PT  - JOURNAL ARTICLE
AU  - Shaker, Hussam
AU  - Rai, Vivek
TI  - Oculomotor Nerve Palsy after Herpes Zoster Opthalmicus: A Case Report and Review of Literature (P1.297)
DP  - 2016 Apr 05
TA  - Neurology
PG  - P1.297
VI  - 86
IP  - 16 Supplement
4099  - http://n.neurology.org/content/86/16_Supplement/P1.297.short
4100  - http://n.neurology.org/content/86/16_Supplement/P1.297.full
SO  - Neurology2016 Apr 05; 86
AB  - Objective: To report a rare case of Oculomotor Nerve (CNIII) palsy after Herpes Zoster Opthalmicus (HZO) Background: CNIII palsy after HZO is rare, especially with associated pupillary defect. In our review of literature, only 40 cases in last 52 years, oldest in 1963, have been reported from around the world, including some with involvement of trochlear and abducens nerve. Methods:Case report with review of literature. Results:We report a case of 68-year-old male who presented with 3 week history of left HZO subsequently complicated by ptosis and diplopia. Past medical history included immunosuppression with mycophenolate and tacrolimus for renal transplant. He was initially treated with 10 days of Valacyclovir. The rash improved but diplopia and ptosis persisted. Neurologic exam revealed partial oculoparesis and a fixed dilated pupil of the left eye consistent with CNIII palsy. CT Angiography and MRI brain ruled out aneurysm and stroke. Cerebrospinal fluid analysis showed mild pleocytosis. The patient was started on a 21-day course of acyclovir as well as topical steroids. He showed improvement in opthalmoparesis but pupil remained fixed and dilated. Conclusions: HZO is manifestation of re-activation of herpes zoster with involvement of ophthalmic division of trigeminal nerve. CNIII palsy after HZO is rare, especially with associated pupillary defect. The long term prognosis is felt to be excellent with use of antiviral agents and steroids.Disclosure: Dr. Shaker has nothing to disclose. Dr. Rai has nothing to disclose.Saturday, April 16 2016, 8:30 am-7:00 pm