The Experts below are selected from a list of 105 Experts worldwide ranked by ideXlab platform
Stephan Zierz - One of the best experts on this subject based on the ideXlab platform.
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external ophthalmoplegia due to ocular myositis in a patient with Ophthalmic herpes Zoster
Neuromuscular Disorders, 2004Co-Authors: M Krasnianski, M Sievert, V Bau, Stephan ZierzAbstract:External ocular muscle palsies in patients with Ophthalmic Zoster are traditionally interpreted as diseases of III, IV or VI cranial nerves. Orbital myositis associated with Zoster Ophthalmicus has been diagnosed only rarely. We describe a patient with Ophthalmic Zoster and external ophthalmoplegia due to ocular myositis demonstrated by MR imaging. Treatment with acyclovir and cortisone resulted in a rapid improvement of the ophthalmoplegia. In Ophthalmic herpes Zoster associated with external ocular muscle palsies, ocular myositis is an important differential diagnosis to inflammatory involvement of the cranial nerves III, IV, and VI.
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case report external ophthalmoplegia due to ocular myositis in a patient with Ophthalmic herpes Zoster
2004Co-Authors: M Krasnianski, M Sievert, V Bau, Stephan ZierzAbstract:External ocular muscle palsies in patients with Ophthalmic Zoster are traditionally interpreted as diseases of III, IV or VI cranial nerves. Orbital myositis associated with Zoster Ophthalmicus has been diagnosed only rarely. We describe a patient with Ophthalmic Zoster and external ophthalmoplegia due to ocular myositis demonstrated by MR imaging. Treatment with aciclovir and cortisone resulted in a rapid improvement of the ophthalmoplegia. In Ophthalmic herpes Zoster associated with external ocular muscle palsies, ocular myositis is an important differential diagnosis to inflammatory involvement of the cranial nerves III, IV, and VI. q 2004 Elsevier B.V. All rights reserved.
M Krasnianski - One of the best experts on this subject based on the ideXlab platform.
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external ophthalmoplegia due to ocular myositis in a patient with Ophthalmic herpes Zoster
Neuromuscular Disorders, 2004Co-Authors: M Krasnianski, M Sievert, V Bau, Stephan ZierzAbstract:External ocular muscle palsies in patients with Ophthalmic Zoster are traditionally interpreted as diseases of III, IV or VI cranial nerves. Orbital myositis associated with Zoster Ophthalmicus has been diagnosed only rarely. We describe a patient with Ophthalmic Zoster and external ophthalmoplegia due to ocular myositis demonstrated by MR imaging. Treatment with acyclovir and cortisone resulted in a rapid improvement of the ophthalmoplegia. In Ophthalmic herpes Zoster associated with external ocular muscle palsies, ocular myositis is an important differential diagnosis to inflammatory involvement of the cranial nerves III, IV, and VI.
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case report external ophthalmoplegia due to ocular myositis in a patient with Ophthalmic herpes Zoster
2004Co-Authors: M Krasnianski, M Sievert, V Bau, Stephan ZierzAbstract:External ocular muscle palsies in patients with Ophthalmic Zoster are traditionally interpreted as diseases of III, IV or VI cranial nerves. Orbital myositis associated with Zoster Ophthalmicus has been diagnosed only rarely. We describe a patient with Ophthalmic Zoster and external ophthalmoplegia due to ocular myositis demonstrated by MR imaging. Treatment with aciclovir and cortisone resulted in a rapid improvement of the ophthalmoplegia. In Ophthalmic herpes Zoster associated with external ocular muscle palsies, ocular myositis is an important differential diagnosis to inflammatory involvement of the cranial nerves III, IV, and VI. q 2004 Elsevier B.V. All rights reserved.
Y Motegi - One of the best experts on this subject based on the ideXlab platform.
