Subject(s)
Cranial Nerve Diseases/diagnosis , Herpes Zoster/diagnosis , Mononeuropathies/diagnosis , Abducens Nerve Diseases/diagnosis , Abducens Nerve Diseases/drug therapy , Abducens Nerve Diseases/physiopathology , Abducens Nerve Diseases/virology , Aged , Cranial Nerve Diseases/drug therapy , Cranial Nerve Diseases/physiopathology , Cranial Nerve Diseases/virology , Diagnosis, Differential , Diplopia/physiopathology , Earache/physiopathology , Edema/physiopathology , Facial Nerve Diseases/diagnosis , Facial Nerve Diseases/drug therapy , Facial Nerve Diseases/physiopathology , Facial Nerve Diseases/virology , Facial Paralysis/physiopathology , Glossopharyngeal Nerve Diseases/diagnosis , Glossopharyngeal Nerve Diseases/drug therapy , Glossopharyngeal Nerve Diseases/physiopathology , Glossopharyngeal Nerve Diseases/virology , Glucocorticoids/therapeutic use , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sensorineural/drug therapy , Hearing Loss, Sensorineural/physiopathology , Hearing Loss, Sensorineural/virology , Herpes Zoster/drug therapy , Herpes Zoster/physiopathology , Humans , Male , Mononeuropathies/drug therapy , Mononeuropathies/virology , Osteomyelitis/diagnosis , Otitis Externa/diagnosis , Prednisolone/therapeutic use , Skull Base , Vagus Nerve Diseases/diagnosis , Vagus Nerve Diseases/drug therapy , Vagus Nerve Diseases/physiopathology , Vagus Nerve Diseases/virology , Vestibulocochlear Nerve Diseases/diagnosis , Vestibulocochlear Nerve Diseases/drug therapy , Vestibulocochlear Nerve Diseases/physiopathology , Vestibulocochlear Nerve Diseases/virology , Virus ActivationSubject(s)
Cranial Nerve Diseases/diagnosis , Eye Infections, Viral/diagnosis , Herpes Zoster Ophthalmicus/diagnosis , Ocular Motility Disorders/diagnosis , Orbital Diseases/diagnosis , Abducens Nerve Diseases/diagnosis , Abducens Nerve Diseases/drug therapy , Abducens Nerve Diseases/virology , Acyclovir/therapeutic use , Aged , Antiviral Agents/therapeutic use , Cranial Nerve Diseases/drug therapy , Cranial Nerve Diseases/virology , Epithelium, Corneal/pathology , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Female , Glucocorticoids/therapeutic use , Herpes Zoster Ophthalmicus/drug therapy , Herpes Zoster Ophthalmicus/virology , Humans , Male , Ocular Motility Disorders/drug therapy , Ocular Motility Disorders/virology , Oculomotor Nerve Diseases/diagnosis , Oculomotor Nerve Diseases/drug therapy , Oculomotor Nerve Diseases/virology , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/drug therapy , Optic Nerve Diseases/virology , Orbital Diseases/drug therapy , Orbital Diseases/virology , Prednisolone/therapeutic use , Trigeminal Nerve Diseases/diagnosis , Trigeminal Nerve Diseases/drug therapy , Trigeminal Nerve Diseases/virology , Trochlear Nerve Diseases/diagnosis , Trochlear Nerve Diseases/drug therapy , Trochlear Nerve Diseases/virologyABSTRACT
Ocular motor cranial nerve palsies of viral etiology are uncommon and, when accompanied by skin lesions, zoster ophthalmicus is the most frequent diagnosis. We describe the case of a 68-year-old woman who developed fourth and sixth nerve palsies 3 days after appearance of a painful vesicular skin rash on the left side of her forehead. Neuroimaging was normal but polymerase chain reaction (PCR) testing of the cerebrospinal fluid was positive for Herpes Simplex 1 and negative for Varicella Zoster. The patient was treated with intravenous acyclovir, and the cranial nerve palsies resolved over 7 weeks. Although the similarity of the cutaneous vesicular eruption in our patient to that seen with zoster might have led to an incorrect diagnosis, acyclovir seems to be safe and effective for both viral etiologies.
Subject(s)
Abducens Nerve Diseases/etiology , Herpes Simplex/complications , Herpesvirus 1, Human/pathogenicity , Trochlear Nerve Diseases/etiology , Trochlear Nerve Diseases/virology , Abducens Nerve Diseases/virology , Aged , Female , HumansABSTRACT
AIM: To report a unique presentation of 3rd and 6th cranial nerve palsies with nodular scleritis and nummular keratouveitis following an attack of herpes zoster ophthalmicus (HZO). METHODS: Case report. CASE REPORT AND RESULTS: A 56-year-old woman with a 1-month history of HZO presented with drooping of the right upper eyelid, diplopia, and pain around the right eye. She was noted to have right 3rd and 6th cranial nerve palsies. She developed nodular scleritis and nummular keratouveitis at 2 and 4 months follow-up, respectively, which were treated with antivirals and steroids. At 10 months follow-up, although the diplopia in right lateral gaze persisted, there was no recurrence of ocular inflammation with complete recovery of ptosis. CONCLUSIONS: A unique presentation of multiple cranial nerve palsies with nodular scleritis and nummular keratouveitis in an immunocompetent patient following an attack of HZO is highlighted in this report.
