# Hutchinson’s sign complicated by bilateral multiple cranial neuropathies and cerebral infarctions: a case report

## TL;DR

A 61-year-old man with Hutchinson’s sign developed severe complications from VZV, including cranial neuropathies and cerebral infarctions.

## Contribution

This case highlights rare bilateral neurological complications linked to Hutchinson’s sign and VZV infection.

## Key findings

- Hutchinson’s sign preceded HZO and led to acute cerebral infarction and bilateral ophthalmoplegia.
- Bilateral cranial nerve involvement suggests widespread VZV dissemination in the central nervous system.

## Abstract

Varicella-zoster virus (VZV) infection is associated with serious complications, including cranial vasculopathy and herpes zoster ophthalmicus (HZO). Hutchinson’s sign, characterized by VZV lesions on the tip, dorsum, and root of the nose, serves as a strong predictor of ipsilateral ocular complications in HZO. Here we describe a 61-year-old male who developed multiple cranial neuropathies and acute cerebral infarction secondary to VZV infection. His clinical manifestations began with Hutchinson’s sign, progressed to HZO, and subsequently led to acute cerebral infarction and bilateral ophthalmoplegia. The presence of Hutchinson’s sign strongly correlates with the development of HZO-related ocular complications. This striking bilateral cranial nerve involvement and cerebral infarctions suggest a potential mechanism of widespread viral dissemination within the central nervous system.