title: [A case of zoster sine herpete with involvement of the unilateral IX, X and XI cranial and upper cervical nerves].
abstract: We describe a case of unilateral IX, X and XI cranial and upper cervical nerve palsies involving zoster sine herpete (ZSH). A 63-year-old man experienced nausea, loss of appetite and general fatigue. On 4 days of illness, dysphagia, dysarthria and difficulty in elevation of his right arm appeared. Neurological examination showed the right curtain sign, a nasal voice and a decreased right gag reflex. He could hardly elevate his right arm laterally. Needle electromyography revealed positive sharp waves in his right trapezius muscle. Although no skin lesion was detected, anti-varicella-zoster virus antibodies were positive in both serum and cerebrospinal fluid. Acyclovir and a steroid were ineffective for these symptoms. Although case reports of unilateral IX, X and XI cranial nerve palsies with ZSH is very rare, ZSH should be kept in mind in the differential diagnosis of multiple cranial nerve palsies.
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School, Okayama.
authors.forename: I
authors.initials: I
authors.lastname: Funakawa
authors.forename: A
authors.initials: A
authors.lastname: Terao
authors.forename: M
authors.initials: M
authors.lastname: Koga
mesh_terms: D020436:Accessory Nerve Diseases / Q000209:etiology*; D020435:Glossopharyngeal Nerve Diseases / Q000209:etiology*; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000294:innervation*; D010243:Paralysis / Q000209:etiology*; D020421:Vagus Nerve Diseases / Q000209:etiology*