Herpes zoster ophthalmicus with contralateral hemiplegia: identification of cause

A patient with herpes zoster ophthalmicus developed hemiparesis that at first responded to steroids but, when these were reduced, culminated in massive cerebral infarction and death. The cause was an extensive necrotizing arteritis of large and small cerebral arteries. Herpes-like virions were identified in smooth muscle cells of the middle cerebral artery.