A Case of Multiple Cranial Nerve Involvement with Varicella-Zoster Virus

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Varicella-zoster virus causes not only vesicles, but also infectious cranial polyneuropathy, and facial and vestibular nerve paralysis (Ramsay Hunt's syndrome). We report a case of unilateral paralysis of the VII, IX, and X cranial nerves caused by varicella-zoster virus. The patient, a 56-year-old female, was admitted to our hospital complaining of sore throat, left otalgia and rash on the left auricle. A herpetic vesicle was present on the left arytenoid, and the soft palate was infected, but we could not see any paralysis. The day after admission, she suddenly developed of left facial paralysis, hoarseness, and difficulty in swallowing. Physical examinations revealed paralysis of the left soft palate, and left laryngeal paralysis. The serum antibody titer for varicella-zoster virus was significantly elevated on the 18th day. She was diagnosed as having unilateral paralysis of the VII, IX, and X cranial nerves caused by varicella-zoster virus. She was treated with intravenous acyclovir and steroid, and paralysis of the IX, and X cranial nerves was recovered, but facial nerve paralysis remained. MRI imaging indicated active inflammation of the facial nerve. We performed facial nerve surgical decompression, and facial paralysis was gradually improved.
耳鼻咽喉科臨床学会の論文