[A case of multiple cranial neuropathy due to varicella-zoster virus infection: detection of involvement of cranial ganglia with MRI].

We describe here a 50-year-old patient who had multiple cranial nerve palsies (lt.VIII,IX,X,XI and rt.VII, IX,X) with varicella-zoster virus (VZV). He developed hoarseness, dysphagia on 30th, November, 1994. On the 8th day after the onset, he suffered from left tinnitus and left facial nerve palsy. Neurological examination on the 10th day revealed left peripheral facial nerve palsy, lt. vocal cord palsy, mild dysphagia and loss of bilateral taste. He did not show signs of meningeal irritation. On the 11th day, he felt vertigo and had horizontal nystagmus on the right lateral gaze. The cerebrospinal fluid findings revealed increased protein content but not pleocytosis. The antibody titer for varicella zoster virus elevated both in cerebrospinal fluid and in serum. Cranial magnetic resonance imaging (MRI) revealed gadlinium enhancement on the left geniculate ganglion and left superior or inferior ganglion of IX and X nerves, indicating that multiple cranial nerve palsies associated with VZV infection originate in the cranial ganglia. Focal brainstem encephalitis does not seem to be the main cause of multiple cranial neuropathy in this case.