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Zoster lower cranial neuropathy: A case report and a review of literature

Fuyuki Tateno, Ryuji Sakakibara, Masahiko Kishi, Emina Ogawa, Yohei Tsuyuzaki, Tomoe Yoshida, Masahiko Yamamoto

Am J Case Rep 2011; 12:137-139

DOI: 10.12659/AJCR.882093

Abstract: Background: Etiologies of lower cranial neuropathy include trauma, focal/ metastatic tumors, vascular diseases, collagen/granulomatous diseases, and Guillain-Barré syndrome. Varicella-zoster virus (VZV) often affects the first rami of cranial nerves V and VII. We herein report a man with zoster lower cranial neuropathy.
Case Report: A 57-year-old man, after flu-like symptoms, acutely developed left-side lower cranial neuropathy (in VII, VIII, IX, and X). The cerebrospinal fluid (CSF) examination revealed elevated cell count and total protein. Varicella-zoster virus (VZV) titers were elevated in the CSF and serum. All these symptoms gradually ameliorated after a four-month period. In light of other clinical reports and our present findings, in addition to classical V and VII involvement with skin rush, VZV can affect the lower cranial nerves VIII, IX, and X without skin rush.
Conclusions: In light of the clinical reports including ours, we can conclude that VZV preferentially affects the lower cranial nerves V, VII, VIII, IX, and X. Therefore, VZV infection should be listed among the differential diagnosis of lower cranial neuropathy.

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