Herpes simplex virus and recurrent laryngeal nerve paralysis. Report of a case and review of the literature.

A 61-year-old man experienced the abrupt onset of a nonspecific febrile illness followed by the acute development of bilateral vocal cord paralysis. There was no evidence for Guillain-Barré syndrome, multiple sclerosis, brainstem encephalitis, myasthenia gravis, metabolic encephalopathy, poliomyelitis, diphtheria, botulism, tumor, vasculitis, or extrinsic nerve compression. No cause for the fever was ascertained, and the vocal cord paralysis improved sponaneously. Acute and convalescent viral serological studies demonstrated a diagnostic complement-fixation antibody titer rise to herpes simplex virus (HSV) and no rise in titer to influenza A and B, cytomegalovirus, poliomyelitis, or Mycoplasma. This case is similar to several others reported in the literature that suggest a viral neuritis in tenth nerve paralyses in children. The difficulties involved in diagnosing HSV CNS disease before death are discussed, and the medical literature is reviewed for evidence that HSV is the etiological agent in selected cranial neuropathies.