Imaging manifestations on sequential magnetic resonance imaging in pharyngolaryngeal involvement by varicella zoster virus.
Imaging manifestations on sequential magnetic resonance imaging in pharyngolaryngeal involvement by varicella zoster virus.
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水痘带状疱疹病毒咽喉部受累的序贯磁共振成像表现
DOI：
10.1007/s13365-021-00953-5
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Iwasaki S.
中科院分区：
文献类型：
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作者：
Inagaki A;Kojima A;Ogawa M;Sakata T;Iwasaki S.
澄清磁共振成像(MRI)中的时间变化为了解神经病变的病理提供了一个很好的机会；然而，这种信息在水痘带状疱疹病毒(VZV)的舌咽和迷走神经神经病变中是稀有的。在这里，我们介绍了这种病理在发病12个月期间的连续磁共振图像的变化。27岁的女性，由于左侧腭部瘫痪和环状软骨固定而导致吞咽困难和声音嘶哑，在发病2天后出现。发病后第3天，MRI显示左侧颈静脉孔在T2加权像(T2-WI)上大部分充满了高弥散加权成像(DWI)信号，这是以前从未描述过的。DWI信号在第3天最高，然后在2个月后恶化，直到只在颅内水平检测到信号，而在颈静脉孔不能检测到信号。舌咽神经在2个月时已恢复正常。T2-WI上检测到的舌咽和迷走神经肿胀的时间进程表明，尽管瘫痪症状持续存在，但神经肿胀在几个月后有所减轻。此外，高的DWI信号表明，神经肿胀是由神经纤维的水肿性肿胀引起的，而不是由于细胞外间隙的水分置换而导致的纤维断裂。这些发现可能为推测VZV舌咽和迷走神经病变的动态变化的病理提供了很好的线索。
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.