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1.
Arch Soc Esp Oftalmol (Engl Ed) ; 95(8): 404-407, 2020 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32505385

RESUMO

Varicella zoster virus (VZV) infection has a high prevalence worldwide. Within the multiple ophthalmologic manifestations that VZV can cause, sudden diplopia is among them. A review is presented of four clinical cases of 3rd and 4th oculomotor nerve palsies in herpes zoster ophthalmicus. A review is also presented of the physiopathology and most important clinical manifestations. Imaging tests are essential in order to rule out complications. Systemic antiviral administration is the correct treatment.


Assuntos
Herpes Zoster Oftálmico/complicações , Doenças do Nervo Oculomotor/virologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Optom Vis Sci ; 96(5): 367-371, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31046020

RESUMO

SIGNIFICANCE: Varicella-zoster virus is a common cause of morbidity and vision loss in patients worldwide. It can affect any structure of the eye, from keratitis to acute retinal necrosis. Rapid diagnosis and treatment significantly improve clinical outcomes and quality of life. PURPOSE: The purpose of this study was to demonstrate a case where urgent referral to the emergency department was required to treat a patient with disseminated herpes zoster infection. CASE REPORT: This is a rare case of varicella-zoster virus encephalitis in a 70-year-old immunocompetent white man who initially presented to the eye clinic for vertical diplopia and floaters. He also had prior thoracic dermatomal rash, followed by new-onset headaches and cerebellar ataxia. Examination revealed a partial oculomotor nerve palsy in the right eye with bilateral optic disc edema and areas of retinitis consistent with acute retinal necrosis in both eyes. Polymerase chain reaction analysis of his aqueous humor and cerebrospinal fluid confirmed an active zoster infection. He received combination systemic and intravitreal antiviral medication until his retinitis resolved but required adjustments for recalcitrant disease and drug-induced nephrotoxicity. While on maintenance dosing of oral valacyclovir, he experienced reactivation in the form of bilateral vasculitis, which was successfully managed once restarting therapeutic oral dosing. CONCLUSIONS: This case describes a successful clinical course of acute retinal necrosis with strategies for its treatment in the setting of varicella-zoster encephalitis. Antiviral medication should be given as soon as possible, as prompt treatment has been shown to improve patient outcomes, although prognosis is typically poor in these cases. Multiple specialists are often needed to address different clinical challenges, including central nervous system involvement, viral strain resistance, disease reactivation, and drug toxicity.


Assuntos
Encefalite por Varicela Zoster/diagnóstico , Infecções Oculares Virais/diagnóstico , Herpes Zoster Oftálmico/diagnóstico , Herpesvirus Humano 3/isolamento & purificação , Doenças do Nervo Oculomotor/diagnóstico , Síndrome de Necrose Retiniana Aguda/diagnóstico , Idoso , Antivirais/uso terapêutico , Humor Aquoso/virologia , Líquido Cefalorraquidiano/virologia , Quimioterapia Combinada , Encefalite por Varicela Zoster/tratamento farmacológico , Encefalite por Varicela Zoster/virologia , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Foscarnet/uso terapêutico , Glucocorticoides/uso terapêutico , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/virologia , Herpesvirus Humano 3/genética , Humanos , Infusões Intravenosas , Injeções Intravítreas , Masculino , Doenças do Nervo Oculomotor/tratamento farmacológico , Doenças do Nervo Oculomotor/virologia , Reação em Cadeia da Polimerase , Prednisolona/uso terapêutico , Qualidade de Vida , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Síndrome de Necrose Retiniana Aguda/virologia , Valaciclovir/uso terapêutico , Acuidade Visual/fisiologia
5.
Ocul Immunol Inflamm ; 26(2): 187-193, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28622058

Assuntos
Doenças dos Nervos Cranianos/diagnóstico , Infecções Oculares Virais/diagnóstico , Herpes Zoster Oftálmico/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Doenças Orbitárias/diagnóstico , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/tratamento farmacológico , Doenças do Nervo Abducente/virologia , Aciclovir/uso terapêutico , Idoso , Antivirais/uso terapêutico , Doenças dos Nervos Cranianos/tratamento farmacológico , Doenças dos Nervos Cranianos/virologia , Epitélio Corneano/patologia , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Feminino , Glucocorticoides/uso terapêutico , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/virologia , Humanos , Masculino , Transtornos da Motilidade Ocular/tratamento farmacológico , Transtornos da Motilidade Ocular/virologia , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/tratamento farmacológico , Doenças do Nervo Oculomotor/virologia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/tratamento farmacológico , Doenças do Nervo Óptico/virologia , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/virologia , Prednisolona/uso terapêutico , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/tratamento farmacológico , Doenças do Nervo Trigêmeo/virologia , Doenças do Nervo Troclear/diagnóstico , Doenças do Nervo Troclear/tratamento farmacológico , Doenças do Nervo Troclear/virologia
6.
J Neurovirol ; 23(5): 786-788, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28831691

