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After an extensive workup, the patient\u2019s symptoms were determined to be due to sequelae of varicella zoster infection, which was confirmed with antibody titers. The patient\u2019s dysphagia and dysphonia eventually improved with vocal cord medialisation injection and Botox injection. However, despite delayed treatment with acyclovir and valacyclovir, the patient continued to have neuropathic pain and exhibit signs of CN X and CN XI paresis, in addition to scalene muscle atrophy.<\/jats:p>","DOI":"10.1136\/bcr-2021-241881","type":"journal-article","created":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T11:58:22Z","timestamp":1620388702000},"page":"e241881","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Uncommon presentation and complications of herpes zoster infection involving the cervical, vagus and accessory nerves which caused a delay in diagnosis and treatment"],"prefix":"10.1136","volume":"14","author":[{"given":"Ziqi","family":"Wang","sequence":"first","affiliation":[{"name":"University of Florida Health, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Lotina","sequence":"additional","affiliation":[{"name":"Department of 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