Background & Objective: About 95% of the adult population has been infected with varicella zoster virus (VZV). It can involve any part of the nervous system. This study aimed to determine the spectrum of neurological manifestations in patients with primary varicella zoster virus infection, its clinical course and prognosis. Methods: This was an observational study of patients who presented with primary VZV infection in the Institute of Neurology, Madras Medical college, Chennai between August 2015 and February 2018. Patients with neurological manifestations due to VZV reactivation were not included in the study. Detailed history, clinical examination, blood investigations, MRI brain and whole spine, CSF analysis including viral studies, nerve conduction studies, EEG were analysed. All primary VZV patients were found to have characteristic chickenpox rash and/or its scar. The course of disease and clinical outcome after treatment were studied. Results:Among the 22 patients, 10 patients presented with VZV meningoencephalitis, 4 patients with Guillain-Barré syndrome (GBS), 2 patients with meningoencephalitis with cerebellitis, 2 patients with cerebellitis, 1 patient as acute disseminated encephalomyelitis ( ADEM), 1 patient as neuromyelitis optica (NMO), Two patients had acute stroke like deficits due to VZV vasculopathy. GBS and ADEM patients were treated with intravenous immunoglobulin and NMO patient was treated with intravenous methylprednisolone and they clinically improved after 4 weeks. There were two mortalities (9%). Conclusion: Meningoencephalitis followed by GBS were the main manifestations of primary VZV from Chennai, India