Cranial Nerve VI Palsy Secondary to Herpes Zoster Ophthalmicus: A Case Report and Literature Review.

INTRODUCTION: In this report, we describe a rare case of a cranial nerve VI palsy secondary to herpes zoster infection with polyneuropathic involvement. CASE PRESENTATION: An 82-year-old male was seen by ophthalmology for acute onset of double vision. Fourteen days before presenting, he was diagnosed with herpes zoster ophthalmicus. He was suspected to have zoster polyneuropathy also involving cranial nerve IX and X given a sore throat that began prior to the characteristic trigeminal dermatomal rash. He was diagnosed with cranial nerve VI palsy secondary to herpes zoster infection. DISCUSSION: Ophthalmic complications of herpes zoster ophthalmicus are many; however, extraocular nerve palsies secondary to herpes zoster infection and zoster polyneuropathy are documented infrequently in the literature. CONCLUSIONS: Extraocular muscle palsies are a rare complication of herpes zoster infection. This case reviews the most current literature surrounding this condition and discusses the significance of polyneuropathic involvement in varicella zoster virus reactivation.

Fourth and sixth nerve palsies due to Herpes Simplex 1 infection.

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.

Unique presentation of 3rd and 6th cranial nerve palsies, nodular scleritis and nummular keratouveitis in an immunocompetent patient following an attack of herpes zoster ophthalmicus.

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.

[Benign but not harmless intracranial hypertension: a case report]. / Hypertension intracrânienne bénigne, mais pas anodine. À propos d'un cas.

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.

Isolated abducens nerve palsy complicating cytomegalovirus infection.

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.

[Case of herpes zoster ophthalmicus with abducent palsy: the cause and magnetic resonance imaging findings].

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.

HIV-assocated lymphoma: a case report.

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.