@article{3125250,
    title = "Fourth and sixth nerve palsies due to herpes simplex 1 infection",
    author = "Anagnostou, E. and Mouka, V. and Kemanetzoglou, E. and Kararizou, E.",
    journal = "Journal of Neuro-Ophthalmology",
    year = "2015",
    volume = "35",
    number = "1",
    pages = "57-59",
    publisher = "Lippincott Williams and Wilkins",
    issn = "1070-8022, 1536-5166",
    doi = "10.1097/WNO.0000000000000184",
    keywords = "aciclovir, abducens nerve paralysis;  aged;  Article;  case report;  cerebrospinal fluid analysis;  convergent strabismus;  female;  head tilting;  herpes simplex;  herpes zoster ophthalmicus;  human;  neuroimaging;  polymerase chain reaction;  priority journal;  rash;  stabbing headache;  treatment duration;  treatment outcome;  trochlear nerve palsy;  vertical strabismus;  Abducens Nerve Diseases;  complication;  herpes simplex;  Herpes simplex virus 1;  pathogenicity;  Trochlear Nerve Diseases;  virology, Abducens Nerve Diseases;  Aged;  Female;  Herpes Simplex;  Herpesvirus 1, Human;  Humans;  Trochlear Nerve Diseases",
    abstract = "Ocular motor cranial nerve palsies of viral etiology are uncommon and, when accompanied by skin lesions, zoster ophthalmicus is the most frequent diagnosis. We describe the case of a 68-year-old woman who developed fourth and sixth nerve palsies 3 days after appearance of a painful vesicular skin rash on the left side of her forehead. Neuroimaging was normal but polymerase chain reaction (PCR) testing of the cerebrospinal fluid was positive for Herpes Simplex 1 and negative for Varicella Zoster. The patient was treated with intravenous acyclovir, and the cranial nerve palsies resolved over 7 weeks. Although the similarity of the cutaneous vesicular eruption in our patient to that seen with zoster might have led to an incorrect diagnosis, acyclovir seems to be safe and effective for both viral etiologies. © 2014 by North American Neuro-Ophthalmology Society."
}