A case of Vernet syndrome with varicella zoster virus infection

Kawabe, Kiyokazu; Sekine, Tokinori; Murata, Kiyoko; Sato, Ryuta; Aoyagi, Joe; Kawase, Yuji; Ogura, Naoko; Kiyozuka, Tetuhito; Igarashi, Osamu; Iguchi, Hiroaki; Fujioka, Toshiki; Iwasaki, Yasuo

doi:10.1016/j.jns.2008.03.005

Cited by 19 publications

(12 citation statements)

References 3 publications

(6 reference statements)

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“…In Wang’s case, 4 hypoperistalsis occurred in the middle part of the patient’s esophagus, which convinced the authors that dysphagia was caused by the violation of sympathetic nerves and the parasympathetic nerves’ visceral branch. In the other two cases, Ramsay–Hunt syndrome was caused by the violation of glossopharyngeal nerve 5,6 . The laryngoscope revealed a left vocal cord paralysis, in accordance with the patient’s prominent hoarseness and speechless.…”

mentioning

confidence: 71%

Case of Ramsay-Hunt syndrome associated with dysphagia

Wang

Chen

2011

The Journal of Dermatology

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confidence: 71%

Case of Ramsay-Hunt syndrome associated with dysphagia

Wang

Chen

2011

The Journal of Dermatology

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“…There are few case reports of varicella-zoster virus as a rare cause of Vernet syndrome [8,9]. The jugular foramen is divided into two parts?…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is unclear whether the left jugular foramen size contributed to Vernet syndrome in the present case, and further research is needed. The general prognosis of Vernet syndrome is unknown; however, treating Vernet syndrome with combined therapy with antiviral agents and steroids has shown a good prognosis showing restored muscle strength in shoulder joint abduction with improved dysphagia and hoarseness [8,9]. …”

Section: Discussionmentioning

confidence: 99%

Vernet Syndrome by Varicella-Zoster Virus

Chung

Lee

et al. 2013

Ann Rehabil Med

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Vernet syndrome involves the IX, X, and XI cranial nerves and is most often attributable to malignancy, aneurysm or skull base fracture. Although there have been several reports on Vernet's syndrome caused by fracture and inflammation, cases related to varicella-zoster virus are rare and have not yet been reported in South Korea. A 32-year-old man, who complained of left ear pain, hoarse voice and swallowing difficulty for 5 days, presented at the emergency room. He showed vesicular skin lesions on the left auricle. On neurologic examination, his uvula was deviated to the right side, and weakness was detected in his left shoulder. Left vocal cord palsy was noted on laryngoscopy. Antibody levels to varicella-zoster virus were elevated in the serum. Electrodiagnostic studies showed findings compatible with left spinal accessory neuropathy. Based on these findings, he was diagnosed with Vernet syndrome, involving left cranial nerves, attributable to varicella-zoster virus.

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“…[2][3][4] This condition has been termed zoster sine herpete. A wide spectrum of neurologic disorders that include polyneuritis cranialis, aseptic meningitis, encephalitis, acute polyneuritis, and myelitis are associated with VZV infection without skin lesions.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] The cause for these clinicopathologic diversities is unclear. 1,2 However, some D178N patients who had homozygosity for methionine at codon 129 (D178N-129MM) were reported re-cently to have the CJD phenotype.…”

Section: Discordant Clinicopathologic Phenotypes In a Japanese Kindrementioning

confidence: 99%

Polyneuritis Cranialis Caused by Varicella Zoster Virus in the Absence of Rash

Murata¹,

Miwa²,

Kondo³

2010

Neurology

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A 21-year-old man presented with acute hoarseness, pharyngeal pain, and dysphagia on December 24, 2008. He was able to drink water only and his condition did not improve; therefore, he was admitted to our hospital on January 5, 2009. On admission, his body temperature was 38.5°C, and he had mild headache and tenderness of the left external auditory meatus. There was no evidence of a skin rash around his ears or face, and no rash was observed in the oral cavity. No lymphadenopathy or hepatosplenomegaly was observed. On neurologic examination, there was paralysis of the left soft palate and the constrictor muscles of the pharynx and hypoesthesia of the left soft palate and pharynx. The remainder of the neurologic examination was normal. Meningeal signs, long tract signs, and autonomic dysfunction were not observed. These findings were consistent with acute isolated left hemilateral glossopharyngeal and vagus nerve palsy.CSF examination revealed a cell count of 218/mm 3 (mononuclear cells: polynuclear cells was 216:2), and a protein concentration of 56 mg/dL. Antibody titers against varicella zoster virus (VZV) were elevated in both the serum (enzyme immunoassay [EIA]: immunoglobulin G [IgG], 78.6; immunoglobulin M [IgM], 3.78; normal value IgG Ͻ2.0, IgM Ͻ0.8) and CSF (EIA: IgG, 0.57; IgM, 1.39). We performed PCR to identify VZV-DNA in the CSF and pharyngeal scraping throat exudates, using methods described previously. 1 VZV-DNA was detected in both CSF and throat exudates.Cranial MRI with gadolinium enhancement was performed on the day of admission. On plain T1weighted images and T2-weighted images, there was an isointense nodular lesion near the left jugular foramen. The T1-weighted image with contrast showed that this nodular lesion was enhanced (figure). Additional enhancement was observed at the surface of the brainstem. The neurologic findings, presence of antibodies against VZV, and PCR-positive reaction against VZV-DNA supported a diagnosis of polyneuritis cranialis due to VZV, in the absence of a rash. The patient was treated with IV acyclovir (750 mg/day) for 14 days. His symptoms were immediately improved and no residual signs were observed. The cell count, protein concentration, and anti-VZV antibodies in the CSF were decreased after the treatment (cell count, 9/mm 3 ; protein, 53 mg/dL; and EIA: IgG, 2.77; IgM, 0.82). Discussion.Our patient showed only unilateral lower cranial neuritis (glossopharyngeus and vagus nerve) without herpetic lesions. The diagnosis of lower cranial neuropathy was based on the elevation of VZV-IgM antibodies and a PCR-positive reaction against VZV-DNA in the CSF.A noteworthy feature of this patient was the lack of cutaneous herpetic manifestation through the course of the disease. A wide spectrum of neurologic disorders that include polyneuritis cranialis, aseptic meningitis, encephalitis, acute polyneuritis, and myelitis are associated with VZV infection without skin lesions. 2-4 This condition has been termed zoster sine herpete. 5,6 We diagnosed our patient with a lower cra...

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A case of Vernet syndrome with varicella zoster virus infection

Cited by 19 publications

References 3 publications

Case of Ramsay-Hunt syndrome associated with dysphagia

Case of Ramsay-Hunt syndrome associated with dysphagia

Vernet Syndrome by Varicella-Zoster Virus

Polyneuritis Cranialis Caused by Varicella Zoster Virus in the Absence of Rash

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