Kondo M, Hokezu Y, Nagai M, Mori T, Nagamatsu K
Department of Neurology, Oita Prefectural Hospital.
Rinsho Shinkeigaku. 1994 Jul;34(7):720-3.
The patient is a 64-year-old woman with herpes zoster meningo-encephalitis followed by involvement of cranial nerves IX, X, XI. On admission, she had severe neck pain on the left side and mild nuchal rigidity. Three days later, herpetic vesicles on the left side of her neck (C2, C3, area). Herpes zoster meningoencephalitis was diagnosed based on CSF pleocytosis, high serum and CSF titers of herpes zoster antibody, and EEG abnormality. During hospitalization, paralysis of the left vocal cord, rightward deviation of the uvula, and gradual paralysis of the left sternocleidomastoideus and trapezius muscles developed. On cranial magnetic resonance imaging (MRI), T2-weighted image clearly revealed a high-signal lesion in left dorsal part of the medulla oblongata. This area appeared to correspond to the nucleus ambiguous and vagal nucleus. In this case, we believe that the inflammation originated in the C2, C3 posterior ganglion cells, extended to the IX, X, XI cranial nerves and to the part of the medulla oblongata. It is likely that the number of patients in whom a lesion of the cranial nucleus is revealed by MRI will increase in the future.
该患者为64岁女性，患有带状疱疹性脑膜脑炎，随后累及Ⅸ、Ⅹ、Ⅺ脑神经。入院时，她左侧颈部疼痛剧烈，有轻度颈项强直。三天后，其颈部左侧（C2、C3区域）出现疱疹。根据脑脊液淋巴细胞增多、血清和脑脊液中带状疱疹抗体滴度升高以及脑电图异常，诊断为带状疱疹性脑膜脑炎。住院期间，出现左侧声带麻痹、悬雍垂右偏，以及左侧胸锁乳突肌和斜方肌逐渐麻痹。在头颅磁共振成像（MRI）上，T2加权像清楚地显示延髓左侧背侧有一个高信号病变。该区域似乎对应疑核和迷走神经核。在本例中，我们认为炎症起源于C2、C3后神经节细胞，扩展至Ⅸ、Ⅹ、Ⅺ脑神经以及延髓部分。未来，通过MRI显示颅神经核病变的患者数量可能会增加。
