Isolated Third Nerve Palsy Associated with Herpes Zoster: A Case Report

Abstract

Herpes zoster ophthalmicus (HZO) cranial nerve palsies, such as those affecting the third cranial nerve, are very uncommon manifestations of the disease. In this study, we report a case of third cranial nerve palsy caused by HZO. A 37-year-old female patient initially showed signs of cutaneous involvement, which progressed to complete ophthalmoplegia. Her right eye had a mydriatic pupil and ptosis, and she also reported a decrease in visual acuity. Neuroimaging was used to rule out other possible causes of nerve palsies; both brain magnetic resonance imaging (MRI) and brain magnetic resonance angiography (BMRA) were normal, confirming the diagnosis of HZO. The patient was treated with an IV injection of acyclovir 400 mg three times a day for seven days, followed by one week of oral antiviral therapy. Several case studies indicate that HZO is a self-limiting disease; in our case, the symptoms subsided over the course of four months. To lessen the risk of irreversible effects, appropriate treatment should be initiated as soon as the condition is diagnosed.