Orbital apex syndrome and meningoencephalitis: a rare complication of herpes zoster.

Orbital apex syndrome is a rare manifestation of Herpes Zoster (HZ). HZ Mmeningoencephalitis are also rare in immunocompetent persons. We report a rare case that was considered to be HZ meningoencephalitis with orbital apex syndrome in an immunocompetent female. The patient initially manifested with HZ skin lesions and lose of her left sight, diplopia, ptosis, followed by headache, neck pain, and fever, dizziness. Cerebrospinal fluid analysis showed elevation of lymphocytes and protein. A MRI abnormality was remarkable for the presence of a left cerebellum, occipital lobe as well as dura lesion. Head computed tomography and Magnetic resonance venography was normal. Corticosteroid therapy and antiviral therapy was effective to decrease the headache and skin pain. Symptoms were markedly improved after corticosteroid therapy. Three months later, we called the patient to follow up. Her meningoencephalitis symptom recovered. Her follow up brain MRI was normal. But left blindness and external ophthalmoplegia was persistent. This case suggested HZ could affect central nervous system and peripheral nervous system at the same time.