Cases reported "Bell Palsy"

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1/4. Retroauricular pain preceding Bell's palsy: report of three cases and clinical analysis.

    A retroauricular pain (RAP) ipsilateral to the side of facial paralysis (FP), often experienced patients with Bell's palsy, usually occurs around the onset of FP. Whether RAP is a risk factor for incomplete recovery from FP is controversial. This paper reports three patients with Bell's palsy in whom acute RAP preceded FP by several days. The intervals between the onset of RAP and FP were 6, 12, and 12 days, and the quality of RAP was dull/tight or neuralgic. All patients received prednisolone and acyclovir orally, and their facial functions recovered within 8 weeks. Based on the serological tests, FP was diagnosed as due to varicella-zoster virus in two patients and as idiopathic in the other. Among 58 consecutive patients with Bell's palsy, including the three patients described, 26 (44.8%) experienced RAP, the onset of which ranged from 12 days before to 2 days after the onset of FP. While the prognosis of FP was not different between patients with and without RAP, FP recovered well in all seven patients in whom RAP preceded the onset of FP by 4 days or more. These findings suggest that RAP preceding by several days may predict the good prognosis of FP. As RAP can be a preceding symptom of acute FP, patients with acute RAP require medical attention for at least 2 weeks.
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2/4. Acute onset of facial nerve palsy associated with lyme disease in a 6 year-old child.

    Pediatric facial nerve palsy (FNP) can result from a variety of etiologies including lyme disease, varicella, primary gingivostomatitis, herpes zoster oticus (Ramsay Hunt syndrome), coxsackievirus, trauma, otitis media, hiv, diseases causing tumors or demyelinations, compressions, and possibly Epstein Barr virus. lyme disease has been implicated as the cause of over 50% of the FNPs in children. The paralysis of the facial nerve disturbs motor function to the muscles of facial expression and results in a flaccid appearance of the face (unilateral or bilateral). This case report derails undiagnosed lyme disease presenting as a facial palsy in a 6 year, 5 month-old white female. The palsy was recognized and consultation with the child's physician prompted definitive diagnosis and treatment. A review of the literature and the implications of facial nerve palsy are discussed.
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3/4. acyclovir responsive brain stem disease after the Ramsay Hunt syndrome.

    We report an immunocompetent patient with the Ramsay Hunt syndrome (RHS) followed days later by brainstem disease. Extensive virological studies proved that varicella zoster virus (VZV) was the causative agent. Treatment with intravenous acyclovir resulted in prompt resolution of all neurological deficits except peripheral facial palsy. This case demonstrates that after geniculate zoster, brainstem disease may develop even in an immunocompetent individual and effective antiviral therapy can be curative.
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4/4. Subdural empyema and herpes zoster syndrome (Hunt syndrome) complicating removal of third molars.

    We report a case of subdural empyema and herpes zoster syndrome (Hunt syndrome) complicating routine removal of third molars. Subdural empyema is an extremely rare but life-threatening complication of dental sepsis arising spontaneously or after dental surgery. The clinician should be familiar with its presentation and have a high index of suspicion, because late recognition and delay in its treatment can increase the associated morbidity and mortality. Surgical procedures and in particular maxillofacial surgery have also been known to trigger varicella zoster reactivation resulting in Hunt syndrome. Some patients develop the characteristic rash several days after the onset of facial weakness, so that Hunt syndrome may initially be misdiagnosed as Bell's palsy. We highlight the difficulties in diagnosing Hunt syndrome and argue the case for early treatment of all patients with Hunt syndrome and Bell's palsy with a combination of systemic steroids and antiviral drugs.
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