An extreme and unusual variant of Ramsay Hunt syndrome

1999 ◽  
Vol 113 (7) ◽  
pp. 670-671 ◽  
Author(s):  
S. De ◽  
A. G. Pfleiderer
Keyword(s):  
Herpes Zoster ◽  
Facial Nerve ◽  
Cranial Nerves ◽  
Facial Nerve Paralysis ◽  
Vestibulocochlear Nerve ◽  
Nerve Paralysis ◽  
Ramsay Hunt Syndrome ◽  
Diagnostic Uncertainty ◽  
Hunt Syndrome ◽  
Unusual Variant

AbstractRamsay 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.

Tofacitinib-induced Ramsay- Hunt Syndrome in a Patient with Rheumatoid Arthritis

2020 ◽  
Vol 15 ◽  
Author(s):  
Senol Kobak
Keyword(s):  
Rheumatoid Arthritis ◽  
Hearing Loss ◽  
Facial Nerve ◽  
Varicella Zoster Virus ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Varicella Zoster ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome ◽  
Intravenous Acyclovir

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint and systemic involvement. Tofacitinib is a JAK- inhibitor that is an effective agent in the treatment of active RA. Varicella zoster virus (VZV) reactivation is among the most important advers effects of tofacitinib. Ramsay-Hunt syndrome (RHS) is a rare clinical condition that develop as a result of VZV reactivation and progresses with hearing loss, dizziness and facial nerve paralysis. Objective: To present a case with Ramsay-Hunt syndrome due to varicella zoster reactivation in RA patient using tofacitinib Case report: A 63-year-old female RA patient under tofacitinib treatment was admitted to the rheumatology outpatient clinic due to widespread skin rashes on her face and ear, and hearing loss. On inspection widespread erythematous, vesicular rashes on the left side of the face, lips, around the eye and in the ear, and mild facial paralysis on the left side were detected. On laboratory investigations acute phase reactants were increased. Serological study for specific antibodies against varicella zoster virus showed higher titers. Dermatology and ear nose throat specialist consultations was performed, varicella zoster lesions on the left inner ear, face and mild facial paresis were considered. According to clinical and laboratory findings the patient was diagnosed with RHS triggered by tofacitinib. Tofacitinib and methotrexate was discontinued, and intravenous acyclovir was started. On the control examination the patient's skin lesions and facial nerve paralysis regressed. Conclusion: Herein we reported the fırst case of tofacitinib-induced RHS in a patient with RA. This is may be the another side effect of biologic treatment. New studies are needed in this subject.

MRI Findings in Two Cases of Acute Facial Paralysis

1989 ◽  
Vol 101 (5) ◽  
pp. 562-565 ◽  
Author(s):  
James Labagnara ◽  
Anthony F. Jahn ◽  
David V. Habif ◽  
Edward M. Solomon
Keyword(s):  
Facial Nerve ◽  
Treatment Options ◽  
Bell’S Palsy ◽  
Facial Nerve Paralysis ◽  
Bell's Palsy ◽  
Mri Findings ◽  
Diagnostic Dilemma ◽  
Nerve Paralysis ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome

This article describes the use of magnetic resonance imaging (MRI) in the evaluation of the facial nerve paralysis of Bell's palsy and herpes zoster oticus. Identification of the nature of inflammatory facial nerve paralysis often presents a diagnostic dilemma. The site of involvement along the course of the nerve may have importance when treatment options are being considered. We have found MRI to be a unique method for localizing the site of nerve injury in both Bell's palsy and Ramsay Hunt syndrome.

Hypoglossal-Facial Nerve Anastomosis: A Meta-Analytic Study

2007 ◽  
Vol 116 (7) ◽  
pp. 542-549 ◽  
Author(s):  
Sertac Yetiser ◽  
Ugur Karapinar
Keyword(s):  
Facial Nerve ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cranial Nerves ◽  
Facial Nerve Paralysis ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Reliable Technique ◽  
Nerve Paralysis ◽  
Nerve Anastomosis

Objectives: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. Methods: Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. Results: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. Conclusions: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.

scholarly journals Facial nerve schwannoma: a rare case report

2016 ◽  
Vol 3 (1) ◽  
pp. 159
Author(s):  
Suchina Parmar ◽  
Jai Lal Davessar ◽  
Gurbax Singh
Keyword(s):  
Facial Nerve ◽  
Schwann Cells ◽  
Benign Tumor ◽  
Facial Nerve Paralysis ◽  
Vestibulocochlear Nerve ◽  
Nerve Paralysis ◽  
Delay In Diagnosis ◽  
Rare Case Report ◽  
Early Imaging ◽  
Facial Nerve Schwannoma

