Herpes zoster ophthalmicus as a cause of Horner syndrome.

Herpes zoster ophthalmicus is a disease in which the varicella-zoster virus replicates and produces inflammation in the skin of the face supplied by the sensory branches of the ophthalmic division of the trigeminal nerve. It can also cause a conjunctivitis, keratitis, uveitis, extraocular muscle paralysis, and acute retinal necrosis. We found only a single report of this disease as a cause of Horner syndrome. Here we report a case of herpes zoster ophthalmicus that progressed to a sixth nerve palsy and, subsequently, a Horner syndrome. We discuss how the anatomic relationship of the fifth, sixth, and sympathetic nerves in the cavernous sinus provides a route whereby the varicella-zoster virus may produce a Horner syndrome. To our knowledge this is the first fully documented case of Horner syndrome caused by herpes zoster ophthalmicus.

Cerebral infarction and subdural hematoma. Advantage of nuclear magnetic resonance imaging in cerebral ischemia.

Visual hallucinations were the initial complaints in a patient with a posterior cerebral artery occlusions who fell and sustained bilateral subdural hematomas. In addition to poor vision, the patient experienced formed visual hallucinations of the epileptic type in the hemianopic field. The hemianopia was dense with macular sparing. CAT scans, which were done pre- and postoperatively, showed no abnormalities in the temporal and occipital lobes to explain the "epileptic visual hallucinations" and macular sparing. The NMR scan showed low-density changes in those areas. At the time that the NMR scan was done, most of the patient's deficits, including the hemianopia and hallucinations, had resolved.

Concomitant strabismus as a sign of intracranial disease.

A child with a postoperative residual estropia of 16 diopters was suddenly found to have 75 D of esotropia for distance and 65 D of estropia for near. Full versions were noted that would be inconsistent with sixth nerve palsy. Divergence palsy is characterized by a substantially larger convergent strabismus for distance that, in this case, was only 10 D. One is left with the conclusion that concomitant strabismus may indicate the onset of intracranial disease that, in this case, was caused by an arteriovenous malformation.

Computed tomography and angiography in the diagnosis of suprasellar mass lesions.

We studied four cases in which the differentiation between a noncalcified suprasellar aneurysm and tuberculum meningioma, and a calcified suprasellar aneurysm and craniopharyngioma, could not be established by computed tomography scan alone. Cerebral angiography clearly showed both aneurysms.

Orbital neurofibromatosis: involvement of the orbital floor.

Neurofibromatosis has been reported to involve the eye and orbit by causing irregularities of the sphenoid and other facial bones and enlargement of the foramina. To our knowledge, abnormalities of the orbital floor, however, have not been attributed to this disease in the literature until now. Two patients with neurofibromatosis had orbital floor involvement. Multiple neurofibromas eroding the orbital floor threatened vision in one patient. The other case, seen after trauma, had a condition simulating that of a blow-out fracture. Diagnostic workup with adequate roentgenography, especially tomography, helped to establish the diagnosis. We believe this is of importance in modifying the surgical approach, obviating the need for surgical intervention at times.

Tolosa-Hunt syndrome.

A 58-year-old woman with painful ophthalmoplegia of the left eye associated with thrombosis of the left superior ophthalmic vein and normal angiography is presented. Symptoms cleared on systemic prednisone therapy within 72 hours. The clinical picture associated with the venographic findings and response to steroids are characteristic of the Tolosa-Hunt syndrome.