A case with trigeminal herpes zoster manifesting a long lesion of the spinal trigeminal nucleus and tract on MR T2-weighted image]

We reported a 53-year-old man with the right trigeminal herpes zoster with preceding neuralgia (preherpetic neuralgia) in the right upper cervical nerve area. He developed dysesthesia and scapular pain in the right second cervical nerve area. 5 days later, herpes zoster emerged in the area of the right maxillary division of trigeminal nerve. Furthermore, he developed paralysis on the right facial muscle on the 12th day after the onset of scapular pain. Neurological examination revealed decrease in superficial sensation accompanied by pain and dysesthesia in the areas innervated by the right maxillary division of trigeminal nerve and the right second cervical nerve, and the right peripheral facial nerve palsy. Any rash was not observed in the right second cervical nerve area throughout the course. The cerebrospinal fluid showed a mild mononuclear pleocytosis. The antibody titer for varicella zoster virus (VZV) was elevated in both cerebrospinal fluid and blood serum. T2-weighted magnetic resonance (MR) image revealed a continuously long high-signal lesion corresponding to the right spinal trigeminal nucleus and tract, extending from the lower pons to the second cervical segment of the spinal cord. This lesion could have resulted from a centripetal migration of VZV from the Gasser ganglion to the spinal trigeminal nucleus and tract, which was probably related to the preherpetic neuralgia in the upper cervical nerve area without rash.     

Synaptic actions of vagal afferents on facial motoneurons in the cat

Synaptic potentials in facial motoneurons of cats were intracellularly recorded on stimulation of the vagal nerve, superior laryngeal nerve, solitary tract nucleus and spinal trigeminal tract nucleus. A possible disynaptic excitation was elicited in the facial motoneurons by stimulation of the vagal nerves and superior laryngeal nerves on both sides. Activation of the neurons in the solitary tract nucleus and/or trigeminal tract nucleus induced monosynaptic excitatory postsynaptic potentials (EPSPs) in the facial motoneurons.     

Mechanisms and predictors of chronic facial pain in lateral medullary infarction

The purpose of this study was to identify clinical predictors and anatomical structures involved in patients with pain after dorsolateral medullary infarction. Eight out of 12 patients (67%) developed poststroke pain within 12 days to 24 months after infarction. The pain occurred in the ipsilateral face (6 patients) and/or the contralateral limbs and trunk (5 patients, 3 of whom also had facial pain). Ipsilateral facial pain was significantly correlated with lower medullary lesions, including those of the spinal trigeminal tract and/or nucleus, as documented by magnetic resonance imaging. The R2 blink reflex component was abnormal only in patients with facial pain. Likewise, pain and temperature sensation in the ipsilateral face was decreased in all patients with facial pain but not in patients without pain. Ipsilateral touch sensation in the face was also decreased in all patients with facial pain, but the lesions revealed on magnetic resonance imaging did not involve the principal sensory nucleus of the fifth cranial nerve, and the R1 blink reflex latencies were normal. Although facial pain was correlated with lesions of the spinal trigeminal tract and/or nucleus, none of the lesions involved the subnucleus caudalis, which contains most nociceptive neurons. These findings suggest that facial pain after medullary infarction is due to lesions of the lower spinal trigeminal tract (axons of primary afferent neurons), leading to deafferentation of spinal trigeminal nucleus neurons.     

