Complete Oculomotor Nerve Palsy Complicated by Inflammation of the Cavernous Sinus in Herpes Zoster Ophthalmicus.
10.3341/jkos.2015.56.9.1467
- Author:
Sung Soo HWANG
1
;
Soo Jung LEE
Author Information
1. Department of Ophthalmology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. Kris9352@hanmail.net
- Publication Type:Case Report
- Keywords:
Cavernous sinus;
Herpes zoster ophthalmicus;
Oculomotor nerve palsy;
Pupil;
Steroid
- MeSH:
Brain;
Cavernous Sinus*;
Cough;
Dermatology;
Diplopia;
Edema;
Eyelids;
Fever;
Headache;
Herpes Zoster Ophthalmicus*;
Herpes Zoster*;
Humans;
Inflammation*;
Intracranial Aneurysm;
Magnetic Resonance Imaging;
Male;
Middle Aged;
Myalgia;
Mydriasis;
Oculomotor Nerve Diseases*;
Oculomotor Nerve*;
Pupil;
Uveitis
- From:Journal of the Korean Ophthalmological Society
2015;56(9):1467-1472
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To report a case of complete oculomotor nerve palsy with pupil involvement complicated by inflammation of the cavernous sinus. Complete resolution was obtained after 12 days of antiviral and steroid treatments. CASE SUMMARY: A 60-year-old male presented with edema and vesicles of the right upper eyelid. The patient had myalgia, cough, fever and headache 1 week earlier and was treated with conservative therapy. The patient received an antiviral agent (famciclovir 250 mg) twice a day and steroid agent (methylprednisolon 4 mg) once a day at the dermatology department for 1 week. The eyelid edema and vesicles improved. However, ptosis, ocular movement limitation, mydriasis of the right eye and diplopia occurred. Brain magnetic resonance imaging revealed hyperintensity in the right cavernous sinus with enhancement, implicating inflammation. The patient was diagnosed with right complete oculomotor nerve palsy with pupil involvement. An antiviral agent (famciclovir 250 mg) three times a day and a steroid agent (prednisolone 40 mg) once a day were prescribed. From the next day, ptosis and ocular movement limitation improved and 12 days later, completely resolved. CONCLUSIONS: Ocular movement limitation and mydriasis can be accompanied by herpes zoster ophthalmicus without uveitis and cerebral aneurysm. Administering active antiviral and steroid treatment to obtain rapid resolution is important.
