scholarly journals Persistent hemicrania as onset manifestation of Ramsay Hunt Syndrome

2021 ◽  
Author(s):  
Ney Adson Leal II ◽  
Nágila Pereira Mendes ◽  
Caroline Moraes Tapajós Bolzani ◽  
Hilton Mariano da Silva Junior

Context: Ramsay Hunt Syndrome (RHS), also named Optic Herpes Zoster is caused by the reactivation of Varicella-Zoster Virus that occurs in the geniculate ganglion. The classic syndrome is composed of vesicular lesions in the ear, ipsilateral otalgia and peripheral facial palsy. The onset of the syndrome with persistent hemicrania is absolutely atypical as a manifestation of RHS. Case report: A 69 year old woman with subacute onset of left exclusive hemicrania in moderate strong intensity without autonomic signs. Eight days after the onset of headache, she presented left peripheral facial paralysis and after 4 days, she noticed the appearance of vesicles in the left ear and pain in swallowing. She has developed nausea with several episodes of vomiting, important imbalance that made impossible gait. On physical examination she presented vesicles in the left ear and oropharynx, left peripheral facial paralysis House Brackmann grade IV, left hypoacusis, nystagmus and vestibular gait. The brain CT and cerebrospinal fluid analysis were normal. The patient has progressive improvement with Acyclovir. Conclusions: Otalgia or even intermediate neuralgia are more frequent painful manifestations of RHS. This case report highlights the need to consider the diagnosis of SRH in patients with persistent hemicrania, even if without initial classic signs of the syndrome.

2021 ◽  
Author(s):  
Mateus de Miranda Gauza ◽  
Andréia Canello ◽  
Henrique Muller Genero ◽  
Rafael Marques Mendes ◽  
Maria Francisca Moro Longo ◽  
...  

Context: Ramsay Hunt syndrome is uncommon, with an incidence of 5 / 100,000 people (1), characterized by the triad of ipsilateral peripheral facial paralysis, otalgia and vesicles in the ear canal and / or auricular pavilion (1,2,3). It results from the reactivation of the Varicella Zoster virus in the geniculate ganglion and may extend to other cranial pairs, causing inflammation, edema and nerve dysfunction (1,3). As the second leading cause of peripheral facial palsy (1), its importance lies in a lower likelihood of recovery with a worse prognosis compared to Bell’s palsy (4). Case report: M.R.S, female, 54 years old, went to the emergency room due to ophthalmological complaints (blurred vision, diplopia, floaters, photophobia), nausea and vomiting, associated with vertigo, headache and facial hypoesthesia on the left. With the worsening of the condition, she was referred to the neurology service of the municipal hospital São José, presenting dysarthria, vesicular lesions in the left external auditory canal, preserved tactile sensitivity, MRC grade V and facial paralysis on the left (House Brackmann grade IV). Lumbar puncture and cerebrospinal fluid analysis were performed to discard other pathologies of the central nervous system. The diagnosis of Ramsay Hunt syndrome was established and treatment with Acyclovir and prednisone was started. After worsening renal function, drug therapy was suspended and venous hydration increased. She continued with improved renal function and was discharged with valacyclovir and corticosteroids. Conclusions: The importance of early diagnosis and treatment is emphasized in order to avoid permanent sequelae of the disease (1,3).


2019 ◽  
Vol 11 (4) ◽  
pp. 133-136
Author(s):  
Jonathan Kurnia Wijaya ◽  
Hendra Wijaya Wong

AbstractRamsay Hunt Sydnrome is a rare and severe disease caused by the reactivation of varicella zoster virus (VZV) in the ganglia geniculate. The classic triad of this disease includes ear pain (otalgia), vesicles in the auditory canal, and facial paralysis. This case report is about a 37-year-old woman that has the classic triad of Ramsay Hunt Syndrome, as well as a rare complication of cranial polyneuritis in the form of cephalgia and vertigo which occurs only in 1.8% of cases. The patient came one week after the initial symptoms had started and was given antiviral combination therapy and steroids. Treatment of this disease is time sensitive to <72 hours and will determine the prognosis. One month later the follow up showed sequelae in the form of persistent headache and slight facial paralysis as a result of delayed treatment. This case report showed the importance of prompt diagnosis and treatment to minimize complications of Ramsay Hunt Syndrome.


2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Serhan Derin ◽  
Hatice Derin ◽  
Murat Sahan ◽  
Hüseyin Çaksen

Ramsay Hunt syndrome (RHS) is characterized by facial paralysis, inner ear dysfunction, periauricular pain, and herpetiform vesicles. The reported incidence in children is 2.7/100,000. The pathogenesis involves the reactivation of latent varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve. The recovery rate is better in children than in adults. This paper discusses a 12-year-old girl with a rare case of peripheral facial paralysis caused by RHS and reviews the literature.


