First case of herpes zoster involving the nucleus ambiguus: A case report and literature review

Introduction Herpes zoster (HZ) is caused by the re-activation of a dormant infection with the varicella-zoster virus (VZV). Manifestations of HZ in the cranial nerves commonly involve the trigeminal nerve or present as zoster oticus with affection of the vestibulocochlear nerve with or without involving the facial nerve. Affection of other cranial nerves are rare.

Material/Methods The case of a 48 year-old female is presented with an acute onset of dysphagia with nasal regurgitation as well as dysphonia. Rightwarded deviation of the soft palate, vocal cord paresis on the left side as well as a mild muscle weakness in the left sternocleidomastoid and trapezius muscles suggested an involvement of multiple cranial nerves. Serology confirmed a re-activation of VZV. A review of the literature describing similar cranial nerve palsies caused by HZ was conducted.

Results Multiple cases of solitary or combined involvement of the glossopharyngeal, vagus and accessory nerve are published and sometimes referred to as lower cranial polyneuropathy. An association with the nucleus ambiguus so far has not been reported.

Discussion To our knowledge, this is the first documented case suggesting involvement of the nucleus ambiguous. HZ of the nucleus ambiguus should be considered as a possible differential diagnosis in patients with vocal cord paresis but also in solitary involvement of the vagus nerve.

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Artikel online veröffentlicht:
19. April 2024