Central distribution of afferent and efferent components of the chorda tympani in the cat as revealed by the horseradish peroxidase method

Central distribution of afferent and efferent components of the chorda tympani (CT) in the cat was examined by using the anterograde and retrograde tracing techniques of horseradish peroxidase (HRP). HRP was applied to the CT in the tympanic cavity. HRP-labeled CT fibers were traced to the brain stem along the ventral surface of the vestibular nerve. The afferent CT fibers were divided into ascending and descending components. The rostrally directed ascending fibers ended within and around the dorsomedial portions of the principal sensory trigeminal nucleus. The descending fibers entered the solitary tract to run caudally as far as the levels slightly rostral to the obex, giving terminals to the solitary nucleus. A cluster of HRP-labeled neurons were seen ipsilaterally in the lateral reticular formation medial to the spinal trigeminal nucleus; it was observed from the caudalmost levels of the exiting root of the facial nerve to the caudal levels of the facial nucleus. HRP-labeled axons arising from the HRP-labeled neurons firstly ran dorsomedially and then medially under the genu of the facial nerve to form a small genu at the region medial to the genu of the facial nerve. Subsequently the labeled axons ran laterally and ventrolaterally to join other CT fibers at the dorsomedial aspect of the spinal trigeminal tract.     

A case of ipsilateral ageusia, sensorineural hearing loss and facial sensorimotor disturbance due to pontine lesion]

We report a 58-year-old woman with pontine lesion presented with subacute onset of unilateral gustatory disturbance accompanied by facial numbness, and hearing loss. Neurologic examination revealed superficial hypesthesia and paresthesia on the right side of the face, right peripheral type facial paresis, ageusia on the right half of the tongue and right sensorineural deafness. No other neurologic signs were observed, and laboratory data were all normal. Brain MRI revealed a small lesion in the right dorsolateral tegmentum of the middle pons. Electrogustometry showed marked reduction in the sense of taste on the right half of the tongue. ABR showed diminished amplitude in the IV-V wave of the right side, while SEP and VEP were normal. The clinical diagnosis was demyelinating lesion and intravenous methylprednisolone (1 g/day) was administered for 3 consecutive days, resulting in prompt improvement in the symptoms. The lesion was suspected of affecting ipsilateral side of the spinal trigeminal nerve tract and the nucleus, the intraaxial infranuclear facial nerve fiber, the lateral lemniscus adjacent to the superior olivary nucleus and the central gustatory tract. Our case suggests that the central gustatory pathway projecting from the nucleus of the solitary tract to the parabrachial nucleus, presumed to be pontine taste area, ascends ipsilaterally and is located laterally from the medial lemniscus.     

An HRP study of the central course of sensory intermediate and vagal fibers in peripheral facial nerve branches in the cat

Previous studies have shown that sensory fibers of intermediate and vagal nerve origin are present in facial nerve branches to the mimetic muscles in the cat. In the present study the central course of these fibers has been examined by transganglionic transport of horseradish peroxidase (HRP). In some of these experiments the facial nerve proper was transected central to the site of HRP application. In this way, the central course of the vagal fibers could be studied separately. For comparison HRP-conjugated wheat germ agglutinin was injected into the geniculate ganglion, revealing the central course of the entire afferent component of the intermediate nerve. The results show that labeled sensory intermediate nerve fibers, at their level of entrance in the brainstem, form a tract at the dorsal margin of the spinal trigeminal tract (5T). While some fibers ascend from this level to terminate in the main sensory trigeminal nucleus, and a few fibers terminate in the rostral part of the solitary tract nucleus, the majority take a descending course. The main site of termination for these descending fibers is in the medial part of the C2 dorsal horn. Terminal labeling is also seen in the ventrolateral part of the cuneate nucleus (CUN) and in a small area of gray substance between CUN and trigeminal nucleus caudalis. After entering the brainstem some sensory vagal fibers project to the trigeminal nucleus interpolaris and to an interstitial nucleus within the 5T, but the larger part joins the descending tract of intermediate nerve fibers. These descending vagal fibers have a terminal distribution pattern similar to the intermediate nerve fibers.     

Magnetic resonance imaging of third cranial nerve palsy and trigeminal sensory loss caused by herpes zoster.