2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095227
Author(s):  
Jie Zhang ◽  
Xuemei Wei

Ramsay Hunt syndrome involving the vagus nerve is very rare. We herein describe a 53-year-old man who developed severe pharyngeal pain after alcohol intoxication. Antibiotic treatment was ineffective. Laryngoscopy showed an ulcer on the right side of the epiglottis. As the condition progressed, the patient developed hoarseness. He then gradually developed multiple herpes lesions on the right side of the head, face, and neck along with right peripheral facial paralysis. Corticosteroid, analgesic, antiviral, and nutritional nerve therapy resulted in disappearance of the herpes lesions, epiglottis ulcer, pharyngeal pain, and right head and face pain. The facial paralysis slightly improved, but the hoarseness did not improve. The patient was discharged with an unsatisfactory outcome, and he attempted treatment with acupuncture. After 6 months, the right facial paralysis and hoarseness disappeared. Our case emphasizes the importance of early diagnosis and treatment of atypical Ramsay Hunt syndrome as well as timely communication, enhancement of trust, and reduction of disputes between doctors and patients.


2021 ◽  
Vol 38 (4) ◽  
pp. 693-695
Author(s):  
Kemal KEF

Ramsay-Hunt Syndrome (Herpes zoster oticus) is often characterized by severe ear pain, vesicles on external auditory canal or auricula and peripheral facial paralysis. However, the patient in this case presented to the clinic with dizziness, pain in the ear and vomiting. During the physical examination there was no vesicles and no evidence of skin changes found around the auricula that were typical for Ramsay Hunt syndrome. The patient did not have facial paralysis. If there is an unexpected severe ear pain accompanying vertigo, Ramsay Hunt syndrome should be considered in the differential diagnosis even if there is no rash or facial paralysis.


Author(s):  
L Chan ◽  
A Cartagena ◽  
SM Hosseini ◽  
A Bombassaro

Background: Ramsay Hunt Syndrome with cerebellar encephalitis is rare in adult. Case Report: We describe a 55-year-old diabetic female who presented with truncal ataxia, right peripheral facial palsy and right ear pain associated with erythematous vesicular lesions in her external auditory canal. Later, she developed dysmetria, fluctuating diplopia and dysarthria. No facial lesions were identified and lesions were limited to the external auditory canal. Cerebral spinal fluid tested positive for varicella zoster virus polymerase chain reaction. She was diagnosed with Ramsay Hunt Syndrome with spread to the central nervous system and treated with acyclovir intravenous therapy (10 mg/kg every 8 hours). Her facial palsy completely resolved within 48 hours of acyclovir treatment, however, vesicular lesions, imbalance and cerebellar symptoms remained; a tapering course of high dose prednisone was then added.Discussion: Prognosis for facial palsy is poor in Ramsay Hunt Syndrome: Only 10% of patients will have complete resolution of their facial palsy. Improvement of facial palsy may be a good marker for response to treatment. Conclusion: Varicella zoster virus reactivation affecting the central nervous system in adults is rare. Knowledge of Ramsay Hunt syndrome with brainstem and/or cerebellar involvement is important for diagnosis and for consideration of antiviral and prednisone treatment.


Author(s):  
Poorva Saxena ◽  
G. V. Ramachandra Reddy ◽  
Hina Handa ◽  
Ajita Singh

Herpes zoster represents a latent reactivation of the varicella zoster virus infection with a dermatomal pattern of eruption and complicated by post-herpetic neuralgia. Ramsay hunt syndrome is a rare complication of herpes zoster and it is not just a syndrome but it's rather an infectious disease. This syndrome is characterized by peripheral facial nerve palsy associated with an erythematous vesicular rash on the ear. It is characterized by unilateral pattern of facial involvement and presence of vesicles helps in early diagnosis and distinguish the syndrome with diseases mimicking other severe neurological diseases. This article reports a case of 56-year-old male patient who reported with a complaint of severe toothache, which serves as severe prodrome for reactivation of herpes zoster virus which later leads to Ramsay Hunt syndrome. This case report highlights about the management of herpes zoster and its complication and emphasizes on prevention of post herpetic neuralgia complication.


2017 ◽  
Vol 63 (4) ◽  
pp. 301-302 ◽  
Author(s):  
Aline Lariessy Campos Paiva ◽  
João Luiz Vitorino Araujo ◽  
Vinicius Ricieri Ferraz ◽  
José Carlos Esteves Veiga

Summary Ramsay Hunt syndrome (or herpes zoster oticus) is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion occurs. Usually, there are auricular vesicles and symptoms and signs such otalgia and peripheral facial paralysis. In addition, rarely, a rash around the mouth can be seen. Immunodeficient patients are more susceptible to this condition. Diagnosis is essentially based on symptoms. We report the case of a diabetic female patient who sought the emergency department with a complaint of this rare entity.


2004 ◽  
Vol 113 (9) ◽  
pp. 700-705 ◽  
Author(s):  
Yasushi Furuta ◽  
Hiroshi Aizawa ◽  
Hirofumi Sawa ◽  
Fumio Ohtani ◽  
Satoshi Fukuda

2020 ◽  
Vol 73 (11) ◽  
pp. 2555-2556
Author(s):  
Pavel A. Dyachenko ◽  
Anatoly G. Dyachenko

Ramsay Hunt syndrome (RHS) occurs due to reactivation of latent Varicella Zoster Virus (VZV) infection in the geniculate ganglion of the facial nerve. Major clinical symptoms include ipsilateral facial paralysis, otic pain, and herpetic vesicles (rashes) along the nerve with accompanying ear pain. Rarely clinical findings include retrograde transaxonal spread of the virus from the ganglion into the brain parenchyma with developing the encephalitis or multiple cranial nerve involvement. We describe here a patient with both RHS along with complicating brains


Sign in / Sign up

Export Citation Format

Share Document