Immunosuppressed patients are at higher risk for developing herpes zoster (HZ), and neurological complications are frequent in them. However, the influence of immunosuppression (IS) on the severity and prognosis of neurological complications of varicella-zoster virus (VZV) reactivation is unknown. We studied retrospectively patients with neurological complications due to VZV reactivation who attended our hospital between 2004 and 2019. We aimed to assess the clinical spectrum, potential prognostic factors, and the influence of the immune status on the severity of neurological symptoms. A total of 98 patients were included (40% had IS). Fifty-five patients (56%) had cranial neuropathies which included Ramsay-Hunt syndrome (36 patients) and cranial multineuritis (23 patients). Twenty-one patients developed encephalitis (21%). Other diagnosis included radiculopathies, meningitis, vasculitis, or myelitis (15, 10, 6, and 4 patients, respectively). Mortality was low (3%). At follow-up, 24% of patients had persistent symptoms although these were usually mild. IS was associated with severity (defined as a modified Rankin scale greater than 2) (odds ratio, 4.23; 95% confidence interval, 1.74–10.27), but not with prognosis. Shorter latency between HZ and neurologic symptoms was the only factor associated with an unfavorable course (death or sequelae) (odds ratio, 0.82; 95% confidence interval, 0.71–0.95). In conclusion, the clinical spectrum of neurological complications in VZV reactivation is wide. Mortality was low and sequelae were mild. The presence of IS may play a role on the severity of neurological symptoms, and a shorter time between HZ and the onset of neurological symptoms appears to be a negative prognostic factor.

免疫抑制患者患带状疱疹 (HZ) 的风险更高，并且神经系统并发症在他们中很常见。然而，免疫抑制 (IS) 对水痘-带状疱疹病毒 (VZV) 再激活的神经系统并发症的严重程度和预后的影响尚不清楚。我们回顾性研究了 2004 年至 2019 年期间在我院就诊的因 VZV 再激活而出现神经系统并发症的患者。我们旨在评估临床谱、潜在预后因素以及免疫状态对神经系统症状严重程度的影响。共包括 98 名患者（40% 患有 IS）。55 名患者 (56%) 患有颅神经病变，其中包括 Ramsay-Hunt 综合征 (36 名患者) 和颅多发性神经炎 (23 名患者)。21 名患者发展为脑炎 (21%)。其他诊断包括神经根病、脑膜炎、血管炎或脊髓炎（分别为 15、10、6 和 4 名患者）。死亡率很低（3%）。在随访中，24% 的患者有持续的症状，尽管这些症状通常是轻微的。IS 与严重程度（定义为大于 2 的改良 Rankin 量表）（优势比，4.23；95% 置信区间，1.74-10.27）相关，但与预后无关。HZ 和神经系统症状之间较短的潜伏期是与不利病程（死亡或后遗症）相关的唯一因素（优势比，0.82；95% 置信区间，0.71-0.95）。总之，VZV 再激活神经系统并发症的临床范围很广。死亡率低，后遗症轻微。IS 的存在可能会影响神经系统症状的严重程度，