VZV‐reactivation may lead to symptomatic central nervous system (CNS) diseases, but identification of VZV as causative pathogen of CNS‐diseases is challenging. This study was performed to characterize VZV‐specific T cells from cerebrospinal fluid (CSF) and blood of patients with active CNS‐disease and to determine whether this may improve differential diagnosis. 27 patients with pleocytosis in the CSF were recruited and classified into three groups (10 VZV‐related, 10 non‐VZV‐related, 7 unclear). VZV‐specific CD4⁺ T cells were quantified in CSF and blood after simultaneous stimulation with a VZV‐antigen lysate and detection of cytokines (IFN‐γ, IL‐2, TNF‐α) and CTLA‐4. Polyclonal stimulation served as positive control. VZV‐specific CD4⁺ T‐cell frequencies were highest in both CSF (p = 0.0001) and blood (p = 0.011) of patients with VZV‐infection, and were enriched at the site of infection (p = 0.002). While cytokine‐expression profiles only showed minor differences between the groups, CTLA‐4‐expression levels on VZV‐specific T cells from CSF and blood were significantly increased in VZV‐related CNS‐infections (p = 0.0002 and p<0.0001) and clearly identified VZV‐related CNS‐diseases (100% sensitivity and 100% specificity). Polyclonally stimulated T cells did not show any quantitative and phenotypical differences between the groups. Increased frequency and CTLA‐4‐expression of VZV‐specific T cells from CSF or blood are specifically found in patients with VZV‐related CNS‐infection.