A 44-year-old man with right-sided herpes zoster ophthalmicus (HZO) developed ipsilateral third and sixth cranial nerve palsies and first-division trigeminal (fifth cranial nerve) sensory loss. MRI revealed contrast enhancement of the cisternal and cavernous portions of the third cranial nerve and high signal on a FLAIR sequence within the ipsilateral medulla at the presumed location of the trigeminal nucleus and tract. To our knowledge, this is the first report of the combination of these imaging findings in HZO.     

Reflex connections of the facial and vagal gustatory systems in the brainstem of the bullhead catfish, Ictalurus nebulosus

The primary gustatory sensory nuclei in catfish are grossly divisible into a vagal lobe and a facial lobe. In this study, the reflex connections of each gustatory lobe were determined with horseradish peroxidase (HRP) tracing methods. In addition, in order to determine the loci and morphology of the other brainstem cranial nerve nuclei, HRP was applied to the trigeminal, facial, glossopharyngeal, or vagus nerve. The sensory fibers of the facial nerve terminate in the facial lobe. The facial lobe projects bilaterally to the posterior thalamic nucleus, superior secondary gustatory nucleus, and medial reticular formation of the rostral medulla. The facial lobe has reciprocal connections with the n. lobobulbaris, medial reticular formation of the rostral medulla, descending trigeminal nucleus, medial and lateral funicular nuclei, and the vagal lobe, ipsilaterally; and with the facial lobe contralaterally. In addition, the facial lobe receives inputs from the raphe nuclei, from a pretectal nucleus, and from perilemniscal neurons located immediately adjacent to the ascending gustatory lemniscal tract at the level of the trigeminal motor nucleus. The gustatory fibers of the vagus nerve terminate in the vagal lobe, while the general visceral sensory fibers terminate in a distinct general visceral nucleus. The vagal lobe projects ipsilaterally to the superior secondary gustatory nucleus, lateral reticular formation, and n. ambiguus; and bilaterally to the commissural nucleus of Cajal. The vagal lobe has reciprocal connections with the ipsilateral lobobulbar nucleus and facial lobe. In addition, the vagal lobe receives input from neurons of the medullary reticular formation and perilemniscal neurons of the pontine tegmentum. In summary, the facial gustatory system has connections consonant with its role as an exteroceptive system which works in correlation with trigeminal and spinal afferent systems. In contrast, the vagal gustatory system has connections (e.g., with the n. ambiguus) more appropriate to a system involved in control of swallowing. These differences in central connectivity mirror the reports on behavioral dissociation of the facial and vagal gustatory systems.     

Difference in central projection of primary afferents innervating facial and intraoral structures in the rat

Transganglionic transport of horseradish peroxidase-wheat germ agglutinin conjugate was used to study the central projection of primary afferent neurons innervating facial and intraoral structures. The examined primary neurons innervating the facial structures were those comprising the frontal and zygomaticofacial nerves and those innervating the cornea, while the primary neurons innervating the intraoral structures included those innervating the mandibular incisor and molar tooth pulps and those comprising the palatine nerve. The primary afferents innervating the facial structures project to the lateral or ventral parts of the trigeminal principal, oral and interpolar subnuclei, and to the rostral cervical spinal dorsal horn across laminae I through V, with a greater proportion being directed to the spinal dorsal horn. The primary afferents innervating the intraoral structures terminate in the dorsomedial subdivisions of the trigeminal principal, oral and interpolar subnuclei, and in laminae I, II, and V of the medial medullary dorsal horn, with a much denser projection being distributed to the rostral subnuclei. In addition to the above brain stem trigeminal sensory nuclear complex, they project to the supratrigeminal nucleus, caudal solitary tract nucleus, and paratrigeminal nucleus. These observations agree with previously reported data that the central projection of trigeminal nerve is organized in different manners for the facial and intraoral structures. Furthermore, the present findings in conjunction with our previous studies clarify that the central projection of primary afferents from the facial skin is organized in a clear somatotopic fashion and that the terminal fields of primary afferents from the intraoral structures extensively overlap in the brain stem trigeminal nuclear complex particularly in its rostral subdivisions. The central mechanism of trigeminal nociception is discussed with particular respect to its difference between the facial and intraoral structures.     

