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.
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References
Adachi M (2008) A case of Varicella zoster virus polyneuropathy: involvement of the glossopharyngeal and vagus nerves mimicking a tumor. Am J Neuroradiol 29:1743–1745
Bond JD, Zhang M (2020) Compartmental subdivisions of the jugular foramen: a review of the current models. World Neurosurg 136:49–57
Cao D-H, Xie Y-N, Ji Y, Han J-Z, Zhu J-G (2019) A case of varicella zoster encephalitis with glossopharyngeal and vagus nerve injury as primary manifestation combined with medulla lesion. J Int Med Res 47:2256–2261
Chitose S, Umeno H, Hamakawa S, Nakashima T, Shoji H (2008) Unilateral associated laryngeal paralysis due to varicella-zoster virus: virus antibody testing and videofluoroscopic findings. J Laryngol Otol 122:170–176
Choi JH (2013) Two cases of pharyngolaryngeal zoster advanced to multiple cranial neuropathy. Am J Otolaryngol 34:369–372
Cohen JI (2013) Herpes zoster. N Engl J Med 369:255–263
Hoshino C, Yamabe A (2012). Where is reactivation after a long latency? BMJ Case Reports 2012: bcr0120125538.
Kennedy PG, Mogensen TH (2020) Determinants of neurological syndromes caused by varicella zoster virus (VZV). J Neurovirology 26(4):482–495
Kuroda T, Kobayashi Z, Inokuchi N, Nakamura K, Michizaki H, Katayama Y, Ishihara S, Tomimitsu H, Shintani S (2019) Unilateral oropharyngeal mucosal lesions as a clue to the pathogen of encephalitis. J Neurol Sci 397:22–23
Nakagawa H, Nagasao M, Kusuyama T, Fukuda H, Ogawa K (2007) A case of glossopharyngeal zoster diagnosed by detecting viral specific antigen in the pharyngeal mucous membrane. J Laryngol Otol 121:163–165
Nisa L, Landis BN, Giger R, Leuchter I (2013) Pharyngolaryngeal involvement by varicella-zoster virus. J Voice 27:636–641
Noguerol TM, Barousse R, Socolovsky M, Luna A (2017) Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries. Quant Imaging Med Surg 7:398
Ong CK, Chong VFH (2010) The glossopharyngeal, vagus and spinal accessory nerves. Eur J Radiol 74:359–367
Tsau P-W, Liao M-F, Hsu J-L, Hsu H-C, Peng C-H, Lin Y-C, Kuo H-C, Ro L-S (2020) Clinical presentations and outcome studies of cranial nerve involvement in herpes zoster infection: a retrospective single-center analysis. J Clin Med 9:946
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The patient provided written informed consent, and the institutional review board at Nagoya City University approved this retrospective study.
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Inagaki, A., Kojima, A., Ogawa, M. et al. Imaging manifestations on sequential magnetic resonance imaging in pharyngolaryngeal involvement by varicella zoster virus. J. Neurovirol. 27, 186–190 (2021). https://doi.org/10.1007/s13365-021-00953-5
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DOI: https://doi.org/10.1007/s13365-021-00953-5