Subject(s)
Abducens Nerve Diseases/virology , Herpes Zoster Ophthalmicus/virology , Oculomotor Nerve Diseases/virology , Scleritis/virology , Uveitis/virology , 2-Aminopurine/analogs & derivatives , 2-Aminopurine/therapeutic use , Abducens Nerve Diseases/drug therapy , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Diplopia/drug therapy , Diplopia/virology , Drug Therapy, Combination , Famciclovir , Female , Glucocorticoids/therapeutic use , Herpes Zoster Ophthalmicus/drug therapy , Humans , Middle Aged , Oculomotor Nerve Diseases/drug therapy , Prednisolone/therapeutic use , Treatment Outcome , Uveitis/drug therapyABSTRACT
Benign intracranial hypertension (BIH) is characterized as an intracranial pressure increase occurring in the absence of brain tumour, sinus thrombosis or hydrocephaly. But contrary to what its designation might suggest, it threatens the visual prognosis. We report the case of a 15-year-old girl with lymphocytic meningitis, developing secondary a BIH. Cerebrospinal fluid pressure was 70cm water, without enlargement of the cerebral ventricles. Along with the progression, bilateral 6th nerve palsy, impairment of visual acuity and bilateral papilledema appeared. No cause was found after a complete assessment. Treatment consisted in oral acetazolamide and 9 depletive spinal taps. Clinical examination, fundus examination and Goldmann visual field normalized after 8 weeks. No relapse occurred after a 1-year follow-up. This case shows that BIH, which is not a well-known disorder, is incorrectly referred to as benign: both prompt diagnosis and proper management are of major importance.
Subject(s)
Meningitis, Viral/complications , Pseudotumor Cerebri/virology , Abducens Nerve Diseases/virology , Acetazolamide/administration & dosage , Adolescent , Diplopia/virology , Diuretics/administration & dosage , Female , Humans , Meningitis, Viral/diagnosis , Meningitis, Viral/drug therapy , Papilledema/virology , Prognosis , Pseudotumor Cerebri/diagnosis , Pseudotumor Cerebri/drug therapy , Spinal Puncture , Treatment OutcomeABSTRACT
This report describes an immunocompetent 5-year-old female with isolated abducens nerve palsy complicating a cytomegalovirus infection and documented with polymerase chain reaction performed on cerebrospinal fluid; treatment with ganciclovir was associated with rapid clinical improvement. It may be the first report of cytomegalovirus detected in the central nervous system as a cause of isolated abducens nerve palsy.
Subject(s)
Abducens Nerve Diseases/virology , Cytomegalovirus Infections/complications , Antiviral Agents/therapeutic use , Child, Preschool , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Female , Ganciclovir/therapeutic use , HumansABSTRACT
PURPOSE: To report the cause and magnetic resonance imaging (MRI) findings in a case of abducent palsy following herpes zoster ophthalmicus. CASE: A 76-year-old man presented with acute onset of pain, a vesicular cutaneous eruption and herpes zoster ophthalmicus on the right side. He developed complete abducent palsy on the right side two weeks after onset. MRI with gadolinium enhancement showed Meckel's sinus, which contains the trigeminal ganglion, and the abducent nerve on the right side. The patient was treated with intravenous acyclovir and methylprednisolone. The abnormal enhancement shown on MRI vanished immediately and the ophthalmoplegia resolved significantly. CONCLUSION: This is the first reported case where an affected cranial nerve was detected next to the inflammatory cavernous sinus in ophthalmoplegia following herpes zoster ophthalmicus. These MRI findings showed that this ophthlamoplegia was induced by direct viral invasion or extension of inflammation to the ipsilateral cranial nerve. Further studies need to be performed to clarify the role of specific antiviral therapy or anti-inflammatory agents in treating this complication of herpes zoster.
Subject(s)
Abducens Nerve Diseases/etiology , Abducens Nerve Diseases/pathology , Herpes Zoster Ophthalmicus/complications , Magnetic Resonance Imaging , Abducens Nerve Diseases/virology , Acyclovir/therapeutic use , Aged , Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , Drug Therapy, Combination , Herpes Zoster Ophthalmicus/drug therapy , Humans , Infusions, Intravenous , Male , Methylprednisolone/therapeutic use , Treatment OutcomeABSTRACT
We report the case of a 3(1/2) year old boy who presented with sudden onset of headache. Fever and swelling of the left eye. He had complete opthalmoplegia of the left eye and 6th cranial nerve paralysis in the right eye. He was thought to have cavenous sinus thrombosis but CT findings suggestive of lymphoma led to the correct diagnosis of HIV associated Lymphoma It view of the rising incidence of HIV infection and the protein clinical manifestations, it is advised that all patients with disseminated tumour masses should be screened for the HIV virus, and CT examination should be made available to patients.