ArticleRadiology case reports2026
Herpes zoster ophthalmicus with atypical occipital lobe and splenial lesions: A case report.
Article in Radiology case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
A 32-year-old male with past medical history of migraine headaches (last episode 15 years prior) presented with persistent headache lasting 2 days and with associated nausea, photophobia and phonophobia concerning for migraine. Subsequent visits to outside facilities suggested a cortical/subcortical infarct of the left medial occipital lobe secondary to migraines. However, after continued symptoms and the subsequent development of a maculopapular rash along the right orbit and eyelid, suspicion grew that this was not a simple case of migraine induced infarct. Cerebral spinal fluid analysis showed markedly elevated VZV antibodies further raising suspicion. After a 1-week course of high-dose oral valacyclovir the rash and headache resolved. This case demonstrates an atypical pattern of CNS involvement in herpes zoster ophthalmicus, with simultaneous splenial and medial occipital lesions - an imaging pattern not commonly reported in immunocompetent adults. The findings also highlight the importance of a good clinical history and the superior sensitivity of MRI in detecting subtle varicella-zoster-related encephalitic changes when CT is nondiagnostic.
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