Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis

Abstract

A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horner's syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horner's syndrome and diplopia resolved after six months. Here we present the first report of Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis.

Keywords: Abducens nerve palsy; Horner syndrome; Zoster meningitis.

Fig. 1

(A) Left abducens nerve palsy in a 55-year-old woman with zoster meningitis. (B) Improved left abducens nerve palsy one month after hospital discharge.

Fig. 2

Blepharoptosis and augmented anisocoria in the dark of the right eye, which was associated with a right hemifacial anhidrosis.