[A case of herpes zoster meningoencephalitis followed by involvement of cranial nerves IX, X, XI].

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.