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A long-term follow up of right ophthalmoplegia and severe right middle cerebral artery stenosis with right herpes zoster ophthalmics: a case report
- Source :
- Rinsho Shinkeigaku. 55:406-411
- Publication Year :
- 2015
- Publisher :
- Societas Neurologica Japonica, 2015.
-
Abstract
- Here we report a case of a 68-year-old man with severe stenosis of the right middle cerebral artery (MCA) following herpes zoster ophthalmicus. He presented with right-sided ptosis and ophthalmoplegia 2 months after herpes zoster ophthalmicus. Cerebrospinal fluid (CSF) analysis revealed monocytosis, increased protein levels, and positivity for herpes zoster virus immunoglobulin M (IgM). Brain magnetic resonance imaging (MRI) revealed a small asymptomatic infarct in the right basal ganglia and severe stenosis of the right MCA (M1 segment). One month later, he presented with muscle weakness of the fingers of the left hand. Repeat CSF analysis revealed similar abnormalities to the previous analysis, and MRI showed a new small infarct in the right-sided motor area corresponding to the left fingers. He was treated with acyclovir (750 mg/day), prednisolone (1 mg/kg/day), and aspirin (100 mg/day). O2-gas positron emission tomography (PET) revealed decreased cerebral blood flow (CBF) after acetazolamide injection and normal cerebral vascular reactivity (CVR). He was on continuous treatment with prednisolone and aspirin for 1 year. The muscle weakness of the fingers of the left hand and right-sided ophthalmoplegia improved, and magnetic resonance angiography revealed considerable decrease in the stenosis of the right middle cerebral artery. CBF before and after acetazolamide injection and CVR on O2-gas PET also normalized. These results suggested that long-term treatment may prevent subsequent infarcts following herpes zoster ophthalmics.
- Subjects :
- Middle Cerebral Artery
medicine.medical_specialty
Ophthalmoplegia
medicine.diagnostic_test
business.industry
Prednisolone
Muscle weakness
medicine.disease
Asymptomatic
Magnetic resonance angiography
Stenosis
Cerebrospinal fluid
Ptosis
Cerebral blood flow
Herpes Zoster Ophthalmicus
Internal medicine
Cardiology
Humans
Medicine
Cerebral Arterial Diseases
Neurology (clinical)
medicine.symptom
business
Aged
Subjects
Details
- ISSN :
- 18820654 and 0009918X
- Volume :
- 55
- Database :
- OpenAIRE
- Journal :
- Rinsho Shinkeigaku
- Accession number :
- edsair.doi.dedup.....66897070fc6cc189d270b08c3ce67028