Herpes zoster internuclear ophthalmoplegia

Vijayashankar Paramanandam, Sowmini Perumal, Malcolm Jeyaraj, Sakthi Velayutham, Gobinathan Shankar Department of Neurology, Stanley Medical College & Hospital, Chennai 600001, Tamilnadu, India. Internuclear ophthalmoplegia (INO) is caused by a lesion in the medial longitudinal fasciculus. Patients with INO are usually asymptomatic but may have diplopia and oscillopsia. The most common causes of INO are ischemia and demyelination. Occurrence of INO due to infectious etiologies like tuberculosis, AIDS, brucellosis, cysticercosis and syphilis is well known. However, clinical presentation of INO associated with herpes zoster is very rare. The possible pathogenic mechanism for varicella zoster virus (VZV) induced INO could be demyelination or microinfarction in the brainstem. In the present study, a case of 56 years old male with double vision, with a recent history of herpes zoster, has been reported. Clinical examination revealed right INO. VZV IgM antibodies were positive and patient recovered fully after treatment with acyclovir and steroids.