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and IV methylprednisolone followed by oral prednisolone. inclusions and multinucleated giant cells. [9]
He symptomatically improved within two months.
In our present study, although the patient had a definite
DISCUSSION clinical history of recent herpes zoster supported by
positive serum VZV IgM antibody, the MRI of the brain
In this study, the patient had right INO with a recent with magnetic resonance angiography was found normal.
history of herpes zoster infection presenting painful rash It is possible that microinfarctions due to restriction of
distribution along V3 branch of the left trigeminal nerve. the disease inflammation to a small single artery in the
He possibly had damaged right MLF, without exhibiting brainstem were not detected in MRI scans of the brain.
significant brainstem lesions in the MRI of the brain. The
positive serum herpes zoster IgM antibody report of the A spectrum of neurologic complications may follow
patient suggested recent reactivation of the latent VZV. herpes zoster infection such as motor neuropathies of
The exact pathogenic mechanism by which Varicella the cranial and peripheral nervous system, encephalitis,
zoster causes INO has not been elucidated, however, meningoencephalitis, myelitis and Guillain-Barre
some studies assume it is due to multifactorial etiologies. syndrome. Our patient had presented INO after herpes
The proposed hypothesis are: demyelination in the zoster infection, which is a very rare neurological
brainstem; microinfaractions in the brainstem due to manifestation of VZV, however, he recovered completely
[3]
inflammatory meningovasculitis producing small vessel with appropriate treatment. We wanted to highlight this
vasculopathy of the supplying cranial nerves. [4] case because of its infrequency of occurrence.

The herpes zoster particles spread along trigeminal Financial support and sponsorship
afferent fibers and cause small vessel vasculopathy. Nil.
Initially the reactivated virus spreads transaxonally to
the arterial adventia and then spreads transmurally to Conflicts of interest
the lumen. It causes thickening of intima, disruption of There are no conflicts of interest.
elastic lamina and loss of smooth muscle cells, which
leads to occlusion of the involved vessel. It has been REFERENCES
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