Fourth and Sixth Nerve Palsies Due to Herpes Simplex 1 Infection

Abstract

Ocular motor cranial nerve palsies of viral etiology are uncommon and, when accompanied by skin lesions, zoster ophthalmicus is the most frequent diagnosis. We describe the case of a 68-year-old woman who developed fourth and sixth nerve palsies 3 days after appearance of a painful vesicular skin rash on the left side of her forehead. Neuroimaging was normal but polymerase chain reaction (PCR) testing of the cerebrospinal fluid was positive for Herpes Simplex 1 and negative for Varicella Zoster. The patient was treated with intravenous acyclovir, and the cranial nerve palsies resolved over 7 weeks. Although the similarity of the cutaneous vesicular eruption in our patient to that seen with zoster might have led to an incorrect diagnosis, acyclovir seems to be safe and effective for both viral etiologies.

Clinical, neuropathological, and immunological short‐ and long‐term feature of a mouse model mimicking human herpes virus encephalitis

“…HSE occurs sporadically and is characterized by high mortality of up to 70%, if undiagnosed and untreated, with only a minority of patients returning to normal life [4]. Patients initially present with unspecific clinical signs, which, however, get worse with disease progression and include disorientation, aphasia, changes in mental status, disorders of cranial nerves IV and VI, or seizures [5,6]. Specifically, behavioral abnormalities occur which include hypomania, Kluver-Bucy syndrome, and memory impairment [7].…”