Orhan Varoğlu Asuman, Avarisli Aysenur
Department of Neurology, Istanbul Medeniyet University, Istanbul, TUR.
Cureus. 2021 Sep 30;13(9):e18412. doi: 10.7759/cureus.18412. eCollection 2021 Sep.
The varicella-zoster virus (VZV) infection results in varicella (chickenpox) and is generally seen in immunocompromised persons. VZV virus remains latent in the ophthalmic branch in the trigeminal ganglion. When reactivated, herpes zoster ophthalmicus (HZO) develops and sometimes leads to chronic ocular complications, among which cranial nerve palsies are rarely seen. Though the third cranial nerve is most frequently involved, the fourth and sixth nerves may also be involved in some cases. Treatment includes systemic antiviral therapy and steroid administration. The prognosis is generally good when treatment is executed. Improvement can also be observed without treatment. In this article, we would like to highlight two such cases in which these two cranial nerves got involved following an episode of HZO. One is a 67-year-old female patient having diabetes mellitus (DM), hypertension (HT), and coronary heart disease with fourth and sixth cranial nerve complete palsy. The other is a 76-year-old male patient with HT, DM, and heart failure with only sixth cranial nerve complete palsy. Despite adequate treatment, both patients had a poor prognosis. Advanced age and the presence of multiple comorbidities are important factors in predicting poor prognosis in HZO cases.
水痘带状疱疹病毒（VZV）感染会导致水痘，通常见于免疫功能低下者。VZV病毒潜伏在三叉神经节的眼支中。当病毒重新激活时，会发生眼部带状疱疹（HZO），有时会导致慢性眼部并发症，其中很少见颅神经麻痹。虽然第三颅神经最常受累，但在某些情况下第四和第六神经也可能受累。治疗包括全身抗病毒治疗和类固醇给药。当进行治疗时，预后通常良好。未经治疗也可观察到病情改善。在本文中，我们想重点介绍两例这样的病例，即在HZO发作后这两条颅神经受累。一例是一名67岁的女性患者，患有糖尿病（DM）、高血压（HT）和冠心病，伴有第四和第六颅神经完全麻痹。另一例是一名76岁的男性患者，患有HT、DM和心力衰竭，仅第六颅神经完全麻痹。尽管进行了充分治疗，但两名患者的预后都很差。高龄和多种合并症的存在是预测HZO病例预后不良的重要因素。