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ipsilateral truncal sensory deficit in a patient with Ophthalmic Zoster sine herpete
Neurology, 2003Co-Authors: S Yamada, Naoki Atsuta, S Tokunaga, Y MotegiAbstract:Herpes Zoster (HZ) and Zoster sine herpete (ZSH), defined as pain in a dermatomal distribution without the rash of cutaneous Zoster, result in an array of neurologic complications.1 We report a patient with Ophthalmic ZSH that had the unusual complication of sensory disturbance over the ipsilateral upper trunk. Brain MRI showed an abnormal signal lesion in the medulla, possibly regional encephalitis due to direct invasion of varicella Zoster virus (VZV). A 46-year-old immunocompetent man developed acute painful neuralgia in the first division of his left trigeminal nerve without skin rash. In 7 days, numbness spread over the left half of his face, head, neck, and entire left arm. Three days later, he awoke to left facial palsy and tinnitus in his left ear, leading to hospitalization. On admission, he had generalized headache and low-grade fever with mild neck stiffness. He showed complete left facial palsy and sensorineural hearing loss in his left ear. His palate moved symmetrically, and the …
Simon P Harding - One of the best experts on this subject based on the ideXlab platform.
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management of Ophthalmic Zoster
Journal of Medical Virology, 1993Co-Authors: Simon P HardingAbstract:The natural history of herpes Zoster Ophthalmicus and aspects of its treatment and prevention are presented. Intraocular complications occur in 50 percent of cases. Anterior uveitis and the various varieties of keratitis are commonest, affecting 92% and 52% of patients with ocular involvement, respectively. Sight-threatening complications include neuropathic keratitis, perforation, secondary glaucoma, posterior scleritis/orbital apex syndrome, optic neuritis, and acute retinal necrosis. Twenty-eight percent of initially involved eyes develop long-term ocular disease (6 months), with chronic uveitis, keratitis, and neuropathic ulceration being the commonest. Acute pain occurs in 93% of patients and is still present in 31% at 6 months. Of patients aged 60 and over pain persists in 30% for 6 months or longer, and this rises to 71% in those aged 80 and over. Current evidence favours the use of topical acyclovir alone for treatment of established ocular complications, with topical steroids being withheld in all but the most severe cases. Stellate ganglion block has proved useful in the treatment of established acute pain. Amitryptiline, and to a lesser extent sodium valproate, are useful in established chronic pain. Evidence of the efficacy of early oral acyclovir on ocular complications is conflicting, with two studies reporting significant improvement in differing disease parameters. A similar situation exists for pain, with published studies showing differing effects on pain at varying times after the onset of disease. The use of systemic steroids to prevent pain is not supported by currently available evidence, but its therapeutic relationship with acyclovir requires further evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)
Soo Young Moon - One of the best experts on this subject based on the ideXlab platform.
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acute orbital myositis before herpes Zoster Ophthalmicus
Korean Journal of Anesthesiology, 2012Co-Authors: Soo Young MoonAbstract:In the literature, 7% of all cases of herpes Zoster present as herpes Zoster Ophthalmicus (HZO). Of these cases, 20 to 79% have orbital involvement [1]. Nearly all orbital tissues, including extra-ocular muscles, can be affected by the varicella Zoster virus. Orbital involvement may present as keratitis, uveitis, scleritis, optic neuritis, ocular motor palsy, or postherpetic neuralgia (PHN) [2]. HZO is often suspected when Ophthalmic symptoms and signs follow characteristic skin rashes and edema. Here, we report an unusual case where orbital myositis preceded vesicular skin eruptions. A 66 year-old man, who had diabetes for 15 years and hypertension for 10 years, was hospitalized due to a 4-day history of left orbital shooting pain. Cranial nerve examination was nearly normal except for mild ptosis and hyperemic conjunctiva on the left side. Ophthalmic examination revealed normal intraocular pressure and normal eyeground. There were no specific findings in other physical examinations. Orbital CT revealed left orbital myositis involving superior, inferior, medial, and lateral rectus muscles compared with the right orbit (Fig. 1A). We treated him with intra-venous mannitol, 60 mg/day per-oral prednisolone (nisolone®, Kukje, Seongnam, Korea), levofloxin eye-drops (Cravit®, Santen, Shiga, Japan), dorzolamide HCl 2% with timolol 0.5% (Cosopt®, MSD, Seoul, Korea), and latamoprost (Xalost®, Taejoon, Seoul, Korea). Fig. 1 (A) Orbital computed tomography (CT) image with contrast, coronal view. CT shows relatively moderately enhanced