Clinical Practice and Cases in Emergency Medicine

Introduction: Herpes zoster ophthalmicus, a reactivation of varicella-zoster virus involving the ophthalmic branch of the trigeminal nerve, is a known but under-recognized risk factor for acute cerebrovascular and cardiovascular events. 

Case Report: We report the case of an 84-year-old female with herpes zoster ophthalmicus who suffered a fatal ischemic stroke and bilateral submassive pulmonary emboli within days of diagnosis. Despite early identification and appropriate antiviral treatment, the patient experienced rapid neurological decline and ultimately succumbed to complications. 

Conclusion: This case underscores the critical association between herpes zoster ophthalmicus and increased risk of stroke and myocardial infarction, as supported by growing epidemiologic evidence. Physicians should be aware of these severe complications, consider close monitoring and cardiovascular risk stratification in patients with herpes zoster ophthalmicus, and they should provide patients with clear return precautions for symptoms suggestive of stroke or embolic disease. Further research is needed to determine preventative strategies beyond antiviral therapy for high-risk patients.