1/14. Bilateral sequential facial palsy during chickenpox.Facial palsy is a rare neurological complication of chickenpox. A 5-year-old girl exhibited a right facial palsy followed by the appearance of the characteristic chicken pox exanthem. Subsequently she suffered a left facial palsy. In this patient both pathophysiological mechanisms responsible and their relation to the phase of infection are illustrated. CONCLUSION: Facial palsy as a complication of chickenpox can result from pre-eruptive haematogenous or neurogenous spread of varicella-zoster virus.- - - - - - - - - - ranking = 1keywords = chickenpox, varicella (Clic here for more details about this article) |
2/14. Delayed facial palsy after middle-ear surgery due to reactivation of varicella-zoster virus.Viral reactivation is thought to be an important cause of post-operative facial palsy of delayed onset. We present an unusual case of Ramsay-Hunt syndrome that occurred as a consequence of middle-ear surgery by triggering varicella-zoster virus reactivation. As a pathognomonic auricular eruption was not seen, the patient was initially misdiagnosed as iatrogenic facial palsy. Clinical features, diagnosis and management are discussed.- - - - - - - - - - ranking = 0.057941086286481keywords = varicella (Clic here for more details about this article) |
3/14. Delayed facial palsy after stapedectomy.OBJECTIVE: To study the incidence, pathogenesis, and prevention of delayed facial palsy after stapedectomy. STUDY DESIGN: Retrospective case review. SETTING: Otology/neurotology referral center. patients: A series of 2152 stapedectomy procedures in 2106 patients over 12 years. INTERVENTION: Delayed facial palsy after stapedectomy was studied. MAIN OUTCOME MEASURE: House-Brackmann facial nerve grading system and serum antibody titer tests for herpes simplex virus type I and type II, and varicella zoster virus. RESULTS: Delayed facial palsy occurred in 11 of 2152 procedures. Delayed facial palsy occurred from 5 to 16 days (mean 8) after stapedectomy. Predisposing factors were bony facial canal dehiscence with bare or bulging facial nerve herniation in 5 patients; chorda tympani nerve stretched, manipulated, or cut in 2 patients; granulomatous reaction to Gelfoam in 1 patient; fever blisters on the upper lip in 1 patient; and sinusitis in 2 patients. Elevated anti-varicella antibody titers were found in all 6 patients studied. Anti-herpes simplex type I and II antibody titers were elevated in 5 of 6 patients. acyclovir was effective in preventing delayed facial palsy in 1 patient who had undergone revision stapedectomy and experienced delayed facial palsy after previous stapedectomy in the same ear with elevated anti-herpes antibody titer. CONCLUSIONS: Delayed facial palsy occurred in 0.51% of patients after stapedectomy. Serologic investigation suggests activation of latent herpesvirus. Mechanical irritation of the facial or chorda nerve during operation may trigger the activation. The anti-herpesvirus agent acyclovir may prevent delayed facial palsy after stapedectomy in patients suspected of having this complication.- - - - - - - - - - ranking = 0.023176434514592keywords = varicella (Clic here for more details about this article) |
4/14. Reactivation of varicella-zoster virus in facial palsy associated with infectious mononucleosis.Facial palsy with infectious mononucleosis, although well-recognized, is rare in children, and its pathogenesis is uncertain. To our knowledge there has been no previous report describing varicella-zoster virus reactivation as a cause of facial palsy associated with infectious mononucleosis. We report such a patient in whom serology showed reactivation of varicella-zoster virus.- - - - - - - - - - ranking = 0.069529303543777keywords = varicella (Clic here for more details about this article) |
5/14. Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms.Ramsay Hunt's hypothesis that herpes zoster oticus results from reactivation of the varicella zoster virus (VZV) in the geniculate ganglion is supported by the detection of viral genome in archival temporal bones of normals and Ramsay Hunt patients by the polymerase chain reaction. Ramsay Hunt syndrome is characterized by the presence of cochleovestibular symptoms in association with facial paralysis. VZV has also been demonstrated in the spiral and/or vestibular ganglion. Two cases are reported in which cochleovestibular symptoms outweighed the facial nerve symptoms, presumably representing VZV reactivation in the spiral and/or vestibular ganglion. From these observations and the known dormancy of VZV in non-neuronal satellite cells, it is argued that the cochleovestibular symptoms in Ramsay Hunt syndrome may result from VZV transmission across the nerves inside the internal auditory canal and that prompt treatment with an antiviral-corticosteroid combination might be justified in the management of any acute non-hydropic cochleovestibular syndrome.- - - - - - - - - - ranking = 0.011588217257296keywords = varicella (Clic here for more details about this article) |