Anatomy of the gustatory system in the hamster: central projections of the chorda tympani and the lingual nerve

The sensory modalities of taste and touch, for the anterior tongue, are relegated to separate cranial nerves. The lingual branch of the trigeminal nerve mediates touch: the chorda tympani branch of the facial nerve mediates taste. The chorda tympani also contains efferent axons which originate in the superior salivatory nucleus. The central projections of these two nerves have been visualized in the hamster by anterograde labelling with horseradish peroxidase (HRP). Afferent fibers of the chorda tympani distribute to all rostral-caudal levels of the solitary nucleus. They synapse heavily in the dorsal half of the nucleus at its rostral extreme; synaptic endings are sparser and located laterally in caudal regions. These taste afferents travel caudally in the solitary tract and reach different levels by a series of collateral branches which extend medially in the the solitary nucleus, where they exhibit preterminal and terminal swellings. Taste afferent axons range in diameter from 0.2 micrometer to 1.5 micrometers. The thickest axons project exclusively to the rostral and intermediate subdivisions of the solitary nucleus; the find ones may distribute predominantly to the caudal subdivision. Afferent fibers of the lingual nerve terminate heavily in the dorsal one-third of the spinal nucleus of the trigeminal nerve and also as a dense patch in the lateral solitary nucleus at the midpoint between its rostral and caudal poles. This latter projection overlaps that of the chorda tympani. Thus the two sensory nerves which subserve taste and touch from coincident peripheral fields on the tongue converge centrally on the intermediate subdivision of the solitary nucleus. Efferent neurons of the superior salivatory nucleus were labelled retrogradely following application of HRP to the chorda tympani. These cells are located ipsilaterally in the medullary reticular formation ventral to the rostral pole of the solitary nucleus; their dendrites are oriented dorsoventrally. The efferent axons course dorsally, form a genu lateral to the facial somatomotor genu, and course ventrolaterally through the spinal nucleus of the trigeminal nerve to exit the brain ventral to the entering facial afferents.     

Cytoarchitecture and topographic projections of the gustatory centers in a teleost, Carassius carassius

The neuronal connections in the central gustatory system of the crucian carp were examined by means of degeneration and HRP methods. Cell morphology in the primary gustatory lobes was studied in Golgi-impregnated material. Medium-sized neurons of the facial lobe emit axons which project to the secondary gustatory nucleus. The nucleus intermedius facialis of Herrick ('05) projects bilaterally. Large neurons send axons through the spinal trigeminal tract to terminate in the spinal trigeminal nucleus and in the medial funicular nucleus. In the vagal lobe, second-order neurons for the ascending projections are located in the superficial part of the sensory zone. These neurons project exclusively to the ipsilateral secondary gustatory nucleus. Neurons located in the deeper part of the sensory zone send axons to the motor zone and to the brainstem reticular formation to form short reflex arcs. The glossopharyngeal lobe has similar neuronal connections to the vagal sensory zone. Both facial and vagal lobes receive afferent projections from the following central structures: nucleus posterioris thalami, nucleus diffusus lobi inferioris, optic tectum, motor nucleus of the trigeminal nerve, medullary reticular formation, and the gray matter of the upper spinal cord. The facial lobe has an additional afferent from the mesencephalic reticular formation. The major sources to the medullary gustatory lobes are the nucleus posterioris thalami and nucleus diffusus lobi inferioris. Each type of neuron classified by morphology and location in the facial, glossopharyngeal, and vagal lobes was correlated with its particular destination. Topographic projections were demonstrated in the secondary and tertiary gustatory centers.     

The seventh cranial nerve of the rat. Visualization of efferent and afferent pathways by cobalt precipitation.

