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.
