Article Text

Pontine inflammatory lesion due to shingles
  1. D KIDD,
  2. J S DUNCAN,
  3. E J THOMPSON
  1. Departments of Clinical Neurology and Neuroimmunology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
  1. Dr D Kidd, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.

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T2 weighted MRI (TR 2800 ms, TE 92 ms) at 0.5T showing a single lesion in the right pons at the origin of the right middle cerebellar peduncle.

A 61 year old woman developed tingling at the corner of the right side of her mouth which spread over the next week to involve the whole of the right side of her face. The symptoms were static for two weeks, then gradually receded over the next four weeks. There were no associated neurological symptoms. Simultaneous with this she developed a painful vesicular rash over the right side of the face.

 Neurological examination showed a right trigeminal sensory neuropathy and no other signs.

 Brain MRI showed an area of high signal in the right pons, and no other lesions elsewhere.

 CSF protein was raised at 0.75 g/l but the CSF was acellular. Oligoclonal bands were present in the CSF but absent in serum. The CSF IgG showed high affinity binding toVaricella zoster antigen. This strongly suggests that the pathogenesis of the brainstem lesion was directly related to the preceding episode of shingles.

 At follow up four months later she had made a complete recovery.

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