Zoster Laryngitis with Multiple Cranial Nerve Palsy Progressed as Ascending Involvement

Abstract

Background: Herpes zoster of the head and neck commonly presents with Ramsay Hunt syndrome. However, vesicular eruptions may occur on the pharyngeal or laryngeal area with multiple lower cranial-nerve (CN) palsy. Case Report: We report on the case of a 54-year-old man with herpes zoster of the pharynx and larynx with multiple CN palsy and persistent hiccups. He initially developed progressive dysphagia, hoarseness, and persistent hiccups (CN IX and X). After admission, Dizziness, hearing impairment, and peripheral facial palsy (CN VII and VIII) were complicated. The results of a polymerase chain reaction test of saliva and vesicular fluid from the ear and throat were strongly positive for varicella zoster virus. The progression of CN palsy was in an ascending sequence. Conclusion: We suggest that the sequence of CN palsy may be either ascending or descending, depending on the initial site of involvement.

Herpes Zoster Oticus With Delayed Facial Palsy and Multiple Cranial Nerve Involvement

“…In the previous case reports, polyneuritis may occur ascending, descending on the progress, or not described. 6) From this point of view, the course of symptoms may vary from person to person; therefore, the symptom manifestation might be different in the two cases. However, delayed facial palsy was not severe in both cases; it was below House-Brackmann grade III, and they recovered.…”