RESUMO

Parvovirus B19 (PB19) is a common, widespread, small, single-stranded DNA virus which has been linked with a broad spectrum of clinical illnesses, including a variety of neurological complications such as encephalitis, meningitis, myelitis, stroke, cerebellar ataxia, and neuropathy. The authors describe a case of PB19 infection associated with hemolytic anemia and cranial polyneuropathy involving the second and third cranial nerves in a 23-year-old immunocompetent woman. The diagnosis of acute PB19 infection was established with detection of positive DNA and anti-PB19 IgM antibodies in blood samples. Antiganglioside antibody studies were performed and serum anti-GD1b IgG was strongly positive. Further investigation was normal or negative, excluding other infectious or autoimmune disorders. The patient was initially treated with a 5-day course of intravenous immunoglobulin (IGIV). Because of incomplete neurological recovery, methylprednisolone was also administered 7 days after IGIV therapy initiation. Complete resolution of clinical symptoms was observed 3 months after disease onset at follow-up visit, despite the persistence of PB19 DNA and anti-PB19 IgM antibodies in serum 5 months after the initial presentation. Our report provides evidence that PB19 could affect both the central and peripheral nervous system, possibly by triggering an autoimmune mechanism that leads to autoantibody production.


Assuntos
Anemia Hemolítica/virologia , Eritema Infeccioso/complicações , Doenças do Nervo Oculomotor/virologia , Doenças do Nervo Óptico/virologia , Autoanticorpos/imunologia , Autoantígenos/imunologia , Eritema Infeccioso/imunologia , Feminino , Gangliosídeos/imunologia , Humanos , Polineuropatias/virologia , Adulto Jovem
7.
Am J Trop Med Hyg ; 95(1): 180-1, 2016 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-27246445

RESUMO

We report the case of a 62-year-old patient who developed an acute painless isolated left third cranial nerve palsy sparing the pupil in the setting of an acute chikungunya infection. The patient had no significant medical history. Specifically, he had no vascular risk factors. Ocular involvement in chikungunya fever is uncommon. The potential virus- and infection-related mechanisms of this third cranial nerve palsy are discussed.


Assuntos
Febre de Chikungunya/virologia , Doenças dos Nervos Cranianos/virologia , Nervo Oculomotor/virologia , Doença Aguda , Aspirina/uso terapêutico , Região do Caribe , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/tratamento farmacológico , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/tratamento farmacológico , Seguimentos , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Nervo Oculomotor/efeitos dos fármacos , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/tratamento farmacológico , Doenças do Nervo Oculomotor/virologia , Fatores de Risco
10.
BMJ Case Rep ; 20122012 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-23109414

RESUMO

Viral infection is a rare cause of painful ophthalmoplegia. We report on a 67-year-old patient who developed painful double vision after a vesicular skin rash on the left forehead. MRI disclosed simultaneous inflammatory lesions in all extraocular muscles, the second and third cranial nerve, as well as pathological signal intensity along the spinal trigeminal tract and nucleus within the medulla oblongata and the pons. Cerebrospinal fluid and serum tests for varicella zoster were positive. The patient was treated effectively with intravenous acyclovir and methylprednisolone. Simultaneous lesions in various neighbouring neural structures may be characteristic for the highly neurotropic behaviour of the herpesviridae and should be considered as a cause of painful ophthalmoplegia that can be depicted by appropriate imaging.


Assuntos
Herpes Zoster Oftálmico/complicações , Herpesvirus Humano 3 , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Óptico/etiologia , Miosite Orbital/etiologia , Síndrome de Tolosa-Hunt/etiologia , Núcleos do Trigêmeo/virologia , Aciclovir/uso terapêutico , Idoso , Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , Diplopia/diagnóstico , Exantema/diagnóstico , Feminino , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/patologia , Herpes Zoster Oftálmico/virologia , Humanos , Metilprednisolona/uso terapêutico , Nervo Oculomotor/patologia , Nervo Oculomotor/virologia , Doenças do Nervo Oculomotor/tratamento farmacológico , Doenças do Nervo Oculomotor/virologia , Nervo Óptico/patologia , Nervo Óptico/virologia , Doenças do Nervo Óptico/tratamento farmacológico , Doenças do Nervo Óptico/virologia , Órbita/patologia , Órbita/virologia , Miosite Orbital/tratamento farmacológico , Miosite Orbital/virologia , Síndrome de Tolosa-Hunt/tratamento farmacológico , Síndrome de Tolosa-Hunt/patologia , Síndrome de Tolosa-Hunt/virologia , Núcleos do Trigêmeo/patologia
11.
Ocul Immunol Inflamm ; 20(5): 365-7, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22794781

RESUMO

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.


