Cases reported "Herpes Zoster Oticus"

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1/5. Sympathetic contralateral vestibulopathy after unilateral zoster oticus.

    A unique case of initially right sided varicella zoster induced Ramsay-Hunt syndrome with complete vestibular loss is reported. The patient subsequently developed deficits of the left vestibule 5 months later. An autoimmune pathogenesis of the left vestibular failure rather than bilateral varicella zoster infection was suggested by the following data: (1) no evidence of vesicular eruptions on the left auricle and the virtual absence of antiviral antibodies after onset of bilateral vestibulopathy; (2) prompt response of the left vestibule to immunosuppressive therapy with corticosteroids; and (3) presence of atypical nervous tissue specific autoantibodies against a 45 kDa protein.
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2/5. 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.
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3/5. herpes zoster oticus-diagnosis and treatment.

    Four cases of herpes zoster oticus (HZO) with facial paralysis are presented. HZO is a Herpes Zoster viral infection of the geniculate ganglion of the facial nerve. It presents classically with severe otalgia, a vesicular rash in the Concha or on the Pinna of the affected ear in association with a lower motor neurone lesion of the homolateral facial nerve. There also may be labyrinthine symptoms, sensineural hearing loss and vesicular eruptions in the regions supplied by the vagus and glossopharyngeal nerves viz, hypopharynx and oropharynx as these nerves communicate with the facial nerve. Treatment consists of acyclovir. One reference in the past refers to a clustering of the condition and its predisposition for females. Interestingly all cases presented were referred with incorrect diagnoses.
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4/5. 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.
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5/5. early diagnosis and treatment of Ramsay Hunt syndrome: the role of magnetic resonance imaging.

    We present the case of a 47-year-old woman with left otalgia, rotatory vertigo, sensorineural hearing loss and acute facial nerve palsy. An enhanced magnetic resonance imaging (MRI) scan showed discrete enhancement of the facial and vestibulocochlear nerves in the left internal auditory canal as well as of the labyrinth. This appearance was compatible with that in Ramsay Hunt syndrome and acyclovir was started prior to the appearance of any vesicular eruption. The diagnosis was subsequently confirmed serologically. She regained full facial function but the sensorineural hearing loss persisted. The literature pertaining to the role of the MRI in acute facial palsies is reviewed.
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