<p class="abstract"><span lang="EN-IN">Schwannoma is a benign tumor arising from Schwann cells which is protective covering of nerves, called myelin sheath and can develop anywhere, where Schwann cells are present. Most common schwannomas are found with vestibulocochlear nerve. Facial nerve schwannoma are uncommon tumour involving 7th nerve out of which also most common site of involvement is geniculate ganglion. Facial nerve schwannoma is uncommon benign tumor. There are no typical patterns of presentation and can easily go untreated or misdiagnosed. Facial nerve palsy is most common mode of presentation. Here we present a case of 35 years male who presented with complaint of facial nerve paralysis. High degree of clinical suspicion and early imaging can lead to diagnosis. An early diagnosis is important as morbidity associated with this disease and as well as surgery leads to delay in diagnosis.</span></p>

Clinical Management of the Acute Facial Palsies

1995 ◽  
Vol 112 (5) ◽  
pp. P140-P140
Author(s):  
N.J. Coker
Keyword(s):  
Herpes Zoster ◽  
Natural History ◽  
Facial Nerve ◽  
Middle Ear ◽  
Clinical Management ◽  
Bone Fractures ◽  
Penetrating Injuries ◽  
Surgical Interventions ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome

Educational objectives: To define the natural history, pathogenesis, and management of the acute facial palsies: Bell's palsy, herpes zoster oticus (Ramsay Hunt syndrome), and facial paralysis secondary to infections of the middle ear and to outline the classification, pathogenesis, and medical-surgical interventions for trauma of the facial nerve, including temporal bone fractures, penetrating injuries, and iatrogenic causes.

scholarly journals Acoustic Neurinoma with Synchronous Ipsilateral Cerebellopontine Angle Lipoma: A Case Report and Review of the Literature

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 120
Author(s):  
Takahiro Kanaya ◽  
Yasuo Murai ◽  
Kanako Yui ◽  
Shun Sato ◽  
Akio Morita
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Surgical Removal ◽  
Acoustic Neurinoma ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Nerve Preservation

Lipomas of the cerebellopontine angle (CPA) and internal auditory canal (IAC) are relatively rare tumors. Acoustic neurinoma is the most common tumor in this location, which often causes hearing loss, vertigo, and tinnitus. Occasionally, this tumor compresses the brainstem, prompting surgical resection. Lipomas in this area may cause symptoms similar to neurinoma. However, they are not considered for surgical treatment because their removal may result in several additional deficits. Conservative therapy and repeated magnetic resonance imaging examinations for CPA/IAC lipomas are standard measures for preserving cranial nerve function. Herein, we report a case of acoustic neurinoma and CPA lipoma occurring in close proximity to each other ipsilaterally. The main symptom was hearing loss without facial nerve paralysis. Therefore, facial nerve injury had to be avoided. Considering the anatomical relationships among the tumors, cranial nerves, and CPA/IAC lipoma, we performed total surgical removal of the acoustic neurinoma. We intentionally left the lipoma untreated, which enabled facial nerve preservation. This report may be a useful reference for the differential diagnosis of similar cases in the future.

scholarly journals Complete Ramsay Hunt Syndrome: a rare case

2021 ◽  
Author(s):  
Maurus Marques de Almeida Holanda Filho ◽  
Maurus Marques de Almeida Holanda ◽  
Camila Maria Bezerra Holanda
Keyword(s):  
Herpes Zoster ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Rare Case ◽  
Partial Recovery ◽  
Peripheral Facial Paralysis ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome ◽  
Complete Condition ◽  
The Right

Background: Ramsay Hunt syndrome or herpes zoster oticus is a disorder caused by the reactivation of the varicella zoster virus in the geniculate ganglion, a bundle of nerve cells in the facial nerve. Symptoms include acute facial nerve palsy, otalgia, loss of taste in the anterior 2/3 of the tongue, dry mouth and eyes, and erythematous vesicular rash in the ear canal, tongue and / or palate. Objectives and Methods: Describe the case of a male patient, 26 years old, with complete Ramsay Hunt syndrome, reporting pain in the right ear with tinnitus, difficult to close his right eye, odynophagia and pain in the anterior 2/3 of the tongue at right side. Results: On examination, the presence of vesicles with erythema was observed in the region of the right external auditory canal and the ear, as well as on the right palate and tongue. Upon inspection, he had peripheral facial paralysis on the right, associated with loss of taste in the anterior 2/3 of the tongue. The patient was treated with antiviral and corticosteroids, followed for 3 months, obtaining partial recovery from facial paralysis. The anatomy of the facial nerve and its pathophysiology due to the involvement of herpes zoster will be discussed. Conclusion: Ramsay Hunt syndrome is often described as the presence of peripheral facial paralysis and vesicles in the auditory canal and the ear. However, this rare case presented the complete condition with the presence of vesicles on the palate and the tongue.