The cobalt sulphide precipitation technique, in conjunction with Timm's intensification procedure, was used to delineate the afferent and efferent intramedullary pathways of the seventh cranial nerve complex in the rat. The branchial motor nucleus with the accompanying first part, genu, and second part of the root are described. The motor branches to the superficial facial musculature do not contain fibres of geniculate ganglion origin or fibres which terminate in the spinal trigeminal nucleus. The motor branches to the deep facial muscles arise from the dorsal part of the branchial motor nucleus and traverse to the midline medial to the genu, then project under the genu into the lateral reticular formation before exiting with the facial nerve. The salivatory and lacrimal nuclei and their intramedullary pathways are described. Sensory fibres from the cutaneous auricular branch enter the spinal trigeminal tract and most of the chorda tympani gustatory fibres enter the fasciculus solitarius. A smaller number of gustatory fibres extend medially to the region of the salivatory nucleus. Fibres of greater superficial petrosal origin also enter the fasciculus solitarius as well as the medial reticular formation. These findings are discussed in relation to previous anatomical, physiological and clinical reports.     

Organization of sensory and motor nuclei of the trigeminal nerve in lampreys

Anterograde and retrograde HRP transport were used to elucidate the primary central projections of the trigeminal nerve in a lamprey, Lampetra japonica, by application to the ophthalmic, apical, basilar, suborbital, and mandibular branches of the trigeminal nerve. (1) Most of the trigeminal and a few facial ganglion cells were labeled. The ganglion cells of each nerve were distributed in separate areas within their respective ganglia. (2) Some ipsilateral medullary and spinal dorsal cells were labeled after HRP application to the ophthalmic and apical nerves, but there was no contralateral labeling. (3) Most of the neurons of the trigeminal motor nucleus were labeled, and when the apical or the basilar nerve was labeled, in each case a cluster of small motor neurons was found ventrolateral to the classic motor nucleus. (4) Miscellaneous neurons were found scattered along the course of the descending trigeminal tract and nucleus in all cases except after application to the mandibular branch. The shape, size, and distribution patterns of these neurons were varied, and several characteristics indicated that they were sensory in nature. (5) In the rostral part of the medulla, sensory fibers of each nerve showed restricted localization within the descending trigeminal tract and nucleus. When compared to the distribution of the same fibers in the hagfish Eptatretus burgeri, another member of the cyclostomes, the distribution pattern in the lampreys studied was closer to the type seen in gnathostomes.     

Pathway of the blink reflex in the brainstem of the cat: Interneurons between the trigeminal nuclei and the facial nucleus

Blink reflex responses evoked by electrical stimulation of the supraorbital nerve were examined using cats and the pathway of the blink reflex in the brainstem was elucidated. Both early response (ER) and late response (LR) were mediated by the main sensory trigeminal nucleus and the spinal trigeminal nucleus. However, a lesion of the main sensory trigeminal nucleus had less effect on the blink reflex than a lesion of the spinal trigeminal nucleus. The ER was mediated not only by the shorter disynaptic pathway of 3 neurons through the trigeminal nerve, the trigeminal nuclei and the facial nucleus but also by a polysynaptic pathway of 4 neurons. The interneurons were located between the trigeminal nuclei and the facial nucleus. Some of these interneurons participated in the production of both ER and LR. The area of the brainstem responsible for ER and LR of the blink reflex was the reticular formation from the rostral part of the medulla to the pons except the medial area around the median sulcus. The LR interneurons were distributed more widely than the ER interneurons.     

