PT  - JOURNAL ARTICLE
AU  - Georgios P Paraskevas
AU  - Evangelos Anagnostou
AU  - Sofia Vassilopoulou
AU  - Konstantinos Spengos
TI  - Painful ophthalmoplegia with simultaneous orbital myositis, optic and oculomotor nerve inflammation and trigeminal nucleus involvement in a patient with herpes zoster ophthalmicus
AID  - 10.1136/bcr-2012-007063
DP  - 2012 Oct 29
TA  - BMJ Case Reports
PG  - bcr2012007063
VI  - 2012
4099  - http://casereports.bmj.com/content/2012/bcr-2012-007063.short
4100  - http://casereports.bmj.com/content/2012/bcr-2012-007063.full
AB  - 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.