Complete Oculomotor Nerve Palsy Complicated by Inflammation of the Cavernous Sinus in Herpes Zoster Ophthalmicus.

Hwang, Sung Soo; Lee, Soo Jung

doi:2015.56.9.1467

J Korean Ophthalmol Soc > Volume 56(9); 2015 > Article

Case Report

Journal of the Korean Ophthalmological Society 2015;56(9):1467-1472.
DOI: https://doi.org/10.3341/jkos.2015.56.9.1467 Published online September 15, 2015.

Complete Oculomotor Nerve Palsy Complicated by Inflammation of the Cavernous Sinus in Herpes Zoster Ophthalmicus.

Sung Soo Hwang, Soo Jung Lee

Department of Ophthalmology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. Kris9352@hanmail.net

해면정맥동염에 의한 완전 동안신경마비를 동반한 안부대상포진 1예

황성수⋅이수정

인제대학교 의과대학 인제대학교 해운대백병원 안과학교실

Received: 9 January 2015 • Revised: 31 March 2015 • Accepted: 6 July 2015

Abstract

PURPOSE
To report a case of complete oculomotor nerve palsy with pupil involvement complicated by inflammation of the cavernous sinus. Complete resolution was obtained after 12 days of antiviral and steroid treatments. CASE SUMMARY: A 60-year-old male presented with edema and vesicles of the right upper eyelid. The patient had myalgia, cough, fever and headache 1 week earlier and was treated with conservative therapy. The patient received an antiviral agent (famciclovir 250 mg) twice a day and steroid agent (methylprednisolon 4 mg) once a day at the dermatology department for 1 week. The eyelid edema and vesicles improved. However, ptosis, ocular movement limitation, mydriasis of the right eye and diplopia occurred. Brain magnetic resonance imaging revealed hyperintensity in the right cavernous sinus with enhancement, implicating inflammation. The patient was diagnosed with right complete oculomotor nerve palsy with pupil involvement. An antiviral agent (famciclovir 250 mg) three times a day and a steroid agent (prednisolone 40 mg) once a day were prescribed. From the next day, ptosis and ocular movement limitation improved and 12 days later, completely resolved. CONCLUSIONS: Ocular movement limitation and mydriasis can be accompanied by herpes zoster ophthalmicus without uveitis and cerebral aneurysm. Administering active antiviral and steroid treatment to obtain rapid resolution is important.

Key Words: Cavernous sinus;Herpes zoster ophthalmicus;Oculomotor nerve palsy;Pupil;Steroid