1/13. 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.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
2/13. 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.- - - - - - - - - - ranking = 0.5keywords = paralysis (Clic here for more details about this article) |
3/13. 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.- - - - - - - - - - ranking = 0.5keywords = paralysis (Clic here for more details about this article) |
4/13. 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 = 0.5keywords = paralysis (Clic here for more details about this article) |
5/13. Vestibular-evoked myogenic potentials in two patients with Ramsay Hunt syndrome.We report on the function of the inferior vestibular nerve, as monitored by the vestibular-evoked myogenic potentials (VEMP), in two patients suffering from Ramsay Hunt syndrome. Both the patients presented canal paresis (CP) and hearing loss, but in one patient normal VEMP was recorded while the other presented vagus nerve paralysis plus no VEMP response at the highest stimulus intensity used in our institute (i.e., 105 dB nHL).- - - - - - - - - - ranking = 0.5keywords = paralysis (Clic here for more details about this article) |
6/13. Bilateral simultaneous facial paralysis--differential diagnosis and treatment options. A case report and review of literature.Bilateral facial paralysis or paresis of peripheral origin is a rare condition and therefore represents a diagnostic challenge. We here present a case of a previously healthy woman who was hospitalized for symptoms of meningitis. On the second day of her hospital stay, she developed bilateral facial paresis. Later, the patient developed also tachycardia and dysrhythmias. A thorough diagnostic procedure including lumbar puncture, routine blood investigation with serological tests, MRI of the brain, Holter monitoring and transoesophageal echocardiographia, revealed meningitis with radiculitis, facial paresis and myocarditis. The clinical triad of meningitis, radiculitis and facial palsy is known as the Bannwarth syndrome (lyme disease). The patient was treated with ceftriaxone and recovered well. Despite repeatedly taken serological tests, borrelia burgdorferi immunoglobulins were not detected. Acquired bilateral facial paralysis can occur in several diseases of infectious, neurological, idiopathic, iatrogenic, toxic, neoplastic or traumatic origin. In this article, we review the differential diagnoses and treatment options of bilateral facial paresis and present a scheme that is helpful in the diagnostic evaluation of this condition.- - - - - - - - - - ranking = 3keywords = paralysis (Clic here for more details about this article) |
7/13. 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.- - - - - - - - - - ranking = 0.5keywords = paralysis (Clic here for more details about this article) |
8/13. 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 = 3.5keywords = paralysis (Clic here for more details about this article) |
9/13. A case of Ramsay Hunt-like syndrome caused by herpes simplex virus type 2.We report an immunocompetent patient with recurrent auricular and facial vesicles associated with painful paresthesias and facial paralysis, consistent with Ramsay Hunt syndrome, due to herpes simplex virus (HSV) type 2. Clinical and laboratory-proven acyclovir resistance developed during therapy. Immunologic assays revealed normal reactivity to HSV-2.- - - - - - - - - - ranking = 0.5keywords = paralysis (Clic here for more details about this article) |
10/13. Ramsay-Hunt syndrome with vesicular stomatitis in a 4-year-old infant.Ramsay-Hunt syndrome (RHS) usually affects adults, but rare cases of preschool children with RHS have been reported. We report a case of RHS in a healthy 4-year-old girl. At the age of 4 years and 5 months, she complained of pain in her mouth and herpes zoster vesicles were noted on the left soft palate and tongue without left pinna, and complete left facial paralysis subsequently developed. She was treated with acyclovir and steroids. Six months later, her facial paralysis had almost fully resolved.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
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