Concluded Case

Herpes zoster opthalmicus

40yrs male with c/c severe headache right half since 5 days. Few ?vesicular rash over right side of forehead With mild edema in right upper eyelid with pink eye × 2days Same problem before 1 month. Past h/o Head injury MRI s/o area of encephalomalacia in right temporal region with ?NCC He is k/c Psoriasis under medicines regularly. H/o ch alcoholism +ve Left 1month back Is there any chances of Herpes zoster

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Concluded answer

This is not cluster head ache. This is HZ 5th 1st division.Treat accordingly.

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Herpes Zoster 5th nerve , the headache is Trigeminal Neuralgia, h/o Psoriasis on medications, chronic alcoholism indicative of immunodeficiency state more prone for HZ , 5th nerve also supplies cornea may get corneal ulcer . I would suggest Valcyclovir 1 gm bd for 2 weeks , opioid analgesics Tramadol+ paracetamol bd, calamine lotion external use, acyclovir eye drops, immune boosters other symptomatics , ophthalmic opinion for corneal complications

Right herpetic lesions

H S O IS AFFECTION OF OPHTHALMIC DIVISION OF TRIGEMINAL BY VARICEELA ZOOSTER VIRUS CONDITION IS USUALLY UNILATERAL.DOES NOT CROSS THE MIDLINE OCCURS USUALLY AFTER 5TH AND 6TH DECADE OF LIFE D M IS A RISK FACTOR IF TIP OF NOSE IS INVOKVED THAT IS INVOLVEMENT OF NASOCILLARY NERVE POSITIVE HUCHANSONS SIGN THEN CORNEAL INVOLVEMENT IS CERTINE CORNEAL.LESIONS ARE DENDRITIC KERATITIS MICRO DENDRITIC KERATITIS KERATITIS PROFUNDA DISCIFIRM KERSTITIS IRIS LESIONS IRIS ATROOHY NEW VESDLS ON IRIS IRITIS POST SAPCAPSULAR CATRACT VITROUS HEAMARGHE A R NECROSIS

AS THERE IS RECURRENCES AFTER A FIRST EPISODE THINK OF SYMPATHETIC OPHTHELMIA VIRUS TRAVELING THRUGH OPTIC NERVE OPETIC CHISMA OF A EPISILATERAL SIDE TO CONTRALATERAL SIDE DUE TO EMMUNISUPRESSION.R/0 CORNEAL LACERATION. PAST VIRAL INFECTION GAVE A ENCEPHALOMALAECIA.. CSF STUDY IS NEEDED.ALING WITH VIRAL CULTURE. WAS THERE A CSF LEAK FORM NOSE SUGGESTIVE OF DAMAGE TO CRIBRIFORM PLATE? UNILATERAL RT SIDED ERUPTION SUGGEST AND VESICULAR RESH ONLY PATHOLOGY OF HERPES ZOSTER.

Looks like Herpes Zoster

This is not cluster head ache. This is HZ 5th 1st division.Treat accordingly.

Thank you doctor
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? HZV ..

Tnx Dr Rakesh Kayasth
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Herpex zoster viruses.. Acylovir ointment used.. Tab Acylovir 800 MG OD 5 days.. Tab multivitamins antioxidants trace elements od.. Coconut oil use.. Ketoconazole shampoo use.. Alovira gel use.. Keep the skin areas Sterile gauge.. Clean skin regularly betadine topical.. For eyes fundus examination and treatment according to disease.. Maintenance hygiene

Thanks doctor kute Ankush sir
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