J Clin Neurol.  2011 Mar;7(1):47-49. 10.3988/jcn.2011.7.1.47.

A Case of Herpes Zoster Ophthalmicus with Isolated Trochlear Nerve Involvement

• Park KC
• Yoon SS
• Yoon JE
• Rhee HY

• KMID: 1452574
• DOI: http://doi.org/10.3988/jcn.2011.7.1.47

Abstract

BACKGROUND
Herpes zoster ophthalmicus (HZO) can involve the oculomotor nerve; however, isolated trochlear nerve palsy has rarely been reported.
CASE REPORT
An 83-year-old man who suffered from HZO in the right frontal area and scalp subsequently developed vertical diplopia and severe pain. Cerebrospinal fluid examination and brain MRI revealed no abnormalities. Isolated right trochlear nerve palsy was diagnosed based on the findings of neuro-ophthalmological tests.
CONCLUSIONS
Isolated trochlear nerve involvement associated with HZO is very rare and may be easily overlooked. Physicians should carefully examine oculomotor involvement in HZO.

Keyword

cranial nerve involvement; herpes zoster ophthalmicus; trochlear nerve

MeSH Terms

Aged, 80 and over
Brain
Diplopia
Herpes Zoster
Herpes Zoster Ophthalmicus
Humans
Scalp
Trochlear Nerve
Trochlear Nerve Diseases

Figure

• 

  Fig. 1 Nine gaze eye positions. The range of eye motion in the cardinal position revealed overelevation of the right eye in adduction, with inferior oblique overaction of the right eye.

Reference

1. Hunt JR. The paralytic complications of herpes zoster of cephalic extremity. JAMA. 1909. 53:1456–1457.

2. Worster-Drought C. Herpes zoster with localized muscular paralysis. Br Med J. 1923. 1:970–971.

3. Edgerton AE. Herpes Zoster Ophthalmicus: Report of Cases and a Review of the Literature. Trans Am Ophthalmol Soc. 1942. 40:390–439.

4. Marsh RJ, Dulley B, Kelly V. External ocular motor palsies in ophthalmic zoster: a review. Br J Ophthalmol. 1977. 61:677–682.

5. Grimson BS, Glaser JS. Isolated trochlear nerve palsies in herpes zoster ophthalmicus. Arch Ophthalmol. 1978. 96:1233–1235.

6. Tsuda H, Ito T, Yoshioka M, Ishihara N, Sekine Y. Isolated trochlear nerve palsy in herpes zoster ophthalmicus. Intern Med. 2007. 46:535–536.

7. Chang-Godinich A, Lee AG, Brazis PW, Liesegang TJ, Jones DB. Complete ophthalmoplegia after zoster ophthalmicus. J Neuroophthalmol. 1997. 17:262–265.

8. Ragozzino MW, Melton LJ 3rd, Kurland LT, Chu CP, Perry HO. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore). 1982. 61:310–316.

9. Archambault P, Wise JS, Rosen J, Polomeno RC, Auger N. Herpes zoster ophthalmoplegia. Report of six cases. J Clin Neuroophthalmol. 1988. 8:185–193.

10. Cope S, Jones AT. Hemiplegia complicating ophthalmic zoster. Lancet. 1954. 267:898–899.

11. Naumann G, Gass JD, Font RL. Histopathology of herpes zoster ophthalmicus. Am J Ophthalmol. 1968. 65:533–541.

12. Kawasaki A, Borruat FX. An unusual presentation of herpes zoster ophthalmicus: orbital myositis preceding vesicular eruption. Am J Ophthalmol. 2003. 136:574–575.

13. Marsh RJ. Current management of ophthalmic herpes zoster. Trans Ophthalmol Soc U K. 1976. 96:334–337.

14. Schoenlaub P, Grange F, Nasica X, Guillaume JC. [Oculomotor nerve paralysis with complete ptosis in herpes zoster ophthalmicus: 2 cases]. Ann Dermatol Venereol. 1997. 124:401–403.

15. Hoang-Xuan T, Büchi ER, Herbort CP, Denis J, Frot P, Thénault S, et al. Oral acyclovir for herpes zoster ophthalmicus. Ophthalmology. 1992. 99:1062–1070. discussion 1070-1071.