6/14. Chronic varicella-zoster virus ganglionitis--a possible cause of postherpetic neuralgia.Postherpetic neuralgia (PHN) is dermatomal distribution pain that persists for months to years after the resolution of herpes zoster rash. The cause of PHN is unknown. Herein, we report clinical, molecular virological, and immunological findings over an 11-year period in an immunocompetent elderly woman with PHN. Initially, blood mononuclear cells (MNCs) contained varicella-zoster virus (VZV) dna on two consecutive occasions. Random testing after treatment with famciclovir to relieve pain did not detect VZV dna. However, the patient was reluctant to continue famciclovir indefinitely and voluntarily stopped drug treatment five times. pain always recurred within 1 week, and blood MNCs contained many, but not all, regions of the VZV genome on all five occasions. Immunological analysis revealed increased cell-mediated immunity to VZV. Chronic VZV ganglionitis-induced PHN best explains the recurrence of VZV dna in MNCs whenever famciclovir was discontinued; the detection of only some regions of the viral genome in MNCs, compared to the detection of all regions of the VZV genome in latently infected ganglia; the increased cell-mediated immunity to VZV; and a gratifying clinical response to famciclovir. The presence of fragments of VZV dna in MNCs likely represents partial degradation of viral dna in MNCs that trafficked through ganglia during productive infection.- - - - - - - - - - ranking = 0.057941086286481keywords = varicella (Clic here for more details about this article) |
7/14. 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.- - - - - - - - - - ranking = 0.011588217257296keywords = varicella (Clic here for more details about this article) |
8/14. Varicella zoster virus: beyond facial paralysis.J. Ramsay Hunt's hypothesis that herpes zoster oticus results from a reactivation of the herpes zoster virus in the geniculate ganglion, has been supported by the demonstration of varicella zoster viral dna in the geniculate ganglion of the side with facial paralysis in patients with Ramsay Hunt syndrome, with the use of the polymerase chain reaction. Similarly, dna of the varicella zoster virus has been identified in the spiral and vestibular ganglion as well. We report on three patients with cochleovestibular symptoms as the first manifestations of Ramsay Hunt syndrome. A 64-year old woman and a 72-year old man presented with vertigo and an auricular herpetiform eruption. Only the woman developed later on a mild facial paralysis. A 58-year old man presented with an acute cochleovestibular syndrome, serologically proven to be a varicella zoster viral reactivation, which was followed three weeks later by the typical cutaneous recrudescence. We believe that these cases result from reactivation of latent varicella zoster virus in the spiral and/or vestibular ganglion. As the varicella zoster virus is dormant in the non-neuronal satellite cells, the facial symptoms in our patients as well as the high incidence of cochleovestibular symptoms in classical Ramsay Hunt syndrome can be explained by viral transmission across the nerves inside the internal auditory canal. Therefore, we think there are grounds to recommend a prompt treatment with an antiviral and a corticosteroid agent, not only in case of an acute facial paralysis but also when confronted with an acute cochleovestibular syndrome.- - - - - - - - - - ranking = 0.057941086286481keywords = varicella (Clic here for more details about this article) |
9/14. Varicella-zoster virus and facial palsy.Two cases of Ramsey-Hunt Syndrome are reported, one of which presented features of the guillain-barre syndrome. It is suggested that the varicella-zoster virus is an aetiological factor in the guillain-barre syndrome.- - - - - - - - - - ranking = 0.011588217257296keywords = varicella (Clic here for more details about this article) |
10/14. Middle ear mucosa in Ramsay Hunt syndrome.We report two patients with Ramsay Hunt syndrome, together with histopathologic findings of the middle ear mucosa near the facial canal. An attempt was made to find specific antigens of varicella zoster virus (VZV) and herpes simplex virus (HSV) by an immunofluorescence method. Histopathologic examination revealed inflammation of the middle ear mucosa. Specific VZV antigens were demonstrated in the cytoplasm and nucleus of elliptically shaped cells and round cells, but no specific antigens of HSV were found. The findings suggest a pathogenetic relationship between VZV infection and inflammatory changes in the middle ear mucosa.- - - - - - - - - - ranking = 0.011588217257296keywords = varicella (Clic here for more details about this article) |
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