Unilateral ataxia following herpes zoster of spinal C4 segment

Focal lesions of central nervous system are extremely rare following cutaneous herpes zoster. A 55 year old male developed cerebellar speech, right sided ataxia and intention tremor, three weeks after herpes zoster of right spinal C4 segment. Clinical examination and investigations confirmed a focal vascular lesion in the midbrain suggestive of granulomatous angiitis which can cause focal neurological defect after herpes zoster.