水痘帯状疱疹ウイルスによる多発脳神経障害をきたした３例

Abstract

Varicella-Zoster virus infection sometimes causes multiple nerve paralysis. We report three cases of multiple cranial nerve paralysis due to Varicella-Zoster virus infection. The first patient, a 58-year-old man, presented with right otalgia, dysphagia and hoarseness. There were painful vesicles on the right auricle, and clinical examination demonstrated right hearing impairment and right vocal paralysis. There was no facial palsy. He was diagnosed with VIIIth, IXth and Xth cranial nerve palsy. The second patient, a 60-year-old woman, presented with right otalgia, vertigo, right hearing loss, and dysphagia. There were painful vesicles on the right auricle, and clinical examination demonstrated right hearing impairment, right canal paralysis and deviation of the tongue. Right facial palsy appeared on the 5th disease day. She was diagnosed with VIIth, VIIIth and XIIth cranial nerve palsy. The third patient, a 70-year-old woman, presented with right otalgia and dysphagia. There were painful vesicles on the right auricle and in the larynx, and clinical examination demonstrated soft palatine paralysis, right vocal cord paralysis and atrophy of the right sternocleidomastoid muscle. She was diagnosed with IXth, Xth and XIth cranial nerve palsy. Serum antibody titers for Varicella-Zoster virus were significantly elevated in all patients. All patients were successfully treated with intravenous or oral steroid and intravenous acyclovir.Varicella- Zoster virus infection should be considered, particularly if unilateral cranial nerve palsy with pain is identified.