Herpes zoster ophthalmicus associated with contralateral hemiplegia

Herpes zoster occurs following a reactivation of dormant varicella virus, which produces neurogenic changes in the nerve roots of spinal and cranial nerves. The symptomatology that follows includes pain and vesicular eruptions over the affected dermatomes. In an attempt to minimize the pain of postherpetic neuralgia that may follow the acute eruption of herpes zoster, a series of stellate gnaglion blocks (for upper extremity head and neck lesions) or lumbar sympathetic blocks (lower abdomen and lower extremity lesions) may be performed. When herpes zoster of the face, i.e., herpes zoster ophthalmicus occurs, contralateral hemiplegia may occur with this condition. This usually follows the migration of the virus from the dorsal root ganglia through the ophthalmic nerves into the carotid vessels. The resulting situation may produce neurological signs and symptoms, which if not accurately diagnosed, may be attributed to complications of the stellate ganglion block series or cerebrovascular accident. The treatment of this clinical syndrome consists of supportive care, intravenous heparin, acyclovir, and physical therapy.

Duke Scholars

Author Winston Clive Victor Parris Anesthesiology, Pain Management