RT Journal Article
SR Electronic
T1 Painful ophthalmoplegia with simultaneous orbital myositis, optic and oculomotor nerve inflammation and trigeminal nucleus involvement in a patient with herpes zoster ophthalmicus
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr2012007063
DO 10.1136/bcr-2012-007063
VO 2012
A1 Georgios P Paraskevas
A1 Evangelos Anagnostou
A1 Sofia Vassilopoulou
A1 Konstantinos Spengos
YR 2012
UL http://casereports.bmj.com/content/2012/bcr-2012-007063.abstract
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.