Herpes zoster induced internuclear ophthalmoplegia a rare case report

AbstractInternuclear ophthalmoplegia (INO) is caused by lesion involving the medial longitudinal fasciculus. Patients with INO are usually asymptomatic but they may complain of diplopia and occasionally oscillopsia. The most common causes of INO are ischemia and demyelination. Various infectious etiologies such as tuberculosis, AIDS, brucellosis, cysticercosis and syphilis may produce INO. Herpes zoster producing INO is a very rare presentation. The possible pathogenic mechanism could be demyelination or microinfarction in the brainstem. Our patient presented with a recent history of herpes zoster followed by double vision. On examination, he had right internuclear ophthalmoplegia. Varicella zoster IgM antibody was positive and he recovered fully after treatment with Acyclovir and steroids.