Cranial Nerve VI Palsy Secondary to Herpes Zoster Ophthalmicus: A Case Report and Literature Review.

INTRODUCTION: In this report, we describe a rare case of a cranial nerve VI palsy secondary to herpes zoster infection with polyneuropathic involvement. CASE PRESENTATION: An 82-year-old male was seen by ophthalmology for acute onset of double vision. Fourteen days before presenting, he was diagnosed with herpes zoster ophthalmicus. He was suspected to have zoster polyneuropathy also involving cranial nerve IX and X given a sore throat that began prior to the characteristic trigeminal dermatomal rash. He was diagnosed with cranial nerve VI palsy secondary to herpes zoster infection. DISCUSSION: Ophthalmic complications of herpes zoster ophthalmicus are many; however, extraocular nerve palsies secondary to herpes zoster infection and zoster polyneuropathy are documented infrequently in the literature. CONCLUSIONS: Extraocular muscle palsies are a rare complication of herpes zoster infection. This case reviews the most current literature surrounding this condition and discusses the significance of polyneuropathic involvement in varicella zoster virus reactivation.

Purtscher-Like Retinopathy with Cardioembolic Stroke: Case Report and Literature Review.

Purtscher-like retinopathy (PUR) is a rare condition characterized by sudden vision loss with associated retinal white patches thought to be due to precapillary arteriolar occlusion. We present a case of PUR associated with a cardioembolic stroke in a patient following temporary cessation of anticoagulant therapy for a surgical procedure. Our patient presented with multiple risk factors for PUR and classic signs and symptoms including multiple peripapillary white retinal lesions near arterioles and sudden unilateral decrease in visual acuity. Optical coherence tomography showed inner retinal hyperreflectivity and thinning consistent with inner retinal ischemia, and fluorescein angiography showed delayed retinal filling. Her complement C5 factor was elevated on laboratory testing. Brain magnetic resonance imaging showed acute/subacute left occipital lobe ischemia thought to be from a cardioembolic stroke. Shortly prior to visual symptoms, our patient's apixaban was held due to surgical drainage of a gluteal abscess. This case highlights the rare occurrence of PUR associated with cardioembolic stroke and the importance of cerebral imaging in a patient presenting with PUR of uncertain etiology.