[Unusual manifestation of zoster sine herpete as unilateral caudal cranial nerve syndrome].

Abstract

Multiple lower cranial nerve palsies are a rare complication following varicella zoster virus (VZV) reactivation, especially if typical herpetic eruptions are lacking. We report a case of a 45-year-old, immunocompetent male with unilateral involvement of the cranial nerves VIII, IX, X, and XI without skin lesions. Cerebrospinal fluid (CSF) studies revealed mononuclear pleocytosis with intrathecal antibody synthesis against VZV, while polymerase chain reaction (PCR) did not detect VZV or HSV (herpes simplex virus). The patient almost completely recovered after aciclovir administration. VZV reactivation without rash (zoster sine herpete) may lead to multiple cranial nerve palsies. PCR is a useful tool to detect VZV-DNA in CSF, but negative results do not exclude a reactivation. In case of multiple cranial nerve palsies of unknown etiology with mononuclear pleocytosis in CSF tumors of the skull base, meningitis tuberculosis, and meningeosis have to be excluded, and antiviral therapy should be discussed.

• Authors: C Terborg, G Förster, U Sliwka
• Journal: Der Nervenarzt (Nervenarzt) Vol. 72 Issue 12 Pg. 955-7 (Dec 2001) ISSN: 0028-2804 [Print] Germany
• Vernacular Title: Ungewöhnliche Manifestation eines Zoster sine herpete als unilaterales kaudales Hirnnervensyndrom.
• PMID: 11789442 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Acyclovir

Topics

• Acyclovir (therapeutic use)
• Cranial Nerve Diseases (diagnosis, drug therapy, virology)
• Diagnosis, Differential
• Herpes Zoster (diagnosis, drug therapy, virology)
• Herpesvirus 3, Human (drug effects, growth & development)
• Humans
• Male
• Middle Aged
• Neurologic Examination
• Otorhinolaryngologic Diseases (diagnosis, drug therapy, virology)
• Patient Care Team
• Polymerase Chain Reaction
• Virus Activation (physiology)