Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Jan 8;14(1):e21036.
doi: 10.7759/cureus.21036. eCollection 2022 Jan.

Management of Cavernous Sinus Thrombosis Following Herpes Zoster Ophthalmicus

Yusuf Mehkri  1 , Jeff A Valisno  1 , Lorena Figueredo Rivas  2 , Jairo Hernandez  2 , Varun Jain  2 , Aisha Elfasi  2 , Justin De Prey  2 , Calvin Hu  2 , Bedirhan Tarhan  2 , Ibrahim S Tuna  3 , Hans H Shuhaiber  2
Affiliations
Case Reports

Management of Cavernous Sinus Thrombosis Following Herpes Zoster Ophthalmicus

Yusuf Mehkri et al. Cureus. .

Abstract

Herpes zoster opthalmicus (HZO) is the reactivation of latent varicella zoster virus (VZV) within the ophthalmic branch of the trigeminal ganglion (V1). Common complications are postherpetic neuralgia and vasculopathy. Here, we report a rare case of a 47-year-old female presenting with HZO and aseptic cavernous sinus thrombosis (CST). Early screening for rare and deadly complications such as CST using CT cerebral venography (CTV) and magnetic resonance venography (MRV), as was done, is crucial to detection at earlier stages when intervention is most effective. Anticoagulation therapy was promptly started, and the patient's symptoms continued to improve during the hospital stay.

Keywords: aseptic cavernous sinus thrombosis; herpes simplex; herpes simplex ophthalmicus; herpes zoster meningitis; varicella-zoster virus.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Contrast-enhanced CT orbits in axial (A) plane demonstrating asymmetric swelling and enhancement of the right preseptal periorbital soft tissues (arrowheads) and right cornea (arrow) compared to left, and coronal (B) plane showing asymmetric swelling and enhancement of the right lacrimal gland (thick arrow).
Figure 2
Figure 2. MRI of the cavernous sinuses were obtained including axial postcontrast 3DT1 space (A and D), coronal T2 fat saturated (B and C), coronal postcontrast T1 (E) and coronal postcontrast T1 subtracted from pre-contrast (F) images. There is asymmetric swelling and enhancement of the right pre-septal orbital soft tissues (arrowheads on A) and right cornea (arrow on A). There is asymmetric swelling and enhancement of the right intra-orbital fat (arrowhead on B and F) and right sided rectus muscles particularly involving the lateral rectus (long arrow on C and F) and medial rectus muscles (short arrow on C and F) as well as right lacrimal gland (thick arrow on B). There is evidence of intracranial extension with subtle asymmetric enhancement of the cisternal segment of the right trigeminal nerve (arrow on D) as well as asymmetric meningeal enhancement of the lateral wall of the right cavernous sinus (long arrow on E) and right Meckel’s cave (short arrow on E).
Figure 3
Figure 3. Subtracted axial (A) and coronal (B) maximum intensity projection imaging of the contrast-enhanced CTV demonstrates asymmetric filling defect and hypo-enhancement in the right cavernous sinus (thick arrow on A and B) and petrosal sinus (arrow on A) compared to left compatible with thrombosis. The remaining dural sinuses including transverse sinuses (arrowheads on A) and superior sagittal sinus (arrowhead on B) are patent.
CTV: computerized tomography venography
Figure 4
Figure 4. Appearance on day three of IV antiviral therapy.
Figure 5
Figure 5. Appearance on day seven of admission.
See this image and copyright information in PMC

References

    1. Chronic and recurrent herpes zoster ophthalmicus. Lee SM, Han J, Yang CM, Choi CY, Khoramnia R, Chung TY, Lim DH. Medicina (Kaunas) 2021;57 - PMC - PubMed
    1. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Liesegang TJ. Ophthalmology. 2008;115:0–12. - PubMed
    1. Minor M, Payne E. Herpes Zoster Ophthalmicus. Treasure Island, FL: StatPearls Publishing; 2021. Herpes zoster ophthalmicus. - PubMed
    1. Ocular manifestation and visual outcomes in herpes zoster ophthalmicus: a prospective study from a tertiary hospital of Eastern India. Goswami M, Bhattacharya S, Bandyopadhyay M. Int J Ophthalmol. 2021;14:1950–1956. - PMC - PubMed
    1. Herpes zoster ophthalmicus. Johnson JL, Amzat R, Martin N. Prim Care. 2015;42:285–303. - PubMed

Publication types

LinkOut - more resources