A previously healthy 64-year-old right handed lorry driver presented in July 2007 with a 2 day history of sudden onset dysphagia and dysarthria, 3 weeks after developing a prickling vesicular rash over the right posterior aspect of his neck with subsequent right facial pain.
The dysphagia was unassociated with odynophagia or difficulty chewing. There was no dysgeusia, visual disturbance, nor problems with limb, autonomic or sphincter function.
A longstanding unchanging asymmetrical hearing loss attributed to otosclerosis was noted. Examination revealed healing lesions characteristic of herpetic vesicles over the right C3 and C4 dermatomes. A nasal, non-fatigable dysarthria was apparent. A right Horner’s was present () with associated palatal weakness () and bovine cough.
Cranial nerves IX, XI, and XII were intact. Fibreoptic nasendoscopy revealed reduced excursion of the right vocal cord with pooling of saliva. The general medical examination was otherwise non-contributory.
A clinical diagnosis of herpes zoster associated cranial polyradiculoneuritis was made and antiviral therapy with corticosteroids were commenced. Feeding continued via a nasogastric tube.
Recovery followed and the patient was discharged home 8 days later tube-free, asymptomatic, and taking a normal diet.