Crossed Zoster Syndrome: A Rare Clinical Presentation Following Herpes Zoster Ophthalmicus

Reactivation of varicella zoster virus (VZV) in the cranial nerve, dorsal root, and autonomic ganglia can lead to unilateral radicular pain and cutaneous dermatomal involvement known as herpes zoster infection. A 75-year-old right-hand dominant female presented to the emergency room in August 2018 w...

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Bibliographic Details
Published in:Canadian journal of neurological sciences 2020-09, Vol.47 (5), p.711-713
Main Authors: Kuczynski, Andrea M., Wallace, Carla J., Wada, Ryan, Tyler, Kenneth L., Kapadia, Ronak K.
Format: Article
Language:English
Subjects:
Chicken pox
Hemorrhage
Infections
Letter to the Editor
Magnetic resonance imaging
Nose
Pathogenesis
Patients
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Summary:Reactivation of varicella zoster virus (VZV) in the cranial nerve, dorsal root, and autonomic ganglia can lead to unilateral radicular pain and cutaneous dermatomal involvement known as herpes zoster infection. A 75-year-old right-hand dominant female presented to the emergency room in August 2018 with a one-week history of vesicular rash on the tip her nose (“Hutchinson’s sign”) and in the right V1 distribution including the forehead. Initial investigations included (1) magnetic resonance imaging (MRI) demonstrating bilateral subcortical edema in the occipital and parietal lobes, with mild local mass effect and subtle leptomeningeal enhancement in keeping with PRES (Figure 1); (2) lumbar puncture with predominant lymphocytic pleocytosis (WBC 248, reference range 0–5 × 106/L; 76% lymphocytes), elevated protein of 1.65 (reference range 0.15–0.45 g/L), negative bacterial and viral cultures, and positive VZV DNA amplification by polymerase chain reaction testing.
ISSN:0317-1671
2057-0155
DOI:10.1017/cjn.2020.91