Herpes Zoster Ophthalmicus and Delayed Contralateral Hemiparesis

Abstract

A stereotyped syndrome exists in which herpes zoster ophthalmicus is followed in three to five weeks by acute contralateral hemiparesis or aphasia. The first case, to our knowledge, in which angiographic studies of the great vessels in the neck and intracranial arteries were done showed a segmental arteritis of the carotid siphon. The literature on the disease granulomatous angiitis of the central nervous system includes two typical cases of herpes zoster ophthalmicus with contralateral hemiplegia that were not clinically recognized as such. However, autopsy showed a segmental ipsilateral arteritis diagnostic of granulomatous angiitis of the nervous system. At least some cases of granulomatous angiitis of the nervous system are due to segmental arteritis by varicella virus, and the pathological basis of the syndrome of herpes zoster ophthalmicus with contralateral hemiplegia is a segmental granulomatous angiitis. (<i>JAMA</i>229:302-304, 1974)