A case of herpes zoster with abducens palsy

Abstract

Only a few reports have focused on ocular motor paralysis in herpes zoster ophthalmicus. We report a case of ocular motor paralysis resulting from herpes zoster. The patient, an 80-yr-old woman, presented with grouped vesicles, papules, and crusting in the left temporal area and scalp, with diplopia, impaired gaze, and severe pain. Her cerebrospinal fluid analysis was positive for varicellar zoster virus IgM. Magnetic resonance imaging was performed to rule out other diseases causing diplopia; there were no specific findings other than old infarctions in the pons and basal ganglia. Therefore, she was diagnosed of abducens nerve palsy caused by herpes zoster ophthalmicus. After 5 days of systemic antiviral therapy, the skin lesions improved markedly, and the paralysis was cleared 7 weeks later without extra treatment.

Fig. 1

Erythematous papules with crusts and erosions on the left scalp and left ear lobe.

Fig. 2

(A) Unsuccessful abduction of the left eye during attempted left gaze. (B) Without extra treatment, slow improvement of the left lateral rectus palsy was observed 7 weeks later.

Fig. 3

Hess screen test: paresis of the left lateral rectus with overreaction of the right medial rectus indicates the ocular movements in left sixth nerve palsy.