Right-sided Herpes Zoster Ophthalmicus Complicated by Bilateral Third, Fourth, and Sixth Cranial Nerve Palsies and Syndrome of Inappropriate Antidiuretic Hormone Secretion

Abstract

Cases of herpes zoster ophthalmicus (HZO) complicated by bilateral ophthalmoplegia are rare, and no cases of bilateral third, fourth, or sixth cranial nerve palsies have been reported. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare complication of HZO. We herein report an 80-year-old Japanese woman with right-sided HZO complicated by meningoencephalitis and discuss the pathogenesis of this condition. She developed bilateral third, fourth, and sixth cranial nerve palsies and SIADH almost simultaneously during treatment for HZO. The bilateral cranial palsy spontaneously resolved within a few months.

Keywords: cranial nerve palsy; herpes zoster ophthalmicus; ophthalmoplegia; syndrome of inappropriate antidiuretic hormone secretion.

Figure 1.

Brain magnetic resonance imaging. (A, B) On admission, hyperintense FLAIR areas were observed in both temporal lobes (white arrows). (C-E) At 32 days after admission, a hyperintense FLAIR area appeared along the right trigeminal spinal tract nucleus (black arrows). FLAIR: fluid-attenuated inversion recovery

Figure 2.

Nine cardinal directions of ocular movement. (A) At 33 days after admission, the right eye had omnidirectionally impaired ocular movement, and the left eye was capable of slight supination and abduction. (B) Three months after discharge, only slight ptosis of the right eyelid remained, and no ophthalmoplegia was observed in either eye.