title: 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.affiliation: Department of Neurology, University of Athens, Athens, Greece.
authors.forename: Georgios P
authors.initials: GP
authors.lastname: Paraskevas
authors.forename: Evangelos
authors.initials: E
authors.lastname: Anagnostou
authors.forename: Sofia
authors.initials: S
authors.lastname: Vassilopoulou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spengos
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D004172:Diplopia / Q000175:diagnosis; D005076:Exanthema / Q000175:diagnosis; D005260:Female; D006563:Herpes Zoster Ophthalmicus / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D014645:Herpesvirus 3, Human; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D009802:Oculomotor Nerve / Q000473:pathology / Q000821:virology; D015840:Oculomotor Nerve Diseases / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D009900:Optic Nerve / Q000473:pathology / Q000821:virology; D009901:Optic Nerve Diseases / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D009915:Orbit / Q000473:pathology / Q000821:virology; D055622:Orbital Myositis / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D020333:Tolosa-Hunt Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000821:virology; D014278:Trigeminal Nuclei / Q000473:pathology / Q000821:virology*
chemical_list: D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D000212:Acyclovir; D008775:Methylprednisolone