title: [Varicella zoster virus-induced meningoencephalitis complicated with orbital apex syndrome: a case report].
abstract: A 69-year-old male was admitted to hospital with clouded consciousness and abnormal behavior. His body temperature was 38.2 degree Celsius upon admission and he was somnolent. Herpes zoster was observed along the first division of the trigeminal nerve on the right side of the face. The right palpebra was severely swollen, and the right eye showed a dilated pupil, loss of light reflex, and total ophthalmoplegia. A spinal tap revealed pleocytosis and increased proteins, and a DNA-PCR test for varicella-zoster virus (VZV) was positive. Optic neuritis was diagnosed based on fundoscopy. Following acyclovir administration, the patient regained full consciousness and the rash was alleviated; however, visual acuity did not recover. VZV-induced meningoencephalitis complicated with orbital apex syndrome is rarely observed. We suspect that VZV initially infected the nasociliary nerve at the distal end of the first division of trigeminal nerve and spread to the adjacent optic, oculomotor, trochlear, and abducens nerves, resulting in VZV-induced meningoencephalitis complicated with orbital apex syndrome.
authors.affiliation: Department of Neurology, Gifu Prefectural General Medical Center.
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakida
authors.forename: Takeo
authors.initials: T
authors.lastname: Sakurai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishida
mesh_terms: D000368:Aged; D006562:Herpes Zoster / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D014645:Herpesvirus 3, Human; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D009916:Orbital Diseases / Q000209:etiology*