Laryngeal zoster with multiple cranial nerve palsies

A young immunocompetent patient is presented with a very rare presentation of a common viral illness: herpes zoster of the left hemilarynx with sensorial and motoric neuropathy of three ipsilateral lower cranial nerves: IX, X and XI. The mucosal lesions were discovered during upper gastrointestinal endoscopy. PCR of erosional exsudate confirmed the clinical diagnosis. Antiviral therapy and corticosteroids possibly contributed to the prosperous evolution with complete healing.

Herpes zoster laryngitis: case report and serological profile

Compared to herpes zoster oticus, varicella zoster virus (VZV) reactivations in immunocompetent patients are rare in laryngeal region. Usually, associated vocal cord paralyses are reported. Herein is a case report of a patient with laryngeal zoster without any associated motor disorders. An attempt is made to assign the distribution of mucosal eruptions to the appropriate neuroanatomical structures. A description of the serological course of VZV IgM and IgG are provided. Vesicles were found on the left sensory distribution areas of the superior laryngeal nerve. VZV IgM and IgG antibodies reached their peak 1 month after initial symptoms. Attentive follow-up and no antiviral therapy were advocated because of the absence of any immune deficiency or endoscopic suspicion of malignancy. In this case of VZV reactivation in the sensitive area of the superior laryngeal nerve, serological profiles of VZV IgM and IgG were profoundly modified up to the fourth month.

Activity of cardiorespiratory networks revealed by transsynaptic virus expressing GFP

A fluorescent transneuronal marker capable of labeling individual neurons in a central network while maintaining their normal physiology would permit functional studies of neurons within entire networks responsible for complex behaviors such as cardiorespiratory reflexes. The Bartha strain of pseudorabies virus (PRV), an attenuated swine alpha herpesvirus, can be used as a transsynaptic marker of neural circuits. Bartha PRV invades neuronal networks in the CNS through peripherally projecting axons, replicates in these parent neurons, and then travels transsynaptically to continue labeling the second- and higher-order neurons in a time-dependent manner. A Bartha PRV mutant that expresses green fluorescent protein (GFP) was used to visualize and record from neurons that determine the vagal motor outflow to the heart. Here we show that Bartha PRV-GFP-labeled neurons retain their normal electrophysiological properties and that the labeled baroreflex pathways that control heart rate are unaltered by the virus. This novel transynaptic virus permits in vitro studies of identified neurons within functionally defined neuronal systems including networks that mediate cardiovascular and respiratory function and interactions. We also demonstrate superior laryngeal motorneurons fire spontaneously and synapse on cardiac vagal neurons in the nucleus ambiguus. This cardiorespiratory pathway provides a neural basis of respiratory sinus arrhythmias.