Painful ophthalmoplegia with simultaneous orbital myositis, optic and oculomotor nerve inflammation and trigeminal nucleus involvement in a patient with herpes zoster ophthalmicus.

Abstract

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.

• Authors: Georgios P Paraskevas, Evangelos Anagnostou, Sofia Vassilopoulou, Konstantinos Spengos
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2012 (Oct 29 2012) ISSN: 1757-790X [Electronic] England
• PMID: 23109414 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Inflammatory Agents
• Antiviral Agents
• Acyclovir
• Methylprednisolone

Topics

• Acyclovir (therapeutic use)
• Aged
• Anti-Inflammatory Agents (therapeutic use)
• Antiviral Agents (therapeutic use)
• Diplopia (diagnosis)
• Exanthema (diagnosis)
• Female
• Herpes Zoster Ophthalmicus (complications, drug therapy, pathology, virology)
• Herpesvirus 3, Human
• Humans
• Methylprednisolone (therapeutic use)
• Oculomotor Nerve (pathology, virology)
• Oculomotor Nerve Diseases (drug therapy, etiology, virology)
• Optic Nerve (pathology, virology)
• Optic Nerve Diseases (drug therapy, etiology, virology)
• Orbit (pathology, virology)
• Orbital Myositis (drug therapy, etiology, virology)
• Tolosa-Hunt Syndrome (drug therapy, etiology, pathology, virology)
• Trigeminal Nuclei (pathology, virology)