An older woman with herpes zoster ophthalmicus complicated by orbital apex syndrome

An older woman with herpes zoster ophthalmicus complicated by orbital apex syndrome Age and Ageing 2018; 0: 1 © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com Clinical Reminder entrapment occurs, with impaired eye movements and vis- An older woman with herpes zoster ual acuity [2]. Other complications of VZV include enceph- ophthalmicus complicated by orbital apex alitis, meningitis, angiitis and stroke [3]. syndrome A 76-year-old woman presented with left periorbital swel- Key points ling, dysaesthesia, eye pain, proptosis and blurred vision. � Herpes zoster eruptions are seen with increasing fre- Examination showed red papules and vesicles around the eye quency in very old or immunocompromised patients. but no fever. Oral famciclovir and amoxicillin were given for � Visual symptoms, unilateral frontal headache, and altered men- herpes zoster ophthalmicus. She became drowsy and a mag- tal status are warning signs for a complicated disease course. netic resonance imaging (MRI) scan showed features of orbital � Herpes zoster ophthalmicus can be complicated by orbital apex syndrome (OAS) (Figure 1). Decompression surgery was apex syndrome, meningoencephalitis, and brain ischaemia. performed. Varicella zoster virus (VZV) was confirmed by � Magnetic resonance imaging (MRI) has a role in evaluat- PCR in cerebrospinal fluid following lumbar puncture and in ing the extent of orbital and intracranial involvement of tissue samples obtained during the surgical procedure. Progress herpes zoster ophthalmicus. was complicated by ischaemic stroke with right hemiplegia. After rehabilitation, she recovered to walk short distances with a Zimmer frame and also regained a capacity to read. Conflict of interest Clinically overt herpes zoster is more common in older or immunocompromised hosts [1]. In OAS, optic nerve None declared. Funding None. 1 2 GUILLAUME MARIE ,MAX SCHEFFLER Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland Department of Radiology, Geneva University Hospitals, Thonex, Switzerland Address correspondence to: M. Scheffler, Department of Radiology, Geneva University Hospitals, Thonex, Switzerland. Tel: +41 22 305 65 83; Fax: +41 22 305 65 90. Email: max.scheffler@hcuge.ch References 1. Shaikh S, Ta CN. Evaluation and management of herpes zos- ter ophthalmicus. Am Fam Physician 2002; 66: 1723–30. 2. Yeh S, Foroozan R. Orbital apex syndrome. Curr Opin Ophthalmol 2004; 15: 490–8. 3. Lexa FJ, Galetta SL, Yousem DM, Farber M, Oberholtzer Figure 1. Coronal contrast-enhanced fat-saturated T1- JC, Atlas SW. Herpes zoster ophthalmicus with orbital pseu- weighted MRI image through orbital apices shows swollen left dotumor syndrome complicated by optic nerve infarction extraocular muscles (arrowheads) exert mass effect on optic and cerebral granulomatous angiitis: MR-pathologic correl- nerve (white arrow), a condition known as orbital apex syn- ation. AJNR Am J Neuroradiol 1993; 14: 185–90. drome. Note associated ipsilateral sinus disease (black arrow) and pachymeningeal enhancement (squiggly arrow). doi: 10.1093/ageing/afy073 Downloaded from https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afy073/4993724 by Ed 'DeepDyve' Gillespie user on 08 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Age and Ageing Oxford University Press

An older woman with herpes zoster ophthalmicus complicated by orbital apex syndrome

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Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com
ISSN
0002-0729
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1468-2834
D.O.I.
10.1093/ageing/afy073
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Abstract

Age and Ageing 2018; 0: 1 © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com Clinical Reminder entrapment occurs, with impaired eye movements and vis- An older woman with herpes zoster ual acuity [2]. Other complications of VZV include enceph- ophthalmicus complicated by orbital apex alitis, meningitis, angiitis and stroke [3]. syndrome A 76-year-old woman presented with left periorbital swel- Key points ling, dysaesthesia, eye pain, proptosis and blurred vision. � Herpes zoster eruptions are seen with increasing fre- Examination showed red papules and vesicles around the eye quency in very old or immunocompromised patients. but no fever. Oral famciclovir and amoxicillin were given for � Visual symptoms, unilateral frontal headache, and altered men- herpes zoster ophthalmicus. She became drowsy and a mag- tal status are warning signs for a complicated disease course. netic resonance imaging (MRI) scan showed features of orbital � Herpes zoster ophthalmicus can be complicated by orbital apex syndrome (OAS) (Figure 1). Decompression surgery was apex syndrome, meningoencephalitis, and brain ischaemia. performed. Varicella zoster virus (VZV) was confirmed by � Magnetic resonance imaging (MRI) has a role in evaluat- PCR in cerebrospinal fluid following lumbar puncture and in ing the extent of orbital and intracranial involvement of tissue samples obtained during the surgical procedure. Progress herpes zoster ophthalmicus. was complicated by ischaemic stroke with right hemiplegia. After rehabilitation, she recovered to walk short distances with a Zimmer frame and also regained a capacity to read. Conflict of interest Clinically overt herpes zoster is more common in older or immunocompromised hosts [1]. In OAS, optic nerve None declared. Funding None. 1 2 GUILLAUME MARIE ,MAX SCHEFFLER Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland Department of Radiology, Geneva University Hospitals, Thonex, Switzerland Address correspondence to: M. Scheffler, Department of Radiology, Geneva University Hospitals, Thonex, Switzerland. Tel: +41 22 305 65 83; Fax: +41 22 305 65 90. Email: max.scheffler@hcuge.ch References 1. Shaikh S, Ta CN. Evaluation and management of herpes zos- ter ophthalmicus. Am Fam Physician 2002; 66: 1723–30. 2. Yeh S, Foroozan R. Orbital apex syndrome. Curr Opin Ophthalmol 2004; 15: 490–8. 3. Lexa FJ, Galetta SL, Yousem DM, Farber M, Oberholtzer Figure 1. Coronal contrast-enhanced fat-saturated T1- JC, Atlas SW. Herpes zoster ophthalmicus with orbital pseu- weighted MRI image through orbital apices shows swollen left dotumor syndrome complicated by optic nerve infarction extraocular muscles (arrowheads) exert mass effect on optic and cerebral granulomatous angiitis: MR-pathologic correl- nerve (white arrow), a condition known as orbital apex syn- ation. AJNR Am J Neuroradiol 1993; 14: 185–90. drome. Note associated ipsilateral sinus disease (black arrow) and pachymeningeal enhancement (squiggly arrow). doi: 10.1093/ageing/afy073 Downloaded from https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afy073/4993724 by Ed 'DeepDyve' Gillespie user on 08 June 2018

Journal

Age and AgeingOxford University Press

Published: May 8, 2018

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