Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history I can not comment on the exact cause of your symptoms. However, if your symptoms have only improved since your stroke/surgery, it's likely your current symptoms are merely residual from that event and are likely permanent. If, however, your symptoms have been changing recently or certainly getting worse, it would be worthwhile to make sure there isn't another process going on. You meant you've previously been positive for HSV-1. That is certainly a common infection of the skin and most often results in cold sores. However, this virus can also cause other infections such as herpes encephalitis, which in theory, one could be at increased risk for in the event they had open skin lesions while they had brain surgery. However, herpes encephalitis is classically a pretty devastating disease acutely usually with fever, changes in thinking, headache, occasionally neck stiffness, extreme sleepiness/coma, weakness localized to certain area(s) of the body, and occasionally seizures. If your neurologist felt this was a likely diagnosis, acyclovir would be an appropriate treatment to help prevent the virus from reproducing as your body works to fight the virus. (Currently no medications kill viruses per se). Additionally, lumbar puncture would commonly be done to look for the virus in the fluid that surrounds your brain and spine and brain imaging should be done (preferably before the lumbar puncture) to look for classic findings. Lumbar puncture studies can often find the virus even 5-7 days after the start of treatment if not longer.
First, let me say, I am not a medical person. I have Ramsay Hunt Syndrome, caused by reactivation of the Varicella Zoster Virus, also known as Herpes Zoster. It is my understanding that acyclovir, which I have taken, does not KILL the herpes virus. It prevents it from multiplying which allows the body the opportunity to fight the virus and heal. It is effective when the rash, cold sore, vesicle is visible (virus is active) and can be used as a suppression dosing. The double vision may be cranial nerve 6 involvement, and from what I have been told (I have CN6,7 and 8) time is what helps heal the nerves. They heal themselves but require time and energy to do so. With RHS we are told to allow 2 years for healing before trying other methods-surgery, stimulation,etc.
Hope this helps.
It has now been a few more days with treatment of Acyclovir and there maybe a subtle increase in sensation on the left (affected) side Whereas after my surgery, things only got worse). Based on the assumption that this was caused by HSV-1, would I have seen more improvement?
Thanks for your time!