Herpes zoster ophthalmicus-induced oculomotor nerve palsy

Harthan, Jennifer; Borgman, Christopher J

doi:10.1016/j.optom.2012.08.005

Cited by 16 publications

(9 citation statements)

References 16 publications

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“…The pupil may or may not be involved. HZO-induced ophthalmoplegia is more likely to manifest 2 weeks 17 , 18 up to 2 months 19 after the rash onset. Acute ophthalmoplegia appearing within the first days of disease presentation is rare.…”

Section: Discussionmentioning

confidence: 99%

“…An unusual finding in this patient was the concurrence of optic neuritis and partial third nerve palsy in the absence of other signs of orbital apex syndrome. Harthan and Borgman 17 reported a case of left partial third cranial nerve palsy with pupillary involvement secondary to HZO, in which APD was present in the left eye. It was an accurately described case of HZ third cranial nerve palsy and optic neuritis similar to ours, but the diagnosis was not emphasized.…”

Section: Discussionmentioning

confidence: 99%

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Successful oral treatment of third cranial nerve palsy and optic neuritis from neglected herpes zoster in an immunocompetent patient

Osman

2020

American Journal of Ophthalmology Case Reports

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Purpose Herpes zoster (HZ) is an acute viral eruption caused by the reactivation of varicella zoster virus (VZV), a herpes virus causing chicken pox in children. We aimed to report a 3-month neglected case of acute herpes zoster-induced third nerve palsy and optic neuritis, followed by a late-onset keratouveitis in an immunocompetent young adult. Observations A 36-year old immunocompetent Egyptian male patient presented with 3-month complaints of blurred vision and drooping of his left upper eyelid that appeared 4 days after a herpetic rash. He had been diagnosed with herpes zoster ophthalmicus (HZO) of the left eye. However, he had not received any systemic antiviral treatment. The patient had an abnormal head posture with post-eruptive scars on the left forehead and the nose tip. Examination revealed weakness of elevation and adduction, partial ptosis, and mid-dilated non-reactive pupil in the left eye. A relative afferent pupillary defect (RAPD) was present in the affected eye. His blood sugar and blood pressure were within normal limits. Contrast magnetic resonance imaging (MRI) showed no space-occupying lesion. However, there were enhancement and enlargement of the left optic nerve on T1-weighted images, denoting optic neuritis. A diagnosis of acute left third nerve palsy with pupil involvement and optic neuritis secondary to HZO was made. Despite late treatment with oral acyclovir and prednisolone, the patient recovered. One and a half months later, he developed a late-onset keratouveitis about 8 months after the rash onset. After the resolution of the episode, oral acyclovir was continued at a prophylactic dose (400 mg BID). Conclusions and importance HZ is a rare cause of third nerve palsy with pupil involvement and optic neuritis. Oral acyclovir and steroids were effective in the delayed treatment in this case. Abnormal optic nerve enhancement on MRI 3 months after the appearance of vesicular rash may suggest chronic HZ activity. Concurrent optic neuritis and third cranial nerve palsy in the absence of other signs of orbital apex syndrome can be seen in cases of HZO. Regular follow-up of patients with HZ is important for detecting recurrence and initiating prompt treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful oral treatment of third cranial nerve palsy and optic neuritis from neglected herpes zoster in an immunocompetent patient

Osman

2020

American Journal of Ophthalmology Case Reports

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“…Literatürde bildirilen izole okülomo-tor sinir felci olan hastada ancak ilk başlangıçtan altı ay sonra pitoziste ve klinik tabloda düzelme saptanmıştır. 15 Yine bu hastada kutanöz lezyonlar ile kornea iltihabının iyileşmesine rağmen okülo-motor sinir felcinin devam ettiği bildirilmiştir. Oftalmoplejinin tamamen düzelmesi 6 ayı bulmuştur.…”

Section: Discussionunclassified

Isolated Oculomotor Nerve Palsy During Herpes Zoster Infection: Case Report

Çelebi¹,

Yıldız²,

Kilavuzoglu³

et al. 2017

Turkiye Klinikleri J Ophthalmol

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opulasyonun %20-30'u hayatlarının bir döneminde herpes zoster ile enfekte olmakta ve bu bireylerin %10-20'sinde göz tutulumu göz-lenmektedir.1 Herpes zoster oftalmikus, varisella zoster virüsünün nöral inflamasyon oluşturarak trigeminal sinirin duyusal dallarının inerve ettiği yerlerde, epidermal yüz bölgesinde veziküler lezyonlar oluşturması ile karakterizedir. Ülkemizde herpes zoster oftalmikusun görülme sıklığını araştıran bir çalışma olmamakla birlikte İzmir'de hastaneye yatırılan herpes zoster hastalarının değerlendirildiği 23 vakalık en geniş kapsamlı orijinal çalışmada, herpes zoster virüsüne bağlı herhangi bir komplikasyon gelişen 65 Herpes Zoster Enfeksiyonu Sırasında Gelişen İzole Okülomotor Sinir Felci Ö ÖZ ZE ET T Bu çalışmada, 59 yaşındaki erkek olguda herpes zoster enfeksiyonu sırasında gelişen izole okülomotor sinir felcinin sistemik tedavisi ile klinik seyri sunulmuştur. Sol gözde kapak düşüklüğü ve çift görme şikâyeti ile kliniğimize başvuran olgunun muayenesinde okülomotor sinir felci ve eş zamanlı olarak alın sol yarısında herpez zoster enfeksiyonu ile ilişkili veziküler lezyonlar saptandı. Kraniyal görüntüleme ile okülomotor sinir felcine neden olabilecek tüm patolojiler araştırıldı. Olguya erken dönemde uygulanan sistemik antiviral tedavi ile çift görme ve kapak düşüklüğü şikâ-yetleri bir ay içerisinde tamamen düzelmiştir. Okülomotor sinir felci olgularında herpes zoster enfeksiyonu ayırıcı tanıda akla getirilmelidir. Bu olgularda erken başlanan bir aylık sistemik antiviral tedavi ile sekelsiz düzelme sağlanabilir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Herpes zoster oftalmikus; okülomotor sinir hastalıkları; oftalmopleji A AB BS S T TR RA AC CT T In this case report, 59 years-old male patient with isolated oculomotor nerve palsy during herpes zoster infection was presented with its systemic treatment and his clinical course during infection. The patient was admitted to our clinic due to ptosis in the left eye and diplopia complaints, oculomotor nerve palsy was diagnosed based on his examination. Vesicular lesions over left half of the forehead associated with concurrent herpes zoster infection was also detected. Cranial imaging was also evaluated to examine other pathologies that may also cause oculomotor nerve palsy. Diplopia and ptosis in the left eye were resolved completely within a month with early onset systemic antiviral therapy. Herpes zoster infection should be considered in the differential diagnosis of oculomotor nerve palsy associated opthalmoplegia. Oculomotor nerve palsy associated with herpes zoster ophthalmicus could be recovered without a sequelae within 1 month systemic antiviral treatment that was started early.

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“…Наиболее отсроченным осложнением герпеса Зостер является постгерпетическая невралгия, проявляющаяся изнуряющей болью по ходу ветвей тройничного нерва, что приводит к снижению качества жизни пациента, к депрессии и обострению сопутствующих заболеваний [7; 8]. Офтальмоплегия встречается у 5-31% пациентов в период везикулярных высыпаний или через 2-4 недели от начала появления кожных проявлений [9]. Однако офтальмоплегия или птоз верхнего века в сочетании с выраженным болевым синдромом, как первичный клинический признак проявления офтальмологического герпеса Зостер, регистрируется очень редко.…”

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