Noradrenergic projections to brainstem nuclei: evidence for differential projections from noradrenergic subgroups

Retrograde transport of the fluorescent tracer True Blue was used in combination with immunohistochemical staining of dopamine-beta-hydroxylase (a marker protein for noradrenergic neurons) to determine the origin of noradrenergic projections to three cranial nerve nuclei: 1) the motor nucleus of the trigeminal nerve, 2) the motor nucleus of the facial nerve, and 3) the spinal trigeminal nucleus pars interpolaris. Noradrenergic cells in the rat brainstem were divided into subgroups and their numbers were determined in serial sections stained with an antiserum to rat dopamine-beta-hydroxylase. Following tracer injections into the three brainstem nuclei, retrogradely labeled noradrenergic neurons were counted and the percentage of True Blue-labeled noradrenergic cells in each subgroup was calculated. Injections of tracer into the three cranial nerve nuclei resulted in distinctly different labeling patterns of noradrenergic cells. Of the total number of norepinephrine neurons projecting to the motor nucleus of the trigeminal nerve, 68% were observed within the A7 cell group; 75% of those innervating the motor nucleus of the facial nerve were found in the A5 cell group, and 65% of those projecting to the spinal trigeminal nucleus pars interpolaris were present in the locus ceruleus and subceruleus. These findings indicate that norepinephrine cells in the rat brainstem do not constitute a homogeneous population of cells but that several discrete systems can be identified that differ not only in topography but also in the terminal distribution of their axons. This combined retrograde transport-immunohistochemical study reveals a much higher degree of topographic order in the projections of norepinephrine neurons than has previously been recognized. The observation of differential projections of noradrenergic subgroups argues against the notion of a global influence of these cells over functionally diverse areas of the brainstem.     

Topographic organization of central terminal region of different sensory branches of the rat mandibular nerve

The central projection of primary neurons comprising the auriculotemporal nerve, cutaneous branch of the mylohyoid nerve, inferior alveolar nerve, mental nerve, lingual nerve, and buccal nerve was investigated using transganglionic transport of HRP in young rats. In view of the topographic organization of central projection fields, the nerves were divided into two groups; i.e., those projecting to the dorsolateral margin of the trigeminal nucleus principalis, subnucleus oralis, and interpolaris (the auriculotemporal, mylohyoid, and mental nerves) and those projecting more medially (the inferior alveolar, lingual, and buccal nerves). The former group of nerves projected more caudally than the latter in the medullary and spinal dorsal horn complex rostral to the 3rd cervical segment, in general. Furthermore, the latter group projected to the nucleus of the solitary tract and the supratrigeminal and paratrigeminal nuclei, whereas the other nerves did not. The data indicate the following points: Primary neurons innervating the intraoral structures terminate medial (in trigeminal nucleus principalis and subnucleus oralis) and ventral (in subnucleus interpolaris) to the terminal fields of those innervating the facial skin. Primary neurons innervating the intraoral structures project to the nucleus of the solitary tract and the supra- and paratrigeminal nuclei, whereas those innervating the facial skin do not. Primary neurons innervating the periphery of the face project to the spinal dorsal horn and those innervating the intra/perioral region project to medullary dorsal horn, though this segregation from the medulla to the 3rd cervical segment is relatively loose. Only those trigeminal primary neurons, whose receptive fields extend to or beyond the midline, project to the contralateral dorsal horn from the medulla to the 3rd cervical segment.     

Afferent connections of the facial nerve

The central connections of the afferents of the facial nerve have been studied by the Nauta-Gygax and Fink-Heimer techniques in the rat, cat, and the rhesus, cynomolgus, and squirrel monkeys. Descending components that entered the spinal V and solitary tract were found in all species studied. The spinal V fibers terminated in the upper cervical dorsal horn, making a minor contribution to the various subdivisions of the spinal V nucleus, and are probably concerned with pain; the solitary fibers terminated in the solitary nucleus, predominantly at levels rostral to the obex. A few degeneration fibers were seen in reticular formation medial to the spinal V tract in all species. An ascending component was found in both the cat and monkey. The identification of some fibers from cranial VII, which ascend and terminate on a prefacial, probably gustatory, portion of the solitary nucleus provides the first confirmation in nerve degeneration studies of Nageotte's results in man. Some ascending fibers also terminated on the most medial cells of the main trigeminal sensory nucleus, a connection not previously described, that probably mediates touch from the auricular region. Another previously unreported connection found only in the monkey was that of some fibers which terminated on a nucleus (paratrigeminal nucleus), dorsolateral to the spinal V tract; this nucleus may represent an oral extension of the lateral cuneate nucleus, and if this is so, the axons terminating in it would be a part of the afferent cerebellar system.     

