Ann Rehabil Med.  2013 Jun;37(3):449-452. 10.5535/arm.2013.37.3.449.

Vernet Syndrome by Varicella-Zoster Virus

• Jo YR
• Chung CW
• Lee JS
• Park HJ

• KMID: 2219546
• DOI: http://doi.org/10.5535/arm.2013.37.3.449

Abstract

Vernet syndrome involves the IX, X, and XI cranial nerves and is most often attributable to malignancy, aneurysm or skull base fracture. Although there have been several reports on Vernet's syndrome caused by fracture and inflammation, cases related to varicella-zoster virus are rare and have not yet been reported in South Korea. A 32-year-old man, who complained of left ear pain, hoarse voice and swallowing difficulty for 5 days, presented at the emergency room. He showed vesicular skin lesions on the left auricle. On neurologic examination, his uvula was deviated to the right side, and weakness was detected in his left shoulder. Left vocal cord palsy was noted on laryngoscopy. Antibody levels to varicella-zoster virus were elevated in the serum. Electrodiagnostic studies showed findings compatible with left spinal accessory neuropathy. Based on these findings, he was diagnosed with Vernet syndrome, involving left cranial nerves, attributable to varicella-zoster virus.

Keyword

Varicella-zoster virus; Cranial nerves

MeSH Terms

Aneurysm
Cranial Nerves
Deglutition
Ear
Emergencies
Herpesvirus 3, Human
Inflammation
Laryngoscopy
Neurologic Examination
Republic of Korea
Shoulder
Skin
Skull Base
Uvula
Vocal Cord Paralysis
Voice

Figure

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  Fig. 1 Clinical photo of the left ear. Crust on the auricle.

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  Fig. 2 Clinical photos of the left uvula and vocal cord in laryngoscopic view. (A) Asymmetric left vocal cord (arrow head) and ipsilateral arytenoid (arrow) movement, especially hypomobile abduction during respiration. (B) Mild deviation of the uvula to the right side (arrow).

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  Fig. 3 (A) Magnetic resonance imaging of the temporal bone. Axial T1-weighted image at the medullary level shows no evidence of brainstem lesion. There is no nodular lesion in the left jugular foramen (arrow), which is smaller than the right. (B) Computed tomography scan reveals asymmetry of the jugular foramina (arrows).

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