Concord Repatriation General Hospital, Concord, Sydney, NSW, 2139, Australia.
University of Sydney, Sydney, Australia.
J Med Case Rep. 2022 Aug 17;16(1):313. doi: 10.1186/s13256-022-03484-7.
Multiple cranial neuropathies carry a wide range of differential diagnoses, and when combined with cerebrospinal fluid monocytosis they often suggest an infective etiology. Reactivation of varicella zoster virus has been associated with a wide range of neurological complications. Among the cranial nerves, the upper cranial nerves (trigeminal and facial nerves) are more commonly affected; there have been some reports of lower cranial polyneuropathies resulting from varicella zoster virus reactivation. However, polyneuropathy involving both the cranial and cervical nerves is rarely reported.
This report highlights the case of a 64-year-old Chinese man presenting with an acute, severe dysphagia and dysphonia secondary to herpes zoster-associated progressive polyneuropathy involving the lower cranial and upper cervical nerves, without any mucocutaneous manifestations.
To our knowledge, this is the first case of varicella zoster virus-associated cranial and cervical polyneuropathy in the literature. The report also highlights the poor sensitivity of varicella zoster virus DNA detection by polymerase chain reaction in the cerebrospinal fluid, and proposes that serology be routinely performed in such polymerase chain reaction-negative cases without a clear diagnosis.
多种颅神经病的鉴别诊断范围很广，当与脑脊液单核细胞增多症结合时，它们通常提示感染性病因。水痘带状疱疹病毒的再激活与广泛的神经并发症有关。在颅神经中，上颅神经（三叉神经和面神经）更常受到影响；有一些报道称，水痘带状疱疹病毒再激活会导致下颅多神经病。然而，很少有报道涉及颅神经和颈神经的多神经病。
本报告重点介绍了一例 64 岁中国男性的病例，他因疱疹相关性进行性多神经病累及下颅和颈上部神经而出现急性、严重的吞咽困难和发声困难，无任何粘膜皮肤表现。
据我们所知，这是文献中首例水痘带状疱疹病毒相关性颅颈多神经病病例。该报告还强调了聚合酶链反应检测脑脊液中水痘带状疱疹病毒 DNA 的敏感性较差，并建议在聚合酶链反应阴性且诊断不明确的情况下，常规进行血清学检查。
