J Neurocrit Care.  2018 Jun;11(1):43-46. 10.18700/jnc.180054.

Zoster Laryngitis with Multiple Cranial Nerve Palsy Progressed as Ascending Involvement

• Hwang W
• Jeong DE

• KMID: 2426213
• DOI: http://doi.org/10.18700/jnc.180054

Abstract

BACKGROUND
Herpes zoster of the head and neck commonly presents with Ramsay Hunt syndrome. However, vesicular eruptions may occur on the pharyngeal or laryngeal area with multiple lower cranial-nerve (CN) palsy.
CASE REPORT
We report on the case of a 54-year-old man with herpes zoster of the pharynx and larynx with multiple CN palsy and persistent hiccups. He initially developed progressive dysphagia, hoarseness, and persistent hiccups (CN IX and X). After admission, Dizziness, hearing impairment, and peripheral facial palsy (CN VII and VIII) were complicated. The results of a polymerase chain reaction test of saliva and vesicular fluid from the ear and throat were strongly positive for varicella zoster virus. The progression of CN palsy was in an ascending sequence.
CONCLUSION
We suggest that the sequence of CN palsy may be either ascending or descending, depending on the initial site of involvement.

Keyword

Herpes zoster; Cranial nerve diseases; Laryngitis; Hiccup

MeSH Terms

Cranial Nerve Diseases*
Cranial Nerves*
Deglutition Disorders
Dizziness
Ear
Facial Paralysis
Head
Hearing Loss
Herpes Zoster Oticus
Herpes Zoster*
Herpesvirus 3, Human
Hiccup
Hoarseness
Humans
Laryngitis*
Larynx
Middle Aged
Neck
Paralysis
Pharynx
Polymerase Chain Reaction
Saliva

Figure

• 

  Figure 1. Flexible laryngoscopy (A) showing multiple vesicles and ulcers with erythematous base on the right epiglottis and larynx, as well as right-side vocal cord palsy. (B) showing multiple small vesicles on the right pharynx and impaired right-side pharyngeal wall contraction and slight uvular deviation to the left-side.

• 

  Figure 2. Detection of VZV DNA from saliva and vesicular fluid by RT-PCR test. M, molecular weight marker (100 bp DNA ladder); Lane 1, MRC-5 cell lysate (negative control); Lane 2, VZV-infected Medical Research Council cell strain 5 cell lysate (positive control); Lane 3-5, saliva, vesicular fluid from the ear and throat, respectively. Probes directed to target VZV DNA were of the 202-bp product. VZV, Varicella-zoster virus; DNA, deoxyribonucleic acid; RT-PCR, reverse transcription polymerase chain reaction.

• 

  Figure 3. Axial T1-weighted gadolinium-enhanced magnetic resonance imaging showing slight enlargement of the right facial nerve (long arrow) and enlargement and swelling of the right ear and adjacent area (short arrow).

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