scholarly journals Facial nerve paralysis

2020 ◽  
Vol 10 (39) ◽  
pp. 68-77
Author(s):  
Dorin Sarafoleanu ◽  
Andreea Bejenariu
Keyword(s):  
Facial Expression ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Complex Structure ◽  
Accurate Determination ◽  
Cranial Nerves ◽  
Facial Nerve Paralysis ◽  
Early Presentation ◽  
Nerve Paralysis ◽  
Common Causes

AbstractThe facial nerve, the seventh pair of cranial nerves, has an essential role in non-verbal communication through facial expression. Besides innervating the muscles involved in facial expression, the complex structure of the facial nerve contains sensory fibres involved in the perception of taste and parasympathetic fibres involved in the salivation and tearing processes. Damage to the facial nerve manifested by facial paralysis translates into a decrease or disappearance of mobility of normal facial expression.Facial nerve palsy is one of the common causes of presenting to the Emergency Room. Most facial paralysis are idiopathic, followed by traumatic, infectious, tumor causes. A special place is occupied by the child’s facial paralysis. Due to the multitude of factors that can determine or favour its appearance, it requires a multidisciplinary evaluation consisting of otorhinolaryngologist, neurologist, ophthalmologist, internist.Early presentation to the doctor, accurate determination of the cause, correctly performed topographic diagnosis is the key to proper treatment and complete functional recovery.

scholarly journals Otorhinolaryngological Disorders Implicated in Facial Nerve Paralysis in a Tertiary Hospital in Port Harcourt

2019 ◽  
pp. 1-8
Author(s):  
Ibekwe Matilda Uju ◽  
Anyama Ernest Ugonna
Keyword(s):  
Facial Nerve ◽  
Otitis Media ◽  
Teaching Hospital ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Ramsay Hunt Syndrome ◽  
Port Harcourt ◽  
Nose And Throat

Background: It is not all facial nerve palsy that presents to the otorhinolaryngologist that is Bell’s palsy; therefore there is a need for proper evaluation of these patients. This study is to determine the pattern and prevalence of otorhinolaryngologic disorders associated with facial nerve paralysis. Aim: To determine the prevalence and pattern of otorhinological disorders implicated in facial nerve paralysis in University of Port Harcourt Teaching Hospital. Patients and Methods: Study design: This was a hospital-based descriptive study. The patients diagnosed with facial nerve paralysis seen in the Ear Nose and Throat surgery and Physiotherapy departments of the University of Port Harcourt Teaching Hospital (UPTH) from January 2014 to December 2018 were collated and those among them with associated otorhinolaryngological disorders were recruited and studied. Data on patient demographics, presenting complaints and ear nose and throat disorders were sought from the case files, clinic and ward registers. Data entry was done using Microsoft Excel and exported to United States CDC Epi-Info version 7 for data analysis. Frequency tables and appropriate charts were used to present data. Chi square statistics was performed to determine significant differences between demographics of the patients and category of facial nerve palsy patients at alpha level of 0.05. Results: 76 patients with facial nerve paralysis, twenty one of them were associated with ORL disorder giving a prevalence of 27.6%. Ages below 40 years were the most affected and a slight male preponderance. Acute and chronic otitis media were seen in 33.3% of these patients respectively while Ramsay hunt syndrome and otitis externa were seen in 9.5%. Age and incidence of ORL disorders in these patients had statistical correlation. Conclusion: ORL disorders associated with facial paralysis are still prevalent and otitis media appear to be the most common.

scholarly journals Unusual Clinical Presentation of Ethylene Glycol Poisoning: Unilateral Facial Nerve Paralysis

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Eray Eroglu ◽  
Ismail Kocyigit ◽  
Sami Bahcebasi ◽  
Aydin Unal ◽  
Murat Hayri Sipahioglu ◽  
...  
Keyword(s):  
Renal Failure ◽  
Ethylene Glycol ◽  
Facial Nerve ◽  
Cranial Nerves ◽  
Delayed Diagnosis ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Mortality And Morbidity ◽  
The Central Nervous System ◽  
End Stage

Ethylene glycol (EG) may be consumed accidentally or intentionally, usually in the form of antifreeze products or as an ethanol substitute. EG is metabolized to toxic metabolites. These metabolites cause metabolic acidosis with increased anion gap, renal failure, oxaluria, damage to the central nervous system and cranial nerves, and cardiovascular instability. Early initiation of treatment can reduce the mortality and morbidity but different clinical presentations can cause delayed diagnosis and poor prognosis. Herein, we report a case with the atypical presentation of facial paralysis, hematuria, and kidney failure due to EG poisoning which progressed to end stage renal failure and permanent right peripheral facial nerve palsy.

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