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We report two cases of cranial nerve palsy due to varicella-zoster virus infection. One patient, a 53-year-old woman, was admitted to our hospital complaining of a sore throat, right otalgia and painful vesicle on the right auricle. Herpetic vesicles were present on the right soft palate and arytenoid. She also reported loss of hearing in the right ear but there was no facial palsy. The serum antibody titer for herpes zoster was significantly elevated, and the cerebrospinal fluid showed pleocytosis. She was diagnosed as having herpes zoster involving the vestibulocochlear nerve and glossopharyngeal nerve. She was treated with intravenous acyclovir and satellite ganglion block. She did not have any residual signs.
The other patient, a 44-year-old woman, complained of a sore throat, hoarseness and difficulty in swallowing. She had no skin rash, but there was a single vesicle on the left arytenoid. Physical examination revealed poor elevation of soft palate on the left side, but gag reflex was preserved. The serum antibody titer for herpes zoster was significantly elevated. She was diagnosed as having herpes zoster involving vagus nerve. She was treated with intravenous acyclovir for 7 days. She did not have any residual sign.
In cases of unilateral cranial nerve palsy with pain, herpes zoster should be considered, and serum antibody titer for herpes zoster should be evaluated.
