[Case of herpes zoster ophthalmicus with abducent palsy: the cause and magnetic resonance imaging findings].
OBJECTIVE
To report the cause and magnetic resonance imaging (MRI) findings in a case of abducent palsy following herpes zoster ophthalmicus.


METHODS
A 76-year-old man presented with acute onset of pain, a vesicular cutaneous eruption and herpes zoster ophthalmicus on the right side. He developed complete abducent palsy on the right side two weeks after onset. MRI with gadolinium enhancement showed Meckel's sinus, which contains the trigeminal ganglion, and the abducent nerve on the right side. The patient was treated with intravenous acyclovir and methylprednisolone. The abnormal enhancement shown on MRI vanished immediately and the ophthalmoplegia resolved significantly.


CONCLUSIONS
This is the first reported case where an affected cranial nerve was detected next to the inflammatory cavernous sinus in ophthalmoplegia following herpes zoster ophthalmicus. These MRI findings showed that this ophthlamoplegia was induced by direct viral invasion or extension of inflammation to the ipsilateral cranial nerve. Further studies need to be performed to clarify the role of specific antiviral therapy or anti-inflammatory agents in treating this complication of herpes zoster.
Department of Ophthalmology, Faculty of Medicine, Saga University, Japan.
Keiichiro
K
Iwao
Hiroshi
H
Kobayashi
Satoshi
S
Okinami
D020434:Abducens Nerve Diseases / Q000209:etiology* / Q000473:pathology* / Q000821:virology; D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006563:Herpes Zoster Ophthalmicus / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D000212:Acyclovir; D008775:Methylprednisolone