Herpes zoster ophthalmicus with delayed contralateral hemiparesis

Area of Science:

• Neurology
• Infectious Diseases
• Vascular Neurology

Background:

• Herpes zoster ophthalmicus (HZO) is a viral infection affecting the ophthalmic nerve, typically presenting with a rash around the eye.
• While HZO is primarily known for ocular complications, neurological sequelae, including cerebrovascular events, are recognized but less common.
• Cerebral infarction, or stroke, can occur due to inflammation and occlusion of cerebral arteries, a condition known as arteritis.

Observation:

• A 35-year-old previously healthy woman presented with left hemiparesis (weakness on one side of the body).
• This neurological deficit occurred sixteen weeks after the onset of right herpes zoster ophthalmicus.
• Cerebral angiography revealed complete occlusion of the right middle cerebral artery and narrowing of the right posterior cerebral artery.

Findings:

• Neuroimaging, including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), confirmed a right hemispheric lesion correlating with the angiographic findings.
• The clinical presentation and imaging results strongly suggested arteritis affecting the cerebral vasculature.
• The patient experienced delayed contralateral hemiparesis, indicating a neurological event affecting the side of the brain opposite to the initial HZO infection.

Implications:

• This case, along with existing literature, suggests that arteritis secondary to HZO can lead to delayed cerebral infarction and hemiparesis.
• The findings underscore the importance of considering cerebrovascular complications in patients with HZO, even with a significant delay in symptom onset.
• Further research may elucidate the precise mechanisms and risk factors associated with HZO-induced arteritis and subsequent stroke.