A Case of Varicella-Zoster Virus Infection Characterized by Vestibular Ataxia, Hearing Loss and Pleocytosis in CSF

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  • KAWAI Shin
    The First Department of Internal Medicine, Kyorin University School of Medicine
  • SAWAGUCHI Yoshiyasu
    The First Department of Internal Medicine, Kyorin University School of Medicine
  • WAKABAYASHI Yukio
    The First Department of Internal Medicine, Kyorin University School of Medicine
  • KOIKE Hidemi
    The First Department of Internal Medicine, Kyorin University School of Medicine
  • YOSHINO Yoshikazu
    The First Department of Internal Medicine, Kyorin University School of Medicine

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Other Title
  • 迷路性運動失調, 難聴, 髄液細胞増多を呈した水痘・帯状疱疹ウイルス感染症の 1 例
  • メイロセイ ウンドウ シッチョウ ナンチョウ ズイエキ サイボウ ゾウタ オ

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Abstract

A 32-year-old man developed, during upper respiratory infection, the right otalgia, vertigo and vomitting followed by gait disturbance due to ataxia and hearing loss which reached almost to deafness at one time. Trigeminal neuralgia on the right side appeared, but facial paresis was not noticed at all. The patient also complained of numbness (dysesthesia and paresthesia) in the right upper extremity and posterior neck. The diagnosis was confirmed by herpetic eruptions on the right auricle and posterior neck as well as a significant elevation in serum of CF antibody titer to varicella-zoster virus (250×). Laboratory examinations were performed about one month after the onset when the patient showed mild ataxia and horizontal nystagmus toward the left. CSF revealed slight pleocytosis (35/3). An audiometry disclosed a reduction of hearing of the right ear in the range of high frequency with marked recruitment phenomenon. A caloric test showed no responce in the right ear, while the eye-tracking test and optokinetic pattern were normal. EEG, CT and peripheral nerve conduction velocities revealed no abnormalities. In cephalic herpes zoster, the facial nerve has been considered to be most vulnerable among the cranial nerves, as is shown in Ramsay Hunt syndrome. Cases of herpes zoster infection with auditory and vestibular complications without facial paresis such as this case are rare in the literature.

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