Sex: M
Vaccine: VARZOS
Symptoms: Cellulitis orbital, Cerebrovascular accident, Computerised tomogram, Extraocular muscle paresis, Facial paralysis
Clinical narrative: right eye weakness; stroke/acute cerebrovascular accident; Orbital cellulitis; sudden right facial tingling; Cranial  II-XII grossly intact; diminished taste/change in taste sensation; facial numbness; difficulty taste; mild right forehead weakness; decreased movement in present in the whole right side of the face; right facial swelling; eye redness; presbyopcia; myopia; Bell's palsy/ right peripheral facial palsy/right side facial droop/right-sided facial weakness noted with droop/right side of the face paralysis/Right face Bell's palsy; venous developmental anomaly; Minor paralysis; acute CVA versus intracranial haemorrhage; This case was reported by a lawyer and described the occurrence of bell's palsy in a patient who received Herpes zoster (Shingrix) for prevention of herpes zoster.  The initial information was received on 13 May 2020 via medical records (case is now medically confirmed). As per the medical record, on 06 January 2020 the patient had Shingrix (zoster vaccine,recombinant injection, lyophilized , doses (0.5ml each) by intramuscularly (IM) at 0 and 2-6 month for prevention of herpes zoster.On 28 January 2020, the patient had right facial weakness. The patient admitting diagnosis was right side facial droop,right-sided facial weakness noted with droop and principal diagnosis was bell's palsy.The patient had difficulty tasting and had diminished taste and patient also noted some change in taste sensation. The patient had right peripheral facial palsy, mild right forehead weakness , minor paralysis. On follow up the patient presents with the right side of the face paralysis with decreased sensation in V2 distribution on right, mild right sided forehead weakness, decreased movement in present in the whole right side of the face. The patient had right face Bell's Palsy and cranial II-XII grossly intact. The patient facial sensation to light touch intact in V1,V2, V3 bilaterally VII, house brackmann III facial palsy. The patient differential diagnosis includes acute CVA versus intracranial hemorrhage given some onset of right-sided facial weakness but spares the forehead apparently. The possibility of onset of stroke symptoms might consider within window of tissue plasminogen activator so the patient was activated as a code stroke.The patient had sudden right facial numbness and sudden right facial tingling. The patient discharged on Prednisone taper and symptoms improved, almost resolved. The patient had right facial swelling, right eye weakness, orbital cellulitis, eye redness, presbyopia and myopia. The patient had present with right facial weakness onset less than 24 hours upon admission. Magnetic resonance imaging (MRI) identified possible vascular malformation. Computed tomography showed possible venous developmental anomaly. The patient's SS (Stroke Scale) was 2 for facial weakness and numbness.The patient CT maxillofacial with intravenous contrast.      Lab Comments: Magnetic resonance imaging (MRI) identified possible vascular malformation. Computed tomography showed possible venous developmental anomaly.  The patient's SS (Stroke Scale) was 2 for facial weakness and numbness. The patient CT maxillofacial with intravenous contrast.