Nagane Y, Utsugisawa K, Yonezawa H, Tohgi H
Department of Neurology, Iwate Medical University Morioka, Japan.
Rinsho Shinkeigaku. 2001 Jan;41(1):56-9.
We reported a 53-year-old man with the right trigeminal herpes zoster with preceding neuralgia (preherpetic neuralgia) in the right upper cervical nerve area. He developed dysesthesia and scapular pain in the right second cervical nerve area. 5 days later, herpes zoster emerged in the area of the right maxillary division of trigeminal nerve. Furthermore, he developed paralysis on the right facial muscle on the 12th day after the onset of scapular pain. Neurological examination revealed decrease in superficial sensation accompanied by pain and dysesthesia in the areas innervated by the right maxillary division of trigeminal nerve and the right second cervical nerve, and the right peripheral facial nerve palsy. Any rash was not observed in the right second cervical nerve area throughout the course. The cerebrospinal fluid showed a mild mononuclear pleocytosis. The antibody titer for varicella zoster virus (VZV) was elevated in both cerebrospinal fluid and blood serum. T2-weighted magnetic resonance (MR) image revealed a continuously long high-signal lesion corresponding to the right spinal trigeminal nucleus and tract, extending from the lower pons to the second cervical segment of the spinal cord. This lesion could have resulted from a centripetal migration of VZV from the Gasser ganglion to the spinal trigeminal nucleus and tract, which was probably related to the preherpetic neuralgia in the upper cervical nerve area without rash.
我们报告了一名53岁男性，患有右侧三叉神经带状疱疹，并伴有右上颈神经区域的前驱神经痛（疱疹前神经痛）。他在右侧第二颈神经区域出现感觉异常和肩胛部疼痛。5天后，三叉神经右上颌支区域出现带状疱疹。此外，在肩胛部疼痛发作后的第12天，他出现了右侧面部肌肉麻痹。神经学检查发现，右侧三叉神经上颌支和右侧第二颈神经支配区域的浅感觉减退，并伴有疼痛和感觉异常，以及右侧周围性面神经麻痹。在整个病程中，右侧第二颈神经区域均未观察到任何皮疹。脑脊液显示轻度单核细胞增多。脑脊液和血清中水痘-带状疱疹病毒（VZV）抗体滴度均升高。T2加权磁共振（MR）图像显示，对应于右侧三叉神经脊束核和束的连续长T2高信号病变，从脑桥下部延伸至脊髓第二颈段。该病变可能是由于VZV从半月神经节向三叉神经脊束核和束的向心性迁移所致，这可能与上颈神经区域无皮疹的疱疹前神经痛有关。
