Kikuchi H, Yoshimura T, Hara H, Mihara F, Kobayashi T
Department of Neurology, Kyushu University, Fukuoka, Japan.
Rinsho Shinkeigaku. 1995 Jul;35(7):814-6.
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.
我们在此描述一名50岁的患者，其患有由水痘-带状疱疹病毒（VZV）引起的多发性颅神经麻痹（左侧第八、九、十、十一颅神经及右侧第七、九、十颅神经）。1994年11月30日，他出现声音嘶哑、吞咽困难。发病后第8天，他出现左耳耳鸣及左侧面神经麻痹。第10天的神经系统检查显示左侧周围性面神经麻痹、左侧声带麻痹、轻度吞咽困难及双侧味觉丧失。他未表现出脑膜刺激征。第11天，他感到眩晕，右侧凝视时出现水平眼震。脑脊液检查结果显示蛋白含量升高但无细胞增多。脑脊液和血清中水痘-带状疱疹病毒抗体滴度均升高。头颅磁共振成像（MRI）显示左侧膝状神经节及左侧第九和第十颅神经的上或下神经节有钆增强，表明与VZV感染相关的多发性颅神经麻痹起源于颅神经节。在该病例中，局灶性脑干脑炎似乎不是多发性颅神经病变的主要原因。