Assuntos
Doenças do Nervo Abducente/virologia , Herpes Zoster Oftálmico/virologia , Doenças do Nervo Oculomotor/virologia , Esclerite/virologia , Uveíte/virologia , 2-Aminopurina/análogos & derivados , 2-Aminopurina/uso terapêutico , Doenças do Nervo Abducente/tratamento farmacológico , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Diplopia/tratamento farmacológico , Diplopia/virologia , Quimioterapia Combinada , Famciclovir , Feminino , Glucocorticoides/uso terapêutico , Herpes Zoster Oftálmico/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/tratamento farmacológico , Prednisolona/uso terapêutico , Resultado do Tratamento , Uveíte/tratamento farmacológico
14.
Acta Ophthalmol ; 86(7): 806-9, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18221497

RESUMO

PURPOSE: To report central nervous system involvement after varicella zoster virus infection. METHODS: We evaluated the frequency and type of neurological complications in patients initially presenting with ophthalmic herpes zoster at an ophthalmological department in a Danish university hospital, over a 7-year period. RESULTS: Of the 110 immunocompetent patients who presented with initial ophthalmic zoster, six (5.5%) suffered from neurological complications other than post-herpetic neuralgia. Four experienced isolated cranial motor nerve palsies, one patient had meningitis with a favourable outcome and one patient had severe encephalitis with a poor clinical outcome. CONCLUSIONS: Central nervous system involvement after varicella zoster virus infection is an uncommon, but potentially life-threatening, complication. Early recognition of neurological complications prompts acute, appropriate antiviral treatment.


Assuntos
Doenças dos Nervos Cranianos/virologia , Encefalite Viral/etiologia , Herpes Zoster Oftálmico/complicações , Herpes Zoster/complicações , Meningite Viral/etiologia , Idoso , Idoso de 80 Anos ou mais , Doenças do Nervo Facial/virologia , Feminino , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/patologia , Humanos , Angiografia por Ressonância Magnética , Masculino , Doenças do Nervo Oculomotor/virologia , Doenças do Nervo Troclear/virologia
15.
Mayo Clin Proc ; 82(11): 1341-9, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17976353

RESUMO

OBJECTIVE: To establish accurate, up-to-date, baseline epidemiological data for herpes zoster (HZ) before the introduction of the recently licensed HZ vaccine. METHODS: Using data from January 1, 1996, to October 15, 2005, we conducted a population-based study of adult residents (Greater than or equal to 22 years) of Olmsted County, MN, to determine (by medical record review) the incidence of HZ and the rate of HZ-related complications. Incidence rates were determined by age and sex and adjusted to the US population. RESULTS: A total of 1669 adult residents with a confirmed diagnosis of HZ were identified between January 1, 1996, and December 31, 2001. Most (92%) of these patients were immunocompetent and 60% were women. When adjusted to the US adult population, the incidence of HZ was 3.6 per 1000 person-years (95% confidence interval, 3.4-3.7), with a temporal increase from 3.2 to 4.1 per 1000 person-years from 1996 to 2001. The incidence of HZ and the rate of HZ-associated complications increased with age, with 68% of cases occurring in those aged 50 years and older. Postherpetic neuralgia occurred in 18% of adult patients with HZ and in 33% of those aged 79 years and older. Overall, 10% of all patients with HZ experienced 1 or more nonpain complications. CONCLUSIONS: Our population-based data suggest that HZ primarily affects immunocompetent adults older than 50 years; 1 in 4 experiences some type of HZ-related complication.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster/complicações , Herpes Zoster/epidemiologia , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Paralisia de Bell/virologia , Feminino , Herpes Zoster da Orelha Externa/epidemiologia , Herpes Zoster da Orelha Externa/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Neuralgia Pós-Herpética/epidemiologia , Neuralgia Pós-Herpética/etiologia , Doenças do Nervo Oculomotor/virologia , Vigilância da População , Recidiva , Estudos Retrospectivos , Superinfecção/virologia
19.
J Child Neurol ; 17(10): 784-5, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12546438

RESUMO

A 10-month-old boy was admitted with ptosis on the left eyelid, which rapidly occurred following a disease with rash about 20 days before admission to our hospital. By history, none of the vaccinations had been performed. On physical examination, his vital signs were stable, and he had marasmus. Isolated left oculomotor nerve palsy was diagnosed. Cranial magnetic resonance imaging was normal. Serum IgM antibody to measles virus was positive. Oculomotor nerve palsy markedly improved on the 15th day of follow-up, and complete improvement was noted on the second month of follow-up. To our knowledge, this is the first case of oculomotor nerve palsy following measles.


Assuntos
Blefaroptose/virologia , Sarampo/complicações , Doenças do Nervo Oculomotor/virologia , Anticorpos Antivirais/sangue , Humanos , Imunoglobulina M/sangue , Lactente , Imageamento por Ressonância Magnética , Masculino , Vírus do Sarampo/imunologia , Nervo Oculomotor/patologia , Desnutrição Proteico-Calórica/virologia
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