VZV has been implicated in causing many Neurologic diseases. Disorders caused by VZV usually present with rash, but can also be caused in the absence of cutaneous VZV. Cranial neuropathies may result from VZV infection, and CN 5-12 have been documented as being involved in various cases.

A 29-year-old woman with no significant medical history who presented with 8 days of diplopia. On exam, patient had horizontal and vertical diplopia. Her right eye was upwardly deviated, and her head was tilted to the left at rest. This was suspicious for right Trochlear nerve mononeuropathy. There symptoms were highly suspicious for MS based on the patient’s age and sex. MRI of the brain and orbits with contrast were done, but they were unremarkable. Lumbar puncture was also done to look for OCBs and CSF was incidentally found to be PCR positive for VZV. CSF also increased WBCs and protein. Patient later endorsed that there were cutaneous vesicles on her arms and legs that she had not previously mentioned because she thought they were insect bites. No lesions were observed on her face, and the tympanic membranes were clear. She was started on IV acyclovir 10 mg/kg Q8H which was continued for 5 days and then transitioned to PO therapy to complete 10 days of therapy.