Cases reported "Herpes Zoster Oticus"

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1/37. Ramsay Hunt syndrome associated with brain stem enhancement.

    Postcontrast T1-weighted MR images in a patient with Ramsay Hunt syndrome showed an enhancing lesion in the region of the nucleus of the pontine facial nerve and abnormal enhancement of the intrameatal, labyrinthine, and tympanic facial nerve segments and of the geniculate ganglion, as well as enhancement of the vestibulocochlear nerve and parts of the membranous labyrinth. This enhancement most probably resulted from a primary neuritis of the intrameatal nerve trunks of the seventh and eighth cranial nerves. ( info)

2/37. 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. ( info)

3/37. Ramsay-Hunt syndrome in a 4-year-old child.

    The Ramsay-Hunt syndrome mostly affects adults, but a small number of children with herpes zoster oticus have been reported. We describe a case of Ramsay Hunt syndrome in a healthy 4-year-old boy. He developed varicella at 7 months of age. At the age of 4 years, he complained of pain in his right ear, and herpes zoster vesicles were noted on his right pinna. Three days later, he developed right facial paralysis. He was treated with intravenous acyclovir and methylprednisolone. One month later, his facial paralysis had fully resolved. ( info)

4/37. Successful treatment of crocodile tears by injection of botulinum toxin into the lacrimal gland: a case report.

    OBJECTIVE: Pathologic lacrimation (crocodile tears) is a rare but stigmatizing symptom after facial nerve paralysis. The aim of this pilot study was to examine whether botulinum toxin injection into the lacrimal gland is effective in reducing pathologic tear secretion. DESIGN: Case report. INTERVENTION: One patient who had crocodile tears after a zoster oticus infection received a botulinum toxin injection (2.5 mouse units) into the lacrimal gland. TESTING: Before injection, 1 week, 1 month, and 6 months after injection, patient's lacrimation was assessed by a Schirmer test. RESULTS: The lacrimation of the injected eye was reduced after 1 week and equal after 1 month when compared to the healthy side. After 6 months, hyperlacrimation reoccurred. No side effects were observed. CONCLUSION: Intraglandular injection of botulinum toxin into the lacrimal gland may serve as a sufficient therapy for crocodile tears. ( info)

5/37. An extreme and unusual variant of Ramsay Hunt syndrome.

    Ramsay Hunt syndrome is characterized by facial nerve paralysis, herpetic vesicles in or around the ear and pain often associated with vestibulocochlear nerve involvement. It is thought to be a cranial polyneuropathy caused by the herpes zoster virus. We present an extreme and unusual variant of this disease with involvement of VIIth, VIIIth, Xth, XIth and XIIth cranial nerves as well as C2-4 sensory dermatomes and profound systemic upset which caused some diagnostic uncertainty. ( info)

6/37. 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. ( info)

7/37. herpes zoster oticus following mandibular block.

    Although a few cases of facial palsy following mandibular nerve block and dental surgery have been described, it would appear that herpes zoster oticus following dental surgery has not been documented. It is possible that the latent virus may be activated by the mandibular nerve block and dental surgical interventions. Two cases of herpes zoster oticus, both following inferior alveolar nerve block anaesthesia for dental treatment are presented. ( info)

8/37. diplopia from skew deviation in Ramsey-Hunt syndrome. A case report.

    OBJECT: Presentation of a 34-year-old pregnant woman with skew deviation due to peripheral vestibular dysfunction caused by herpes zoster oticus. methods: A multidisciplinary approach (neuroophthalmology, otorhinolaryngology, neuroradiology) revealed the diagnosis of Ramsey-Hunt syndrome. CASE REPORT: The patient presented with painful herpes zoster vesicles of the left ear, associated with a rotatory vertigo and hearing loss. Otorhinolaryngological examination showed a unilateral peripheral vestibular loss, a nystagmus towards the unaffected right side, no facial nerve dysfunction and a left perception hearing loss, mainly in the frequencies between 2-6 KHz. The patient was treated with Zovirax IV. Neuroradiological examination (MRI without contrast) revealed no abnormalities. Vertical diplopia from skew deviation was noted /- 10 days after onset of herpes zoster oticus. Neuroophthalmological and orthoptic examination showed a comitant right hypertropia of 6 diopters and a spontaneous nystagmus to the right. CONCLUSION: Skew deviation can be caused by a sudden unilateral cochleo-vestibular loss as described by A.B. Safran. (4,6,7,8). ( info)

9/37. Detection of varicella zoster virus dna in tear fluid and saliva of patients with Ramsay Hunt syndrome.

    OBJECTIVE: To clarify the dynamics of the reactivation of the varicella zoster virus in Ramsay Hunt syndrome. SUBJECTS AND methods: Varicella zoster virus dna in the tear fluid, submandibular gland saliva, and parotid gland saliva of 15 patients with Ramsay Hunt syndrome was studied. The presence of varicella zoster virus dna was detected quantitatively by the use of polymerase chain reaction and a microplate hybridization method. RESULTS: Of 102 specimens of the tear fluid and saliva collected from 15 patients, varicella zoster virus dna was detected in 40 specimens (39%) from 12 patients (80%). The detection rate was 72% in the submandibular saliva, 57% in the parotid saliva, and 27% in the tear fluid. Varicella zoster virus dna was detected not only in specimens from the affected side but also in specimens from the unaffected side at the same rate of detection, and at nearly the same number of dna copies. Regarding the parotid saliva, varicella zoster virus dna was detected in samples collected at an early stage of the disease. In the tear fluid and submandibular saliva, however, the detection rate was high in samples collected 2 weeks after the onset of disease or later. CONCLUSIONS: Secretion of varicella zoster virus dna into the tear fluid and saliva was confirmed in the patient with Ramsay Hunt syndrome. The increase and decrease in the detection rate and the number of varicella zoster virus dna copies detected in samples collected at different times was considered to substantiate varicella zoster virus reactivation in Ramsay Hunt syndrome. Varicella zoster virus reactivation was thought to occur in the unaffected side at the same level as in the affected side, and some of the secreted varicella zoster virus dna was suspected to be derived from the ganglion trigeminale. ( info)

10/37. Corneal epithelial keratitis in herpes zoster ophthalmicus: "delayed" and "sine herpete". A non-contact photomicrographic in vivo study in the human cornea.

    PURPOSE: To investigate the origin of corneal epithelial keratitis occurring without accompanying herpes zoster ophthalmicus (HZO) cutaneous rash. methods: Corneal epithelial lesions in seven patients (four with a history of classical HZO with cutaneous rash, one of herpes zoster oticus, and two with no history of herpes zoster, were examined with the slit lamp and photographed by non-contact in vivo photomicrography. The findings were compared with lesions in classical acute HZO. polymerase chain reaction (PCR) was done in three patients. RESULTS: Slit lamp appearance, morphology at higher magnification, and kinetics of the lesions were indistinguishable from classical acute HZO. PCR was positive for varicella-zoster virus dna in all three samples. CONCLUSIONS: The findings strongly suggest that HZO typical corneal epithelial lesions occurring in the absence of cutaneous rash are in fact recurrent episodes of virus shedding. ( info)
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