ABSTRACT
Clarifying temporal changes in magnetic resonance imaging (MRI) offers a good chance to understand the pathology of neural lesions; however, such information is scarce in varicella zoster virus (VZV) neuropathies for the glossopharyngeal and vagus nerves. Here, we present the changes in sequential MR images of such a pathology over a period of 12 months from symptom onset.A 27-year-old woman with difficulty in swallowing and hoarseness due to a palatal palsy and arytenoid fixation on the left presented 2 days after onset. MRI revealed a lesion which largely filled the left jugular foramen on T2-weighted images (T2-WI) with high diffusion-weighted imaging (DWI) signals, which has never been previously described, on the 3rd day after onset. The DWI signals were highest on day 3, then deteriorated over 2 months until the signal was only detectable at the intracranial level, but not in the jugular foramen. The glossopharyngeal nerve had returned to normal by 2 months.The time course of the glossopharyngeal and vagus nerve swelling detected on T2-WI suggests that nerve swelling reduces over several months, even though the paralytic symptoms persist. Furthermore, the high DWI signal suggests that nerve swelling was caused by edematous swelling of the nerve fibers, rather than fiber disruption with water displacement in the extracellular space. These findings may provide good clues to speculate on the dynamically changing pathology of VZV neuropathies of the glossopharyngeal and vagus nerves.
Subject(s)
Glossopharyngeal Nerve Diseases/diagnostic imaging , Glossopharyngeal Nerve Diseases/virology , Vagus Nerve Diseases/diagnostic imaging , Vagus Nerve Diseases/virology , Varicella Zoster Virus Infection/diagnostic imaging , Adult , Diffusion Magnetic Resonance Imaging , Female , Humans , Jugular Foramina/diagnostic imaging , Neuroimaging/methods , Varicella Zoster Virus Infection/pathologySubject(s)
Cranial Nerve Diseases/diagnosis , Herpes Zoster/diagnosis , Mononeuropathies/diagnosis , Abducens Nerve Diseases/diagnosis , Abducens Nerve Diseases/drug therapy , Abducens Nerve Diseases/physiopathology , Abducens Nerve Diseases/virology , Aged , Cranial Nerve Diseases/drug therapy , Cranial Nerve Diseases/physiopathology , Cranial Nerve Diseases/virology , Diagnosis, Differential , Diplopia/physiopathology , Earache/physiopathology , Edema/physiopathology , Facial Nerve Diseases/diagnosis , Facial Nerve Diseases/drug therapy , Facial Nerve Diseases/physiopathology , Facial Nerve Diseases/virology , Facial Paralysis/physiopathology , Glossopharyngeal Nerve Diseases/diagnosis , Glossopharyngeal Nerve Diseases/drug therapy , Glossopharyngeal Nerve Diseases/physiopathology , Glossopharyngeal Nerve Diseases/virology , Glucocorticoids/therapeutic use , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sensorineural/drug therapy , Hearing Loss, Sensorineural/physiopathology , Hearing Loss, Sensorineural/virology , Herpes Zoster/drug therapy , Herpes Zoster/physiopathology , Humans , Male , Mononeuropathies/drug therapy , Mononeuropathies/virology , Osteomyelitis/diagnosis , Otitis Externa/diagnosis , Prednisolone/therapeutic use , Skull Base , Vagus Nerve Diseases/diagnosis , Vagus Nerve Diseases/drug therapy , Vagus Nerve Diseases/physiopathology , Vagus Nerve Diseases/virology , Vestibulocochlear Nerve Diseases/diagnosis , Vestibulocochlear Nerve Diseases/drug therapy , Vestibulocochlear Nerve Diseases/physiopathology , Vestibulocochlear Nerve Diseases/virology , Virus ActivationSubject(s)
Glossopharyngeal Nerve Diseases/diagnosis , Herpes Zoster/diagnosis , Vagus Nerve Diseases/diagnosis , Adult , Female , Glossopharyngeal Nerve Diseases/virology , Humans , Laryngeal Diseases/diagnosis , Laryngeal Diseases/virology , Mouth Diseases/diagnosis , Mouth Diseases/virology , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/virology , Vagus Nerve Diseases/virologySubject(s)
Accessory Nerve Diseases/diagnosis , Glossopharyngeal Nerve Diseases/diagnosis , Herpes Zoster/diagnosis , Vagus Nerve Diseases/diagnosis , Accessory Nerve Diseases/virology , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Cranial Fossa, Posterior , Electromyography , Glossopharyngeal Nerve Diseases/virology , Herpes Zoster/complications , Herpes Zoster/drug therapy , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neck , Rare Diseases , Syndrome , Thymoma/complications , Thymoma/radiotherapy , Thymoma/surgery , Thymus Neoplasms/complications , Thymus Neoplasms/radiotherapy , Thymus Neoplasms/surgery , Tomography, X-Ray Computed , Vagus Nerve Diseases/virologyABSTRACT
A 40-year-old man was admitted to our department, because of sudden onset of dysphagia, hoarseness, left neck pain and headache. There were no skin lesions. On neurological examination, there were paralysis of the left soft palate and constrictor muscles of the pharynx, weakness of the left sternocleidomastoid and left upper trapezius. In cerebrospinal fluid (CSF) examination, cell count and protein concentration were elevated. Antibody titer to varicella zoster virus (VZV) was elevated in both the serum and CSF. And VZV-DNA was detected by PCR from CSF. Gd enhanced MRI showed the nodular lesion at the left jugular foramen. The diagnosis of Vernet's syndrome (VS) associated with VZV infection was made. The patient's symptoms were immediately improved with 30 mg of prednisone and 3 g of varaciclovir daily for 14 days. Only a few cases of VS due to VZV have been reported previously. Our case is the first case that detected VZV-DNA in CSF by PCR.
