Abducens nerve palsy caused by herpes zoster

Abstract

We report a case of abducens nerve palsy secondary to herpes zoster infection on the area of the face innervated by the first division of the trigeminal nerve. A 52-year-old man presenting with right facial pain and eruption was diagnosed with right trigeminal herpes zoster by a dermatologist. Two weeks later, he noticed double vision and was diagnosed as having right abducens nerve palsy by a neurosurgeon. Brain MRI was unremarkable. After the skin lesion resolved, the abducens nerve palsy and the facial pain remained. He was referred to our department and we initiated stellate ganglion block, which improved the palsy. The abducens nerve palsy may have been induced by the direct extension of inflammation, ischemia, or compression in the cavernous sinus to the ipsilateral trigeminal nerve. We herein suggest that it is important to pay attention to the eye movements of patients who have herpes zoster infection on the first division of the trigeminal nerve as herpes zoster infection of this facial region could result in abducens nerve palsy.