A 78-year-old immunocompetent man initially presented with 7 days of dysphagia and an otherwise negative review of systems (no prodrome or rash), before developing hoarseness. Presumed diagnosis after laryngoscopy was post-viral right vocal fold paralysis (PVVFP), but this did not improve with oral steroids. Otolaryngology again evaluated the patient and found poor right palate elevation and pooling of secretions in the right pyriform sinus (indicative of right pharyngeal weakness), consistent with cranial nerve (CN) IX-X palsy. The symptoms did not fluctuate and did not include pain or sensorimotor deficits. 11 days after dysphagia/dysphonia onset, patient acutely developed a right lower motor neuron facial droop (CN VII) but emergent head imaging was negative. Given a wide differential diagnosis, an extensive work-up was sent and was negative, apart from lumbar puncture (LP) which showed elevated protein, pleocytosis, and positive varicella zoster virus (VZV) polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF). Patient was started on high-dose intravenous acyclovir, 12 days after the onset of dysphagia. Neurologic exam was stable after starting acyclovir, however his dysphagia remained severe, thus a gastric tube was placed for tube feeds. Throughout the course of his hospitalization, the patient did not experience significant neurologic improvement.