PDF(Pubmed)
Abstract：
Herpes zoster ophthalmicus (HZO) manifests as a consequence of the reactivation of the Varicella-zoster virus (VZV) and primarily affects the ophthalmic division of the trigeminal nerve. Identification of the vesicular eruption is central to the diagnostic process; however, the delayed manifestation of this cutaneous phenomenon poses a challenge to timely and accurate diagnosis. This report elucidates the case of a 61-year-old Japanese male with painful trigeminal neuropathy attributed to VZV that was initially diagnosed as cluster headache, mainly due to the delayed cutaneous eruption. Contrary to the expected pattern of cluster headache presentations, there was no discernible fluctuation in headache severity. The transient improvement of symptoms following interventions tailored for cluster headache management, including pure oxygen inhalation and subcutaneous sumatriptan injection, inadvertently contributed to a delay in accurate diagnosis. The importance of distinguishing HZO from cluster headache is emphasized, particularly in cases involving elderly patients or those with persistent cephalo-ophthalmalgia without the characteristic fluctuation of symptoms. In cases where clinical suspicion of HZO is raised, cerebrospinal fluid analysis should be performed. This approach is consistent with the overall goal of facilitating a prompt and accurate diagnosis.
摘要：
眼带状疱疹（HZO）表现为水痘带状疱疹病毒（VZV）重新激活的结果，并主要影响三叉神经的眼科分裂。水泡喷发的识别是诊断过程的核心；然而，这种皮肤现象的延迟表现对及时准确的诊断提出了挑战。本报告阐明了一名61岁的日本男性，患有归因于VZV的疼痛性三叉神经病变，最初被诊断为丛集性头痛。主要是由于皮肤喷发延迟。与丛集性头痛的预期模式相反，头痛严重程度无明显波动.针对丛集性头痛管理量身定制的干预措施后症状的短暂改善，包括纯氧吸入和皮下注射舒马曲坦，无意中导致了准确诊断的延迟。强调了区分HZO和丛集性头痛的重要性，特别是在涉及老年患者或患有持续性头眼痛而没有症状特征波动的患者中。在临床怀疑HZO的情况下，应进行脑脊液分析。这种方法与促进迅速和准确诊断的总体目标是一致的。
