|Year : 2000 | Volume
| Issue : 5 | Page : 264-265
Polyneuritis cranialis following herpes zoster
H Radhakrishna, T Malakondaiah, Chandrasekha Reddy
Source of Support: None, Conflict of Interest: None
Herpes zoster is a common clinical condition involving cranial nerves. We encountered 3 cases in which multiple cranial nerves were involved besides the commoner ones. All the three cases were treated with acyclovir and oral steroids. Recovery of motor function was only partial in all three cases when reviewed 2 months after discharge. The clinical details and a brief review of literature are presented.
Keywords: Zoster, Polyneuritis, Herpes zoster
|How to cite this article:|
Radhakrishna H, Malakondaiah T, Reddy C. Polyneuritis cranialis following herpes zoster. Indian J Dermatol Venereol Leprol 2000;66:264-5
|How to cite this URL:|
Radhakrishna H, Malakondaiah T, Reddy C. Polyneuritis cranialis following herpes zoster. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 May 25];66:264-5. Available from: http://www.ijdvl.com/text.asp?2000/66/5/264/4943
| Introduction|| |
Cranial herpes zoster is an infective disease commonly encountered in the clinical practice. The commonest cranial nerve involved is trigeminal nerve, followed closely by facial nerve. Other cranial nerve involvement is very rare and is not mentioned at all in many standard textbooks. Widespread herpes zoster and involvement of central nervous system is seen in immunocompromised situations like AIDS, steroid therapy, and lymphomas.
| Case Report|| |
A-49-year-old woman was seen for complaints of pain and vesicular eruption around right ear of 20 days, change in voice of 17 days duration and dysphagia. She was nondiabetic and normotensive. General examination was unremarkable. Healing herpes zoster lesions were seen over the right ear and external auditory meatus. Voice was hoarse. Right 7th,9th and 10th cranial nerve palsies were noted.
Blood urea was 22 mg/dl,random blood sugar was 132 mg/dl CSF: 4 cells/c.mm, all lymphocytes, proteins 58 mg/dl and glucose 73 mg/di. Hemoglobin was 8.8 gms. She was treated with acyclovir, steroids, eye bandage and symptomatic medications.
A 60-year-old man was seen for pain and vesicular eruption over right ear, dysphagia, cough and fever of 13 days duration and change in voice of 10 days duration. On examination he was conscious, febrile, and coughing brought mucopurulent sputum. Herpetic lesions were present over the right ear. There was associated dysphagia and hoarseness of voice. The 8t, 9th and 10th cranial palsies were noted. Other cranial nerves were normal.
His investigation work up was normal in relation to diabetes, cranial CT as well as chest X-ray. He was given acyclovir and symptomatic treatment. Fever subsided in 1 weak and steroids were given 8 days later. At discharge, he was able to swallow sips of water, though the feeding was mainly through nasogastric tube. When reviewed after 2 months he still required tube feeding. Palatal movements were still abnormal.
A 40-year- old woman was seen for vesicular eruption in the left ear associated with pain of 10days duration. She was found to have herpes zoster lesions around right ear along with right LMN type of 7th nerve paralysis, right 9th, 10th and 11th nerve palsies leading to hoarse voice, and regurgitation of fluids. She was nondiabetic, and normotensive. There was improvement during the hospital stay of 13 days. She received acyclovir, and steroids along with H 2 blockers.
| Discussion|| |
Cranial nerve palsy is not uncommon in herpes zoster. But multiple cranial nerve involvement as seen in our patients is rare. Cranial nerve palsies due to herpes zoster are reported to have good prognosis.  About 55% of patients with motor deficit are said to recover completely and in 30% recovery may be partial. 
All three of our patients showed normal palatal movements when reported for review 2 months after discharge but facial palsy was persistent in our first case. Second patient showed signs of recovery of nerve palsy during her hospital stay. The time taken for complete recovery of motor function is reported to range from 3 weeks to 6 months. Specific therapy with acyclovir is definitely beneficial in zoster if started within 48 hours of onset of the eruption as it reduces the duration of disease, but it does not have any effect on post herpetic neuralgia.  There is no evidence that acyclovir therapy shortens recovery time in cranial nerve palsies due to zoster. But corticosteroids along with acyclovir might possibly reduce nerve inflammation resulting in faster recovery.
| References|| |
|1.||Nagabhushan NR, Ashakiran BG. Postherpes zoster motor deficit, Indian J Dermatol Venereol Leprol 1992;58:50. |
|2.||Heathfield KW, Mee AS. Prognosis of the Ramsay Hunt syndrome. Br Med J 1976;1:343-4. |
|3.||Thomas J E, Howard FM. Segmental zoster paresis-A disease profile, Neurol (Minne ap) 1972;22:459. |
|4.||Raymond and Adams, Editors: Principles of Neurology. 5 thsub Edn; p. 647. |