Subject(s)
Encephalitis, Varicella Zoster/complications , Glossopharyngeal Nerve Diseases/etiology , Vagus Nerve Diseases/etiology , Adult , Antibodies/blood , Antibodies/cerebrospinal fluid , Encephalitis, Varicella Zoster/metabolism , Encephalitis, Varicella Zoster/pathology , Glossopharyngeal Nerve Diseases/metabolism , Glossopharyngeal Nerve Diseases/pathology , Glossopharyngeal Nerve Diseases/virology , Herpesvirus 3, Human/immunology , Humans , Magnetic Resonance Imaging , Male , Vagus Nerve Diseases/metabolism , Vagus Nerve Diseases/pathology , Vagus Nerve Diseases/virologyABSTRACT
The relationship between varicella-zoster virus and idiopathic associated laryngeal paralysis was examined in five patients, using complement fixation or enzyme immunoassay testing. In all cases, significant changes in serum levels of varicella-zoster virus antibody were observed. Videofluoroscopy was useful in assessing the severity of the dysphagia and in making an accurate diagnosis; both laryngeal elevation and weakness of pharyngeal wall contraction were also observed. In two cases in which antiviral therapy was delayed, the outcome was poor, with increased levels of varicella-zoster virus immunoglobulin M found on enzyme immunoassay. The outcome of the condition may thus depend both on the speed of antiviral therapy commencement following onset of symptoms, and on the levels of varicella-zoster virus immunoglobulin M antibody (measured by enzyme immunoassay). Our study suggests that varicella-zoster virus should be considered in the differential diagnosis of patients with idiopathic associated laryngeal paralysis, and rapid antiviral therapy should be initiated when necessary.
Subject(s)
Glossopharyngeal Nerve Diseases/virology , Herpes Zoster/complications , Vocal Cord Paralysis/virology , Aged , Antibodies, Viral/blood , Antiviral Agents/therapeutic use , Female , Glossopharyngeal Nerve Diseases/diagnosis , Glossopharyngeal Nerve Diseases/drug therapy , Herpes Zoster/diagnosis , Herpesvirus 3, Human , Humans , Middle Aged , Photofluorography/methods , Treatment Outcome , Vocal Cord Paralysis/drug therapyABSTRACT
Glossopharyngeal nerve paralysis caused by varicella zoster virus reactivation is rare. We present a case of glossopharyngeal zoster confirmed by direct immunofluorescence staining for virus antigens. A 35-year-old man presented with right-sided, severe swallowing pain and dysgeusia. Physical examination showed a loss of ipsilateral gag reflex. White spots on the posterior wall of the right pyriform sinus were seen by laryngofibroscopy, and a loss of taste on the right posterior part of the tongue was confirmed by gustometry using the filter paper disc method. The varicella zoster virus antigen was revealed by direct immunofluorescence staining by fluorescein isothiocyanate labelled mouse monoclonal antibody specific for varicella zoster virus glycoprotein, using samples obtained from the mucosal lesion by abrasion with a cotton swab. The patient was treated by intravenous administration of acyclovir. His throat pain and dysgeusia completely resolved. We discuss the advantages of direct immunofluorescence staining for varicella zoster virus antigen for the diagnosis of glossopharyngeal zoster.
