Herpes Zoster Ophthalmicus Affecting the Spinal Trigeminal Nucleus and Tract

We report a case of a patient with herpes zoster ophthalmicus involving the spinal trigeminal nucleus and tract. The patient presented with 1 week of right-sided eye pain associated with swelling, white discharge, and ulcerative papules involving the surrounding skin. MR imaging showed findings typical of disease involving the ophthalmic division of the trigeminal nerve, with additional linear signal-intensity abnormality of the ipsilateral brain stem. This constellation of findings is consistent with transaxonal spread of herpes zoster along the trigeminal nerve and the STNT.