  
  A physical condition characterized by lack of sensitivity to sound.
  
  
• Tinnitus
  
  Tinnitus is the medical term for noise that people hear in one ear, both ears or in their head without stimulus from the surroundings. Tinnitus is experienced in many different ways, such as ringing, buzzing, humming, whistling, or music.
  
  

Eye Problems

• Blindness
  
  Blindness is the condition of lacking visual perception due to physiological or psychological factors.
  
  
• Conjunctivitis
  
  Conjunctivitis (aka pinkeye) is an inflammation of the conjunctiva, the mucus membrane covering the inner side of the eyelids and the white of the eyes. It is a fairly common condition and is usually caused by allergies or baterial/viral infections.
  
  
• Corneal ulceration
  
  An ulcer on the cornea of the eye, considered an ophthalmologic emergency because of the danger of scarring and blindness. The ulcers generally follow a trauma (e.g., abrasion) to or severe dryness of the corneal epithelium, providing an entry for bacteria.
  
  
• Glaucoma
  
  Glaucoma is a group of diseases of the optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy.
  
  
• Iridocyclitis
  
  Iridocyclitis, a type of anterior uveitis, is a condition in which the uvea of the eye suffers inflammation.
  
  
• Keratitis
  
  Keratitis is an inflammation of the cornea, the clear membrane which covers the coloured part of the eye (iris) and the pupil. Bacterial/viral infections, abrasions on the cornea and a very dry cornea can lead to keratitis. If left untreated it can cause blindness so immediate medical attention is required.
  
  

Other Cranial Nerve Syndromes

Particularly Ophthalmic Zoster.

• Ophthalmic Zoster.
  
  When the varicella-zoster virus is reactivated in the trigeminal nerve’s ophthalmic division, the infection is called ophthalmic zoster or herpes zoster ophthalmicus. Most frequently, vesicles appear around the orbit of the eye. Complications of ophthalmic zoster may include chronic ocular inflammation, loss of vision, and debilitating pain.
  
  

Shingles Vesicles

• Disseminated Cutaneous Zoster
  
  Disseminated cutaneous zoster has been defined as more than 20 vesicles outside the area of the primary and adjacent dermatomes. This complication of zoster has been described in immunocompromised persons (HIV, cancer, patients on immunosuppressive therapy). However, disseminated cutaneous zoster in otherwise healthy persons who are not on immunosuppressive therapy and have no underlying cancer is rare.
  
  
• Secondary bacterial infection of the vesicles
  
  Secondary infections, including cellulitis, can be caused by the introduction of any one of many bacteria to open lesions at the site of the zoster outbreak. Such bacteria can include Group A streptococcus, which can cause severe infection. Good hygiene can help prevent this complication. Should such secondary bacterial infection occur, early recognition and treatment of the infection is necessary. This is most often seen in immunocompromised patients. However, open, weeping sores in any RHS patient are vulnerable to additional infection