Afferent fibers in the hypoglossal nerve: a horseradish peroxidase study in the cat

The existence of afferent fibers in the cat hypoglossal nerve was studied by transganglionic transport of horseradish peroxidase (HRP). Injections of wheat germ agglutinin-conjugated HRP (WGA-HRP) into the hypoglossal nerve resulted in some retrograde labeling of cell bodies within the superior ganglia of the ipsilateral glossopharyngeal and vagal nerves. A few labeled cell bodies were also present ipsilaterally within the inferior ganglion of the vagal nerve and the spinal ganglion of the C1 segment. Some of the labeled glossopharyngeal and vagal fibers reached the nucleus of the solitary tract by crossing the dorsal portion of the spinal trigeminal tract. Others distributed to the spinal trigeminal nucleus pars interpolaris and to the ventrolateral part of the medial cuneate nucleus by descending through the dorsal portion of the spinal trigeminal tract. In the spinal cord these descending fibers, intermingling with labeled dorsal root fibers, distributed to laminae I, IV-V and VII-VIII of the C1 and C2 segments. Additional HRP experiments revealed that the fibers in laminae VII-VIII originate mainly from dorsal root of the C1 segment.     

The motor complex and primary projections of the trigeminal nerve in the monitor lizard, Varanus exanthematicus

The sensory projections and the motor complex of the trigeminal nerve of the reptile Varanus exanthematicus were studied with the methods of anterograde degeneration and anterograde and retrograde axonal transport. The primary afferent fibers diverge in the brainstem into a short ascending and a long descending tract. The former distributes its fibers to the principal sensory trigeminal nucleus, where nerves V1, V2, and V3 are represented along a lateromedial axis. The fibers of the descending tract enter the nucleus of this tract and the reticular formation. Both in the tract and its nucleus, nerves V1, V2 and V3 occupy successively more dorsal positions. A small contingent of nerve V1 fibers course to the accessory abducens nucleus. The descending tract extends caudally into the first and second cervical segments of the spinal cord. The trigeminal motor complex consists of dorsal, ventral, and dorsomedial nuclei. The m. adductor mandibulae externus (the main jaw closer) is represented in the dorsal nucleus, predominantly in its rostral part. The muscles innervated by nerve V3 are represented in the ventral nucleus, mainly in its caudal part. All three divisions of the trigeminal nerve contain peripheral branches of the mesencephalic trigeminal system. Collaterals of the central branches of this system were traced to the ventral motor and the principal sensory trigeminal nuclei.     

A case of multiple cranial nerve palsy with severe dysphagia due to herpes zoster infection]

A case of multiple cranial nerve palsy by herpes zoster was reported. A 79-year-old man showed fever, sore throat, and dysphagia. No vesicle was noted at ear and pharynx. The patient developed, later, left peripheral facial nerve palsy. The cerebrospinal fluid revealed pleocytosis with increased protein. The viral antibody titer of herpes zoster was significantly elevated both in cerebrospinal fluid and in serum. The left facial palsy was slightly improved. But his dysphagia didn't improve during at least 10 months after the onset. Among the cranial nerves, trigeminal and facial nerves are the most commonly affected by herpes zoster. But there are a few cases of the 9th and 10th cranial nerve involvement in the literature. However, dysphagia has rarely been reported in these previous cases, only four cases developed severe dysphagia like the present patient. All of these cases including our case were over sixty years old, while cases with slight dysphagia were under sixty years old. No other differentiating factor is noted between these two groups with regard to sites of vesicles, findings of cerebrospinal fluid and mode of therapy.