and enlarged left superior, inferior, medial, and lateral rectus muscles compared with right orbit. (B) 2 weeks later, a follow-up orbital ... After 3-days, he developed vesicular skin rashes at the distribution of the Ophthalmic branch of the left trigeminal nerve and along the nasal ridge (Hutchinson's sign) (Fig. 1C). He complained of severe pain in his left forehead and nose. The pattern of the pain included lancinating, shooting, and itching sensations. The pain measured by the visual analogue scale (VAS) was approximately 90/100 mm. Laboratory data, including routine biochemical and hematological examinations, were normal except for glucose (423 mg/dl) and hemoglobin A1c (10.6%). The erythrocyte sedimentation rate (ESR) was 30 mm/hr and C-reactive protein (CRP) was 0.74 mg/dl. Immunologic studies, including IgA, IgM, C3, C4, antimitochondrial antibody (AMIA), anti-nuclear antibody (ANA), and anti-double stranded DNA, were all within normal limits. Thyroid function test was normal and the VDRL/TPHA test was negative. Immediately, we treated him with 7-day intra-venous (IV) acyclovir, IV dexamethasone, and per-oral (PO) gabapentin. At the same time, we performed supraorbital and supratrochlear nerve blocks. After the nerve block, the headache and allodynia were improved. The eyelid swelling and orbital pain gradually lessened by the time he was discharged. The patient returned to our clinic with persistent left orbital pain and paroxysmal and lancinating pain along the nose ridge and forehead. We performed supraorbital and supratrochlear nerve blocks then and again in two weeks, for a total of three times. The pain was reduced to VAS 10-20/100 mm. A follow-up orbital CT revealed resolved myositis in the rectus muscles (Fig. 1B). The patient was undergoing oral administration of gabapentin (600 mg/day). He revisited the hospital 5 months later without particular exacerbation of the pain or any other inconvenience in his daily tasks. Ophthalmic complications following HZO result directly from inflammatory changes or nerve damage, or indirectly from tissue scarring. These complications vary from mild, which may pass unnoticed, to severe, which may threaten life or sight. Except for diplopia, our patient developed characteristic symptoms of orbital myositis, such as orbital pain worsening with eye movements, proptosis, swollen eyelid, and hyperemic conjunctiva. He had Hutchinson's sign, which is typical for HZO [1]. Normal immunologic and serologic surveys excluded other etiologies of orbital myositis, for example, thyroid disease, syphilis, and auto-immune diseases. His ocular symptoms improved after antiviral therapy and the follow-up orbital MRI four months later revealed total recovery of orbital myositis. Typically, Ophthalmic complications of HZO occur between 5 days and 14 days following cutaneous lesions. Our case is unusual in that the orbital myositis preceded vesicular rashes. Two similar patients have been reported previously [3,4]. Both patients came to the hospital for retrobulbar pain with diplopia. Volpe et al. demonstrated orbital myositis on computed tomographic (CT) scans in their patient one day before the development of skin vesicles [3]. As reported by Kawasaki et al., MRI demonstrated orbital myositis three days prior to appearance of typical skin eruptions in their patient [4]. In these two patients and ours, their extraocular myositis had excellent recovery. However, our patient suffered from PHN, which did not occur in the previously reported patients. Although Marsh and Cooper had proposed extraocular myositis as a possible cause of ophthalmoplegia in HZO [2], it was not well documented until these case reports. To date, there is no histopathologic study of orbital myositis in HZO [4]. Orbital myositis preceding vesicular skin eruptions is a diagnostic challenge in HZO. Since Zoster rashes may develop one week or more after dermatomal pain [1], serological and immunological tests may be helpful for early diagnosis in extraocular myositis preceding Zoster rashes. In 1958, Lewis reported a syndrome of "Ophthalmic Zoster sine herpete" [5], in which orbital pain, extraocular palsy, and periorbital skin swelling occurred without skin rashes. "Ophthalmic Zoster sine herpete" further confounds the diagnosis of HZO. We emphasize that, even without vesicular skin rashes, a diagnosis of extraocular myositis case as idiopathic should not be given before the availability of negative serological and immunological results for herpes Zoster. In conclusion, orbital myositis can be the presenting sign of HZO. In these patients, recovery of extraocular myositis is excellent and serological and immunological studies may be helpful for early diagnosis. HZO should be listed as a cause of acute orbital myositis even without skin eruptions. Therefore, early diagnosis of acute orbital myositis and anti-viral therapy will prevent PHN. And, if Zoster skin rashes are found, we should control pain aggressively by nerve blocks to prevent the development to PHN.