Mukai Tatsuya, Saiga Toru, Araki Takehisa
Department of Neurology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital.
Rinsho Shinkeigaku. 2020 Dec 26;60(12):861-864. doi: 10.5692/clinicalneurol.cn-001462. Epub 2020 Nov 20.
A 72-year-old man was admitted to our hospital because of right facial muscle weakness and diplopia. He had been treated for aplastic anemia with cyclosporin for 2 years. Thirteen days before admission, a diagnosis of herpes zoster was made and treated with amenamevir. On admission, neurological examination revealed mild cognitive disturbance, mydriasis, weakness of the inferior rectus muscle of the left eye, and right peripheral facial nerve palsy. Cerebrospinal fluid (CSF) analysis showed elevated leukocytes and increased protein levels. Antibody index to varicella-zoster virus (VZV) was elevated in CSF to 25.6, although VZV DNA was negative by PCR. Head CT revealed multiple intracerebral hemorrhages in the left dorsal pons, left ventral midbrain, left thalamus, and left front-parietal lobe. MR angiography detected cerebral artery stenosis. In addition to intravenous acyclovir, the patient was treated with steroid pulse therapy and steroid tapering therapy. One month after admission, his symptoms improved. We diagnosed him with VZV vasculopathy. We believe that multiple intracerebral hemorrhages due to VZV vasculopathy caused facial and oculomotor nerve palsy. Our findings suggest that cerebral hemorrhage induced by VZV vasculopathy must be considered when differentiating cranial nerve palsy after herpes zoster.
一名72岁男性因右侧面部肌肉无力和复视而入住我院。他因再生障碍性贫血接受环孢素治疗已达2年。入院前13天，诊断为带状疱疹并接受阿昔洛韦治疗。入院时，神经系统检查发现轻度认知障碍、瞳孔散大、左眼内直肌无力以及右侧周围性面神经麻痹。脑脊液（CSF）分析显示白细胞增多和蛋白质水平升高。脑脊液中水痘-带状疱疹病毒（VZV）抗体指数升高至25.6，尽管PCR检测VZV DNA为阴性。头部CT显示左侧脑桥背侧、左侧中脑腹侧、左侧丘脑和左侧额顶叶多发脑内出血。磁共振血管造影检测到脑动脉狭窄。除静脉注射阿昔洛韦外，患者还接受了类固醇冲击疗法和类固醇减量疗法。入院1个月后，他的症状有所改善。我们诊断他为VZV血管病变。我们认为，VZV血管病变导致的多发脑内出血引起了面部和动眼神经麻痹。我们的研究结果表明，在鉴别带状疱疹后颅神经麻痹时，必须考虑VZV血管病变引起的脑出血。
