Herpes Zoster Oticus With Delayed Facial Palsy and Multiple Cranial Nerve Involvement

Herpes zoster oticus with multiple cranial nerve (CN) involvement and delayed facial paralysis is a rare occurrence, and there is limited information regarding the disease. We herein report two cases of RHS with delayed facial palsy involving multiple lower CNs. The degree of facial paralysis was not severe as grade III or less, and recovery was observed after treatment. To our knowledge, these are the first cases in the literature to report RHS with delayed facial paralysis and its favorable recovery. It will be a good example for expanding the possibility of treatment in RHS with delayed facial paralysis and multiple CN involvement.

Unilateral Cranial Polyneuropathy in Herpes Zoster Oticus: Infection teaching us Anatomy

Herpes zoster oticus or Ramsay Hunt syndrome is an uncommon neurological manifestation of herpes virus infection causing external ear rash with otalgia and facial nerve palsy. Rarely herpetic infection may present with multiple cranial nerves palsies involving VII, VIII, IX and X cranial nerves. Here we report a case of herpes zoster oticus with multiple cranial nerve palsy. This case study will help in understanding the dermatomal distribution of cranial nerves with cranial polyneuropathy due to reactivation of neurotropic herpes virus. Some interesting case reports regarding different cranial nerve involvement in herpetic infection are discussed in the table which helps in understanding the neurotropism of herpes virus.

Síndrome de Ramsay Hunt: uma revisão sistemática

Objetivo: Realizar revisão sistemática sobre a Síndrome de Ramsay Hunt, abordando seus aspectos etiológicos, os fatores de risco, as manifestações clínicas, o diagnóstico e o tratamento. Métodos: A pesquisa foi realizada a partir das bases de dados: SciELO, Medline, LILACS por meio dos descritores: Paralisia facial AND Herpes Zoster de Orelha Externa AND Síndrome Ramsay Hunt. No Pubmed, foram utilizados termos do MESH, Facial Paralisy AND Herpes Zoster Oticus. Foram incluídos artigos publicados entre 2017 e 2019 sobre o assunto e dois livros de otorrinolaringologia. Resultados: A busca produziu um total de 291 artigos, foram retirados 265 por não estarem no critério de tempo e 10 por estarem duplicados em bases de dados. Destes, 16 artigos atenderam aos critérios de inclusão previamente estabelecidos. A busca por livros em otorrinolaringologia resultou na inclusão de 2 livros que abordaram a temática de forma ampla e detalhada. Considerações Finais: Foi possível constatar a heterogeneidade nos estudos sobre a síndrome. Entretanto, todos apontam para a importância de seu reconhecimento, característica clínica e seguimento; uma vez que o rápido diagnóstico e tratamento diminuem o tempo de doença ativa, reduz o dano neural e possível neuralgia pós-herpética.

Herpes Zoster Otikus Dengan Paresis Nervus Fasialis (Sindrom Ramsay Hunt) Pada Pasien Imunokompromais

Latar belakang: Sindrom Ramsay Hunt (SRH) merupakan komplikasi yang jarang terjadi pada herpes zoster. SRH dapat terjadi tanpa adanya ruam kulit (zoster sine herpete). Karena gejala-gejala ini tidak selalu muncul saat onset, sindrom ini sering salah didiagnosis. Insidensi 5/100.000 kasus pada populasi di Amerika Serikat dan meningkat pada kelompok umur di atas 60 tahun dan kondisi imunokompromais. Laporan Kasus: Laki-laki, 66 tahun, timbul plenting-plenting di daerah telinga kiri menyebar ke dada sebelah kiri sejak 8 hari sebelum dikonsulkan. Terdapat nyeri pada telinga, pendengaran berkurang, pusing berputar, wajah sebelah kiri sulit digerakkan dan sulit berbicara. Permeriksaan fisik ditemukan vesikel berkelompok dengan dasar kulit eritem dan edema, bula, erosi, krusta, konfigurasi herpetiformis, distribusi unilateral, segmental setinggi persarafan servikal 2-4. Temuan tzank test menunjukkan sel datia berinti banyak. Penatalaksanaan dengan sistemik asiklovir dan metilprednison. Pembahasan: SRH merupakan hasil reaktivasi virus varicella zoster laten diganglion genikulatum yang menyebabkan vesikel pada aurikula, otalgia dan paresis/paralisis fasialis. Mekanisme pencetus reaktivasi pada pasien ini diduga berhubungan dengan imunokompromais (keganasan). Pasien imunokompromais memiliki resiko 20-100 kali lebih besar. Pemeriksaan Tzank sesuai dengan gambaran herpes zoster. Terapi SRH yang paling disarankan adalah terapi kombinasi antivirus dan kortikosteroid. Kesimpulan: Telah dilaporkan kasus herpes zoster otikus dengan paresis nervus fasialis (Sindrom Ramsay Hunt) pada pasien imunokompromais. Hasil terapi memuaskan. Prognosis qua ad vitam ad bonam, ad sanam dubia ad malam, ad cosmeticam dubia ad bonam. Kata kunci: Sindrom Ramsay Hunt, Herpes Zoster Otikus, Paresis Nervus Fasialis, Immunokopromais. Background; Ramsay Hunt Syndrome (RHS) is a rare complication in shingles. RHS can occur without the presence of skin rash (zoster sine herpete). Because these symptoms do not always appear at onset, RHS is often misdiagnosed. The incidence of 5/100,000 cases in the US and increase in the age above 60 years and immunocompromised. Case: A 66-years-old male complaint of vesicle on the left ear spreading to left chest, since 8 days prior to the consultation. There was otalgia, dizziness, hearing impairment, difficulty in movement and speaking on the left side. Physical examination found clustered vesicle on an erythematosus and oedematous base, bullaes, erosions, crusts, in a herpetiformis configuration, unilateral distribution, in a level of 2-4 cervical nerve innervation. The Tzank test showed multinucleated giant cells. Management with systemic acyclovir and methylprednisolone. Discussion: RHS is the result of reactivation of latent varicella zoster virus in geniculate ganglion which causes vesicles in the auricle, otalgia and facial paresis / paralysis. The mechanism for triggering reactivation in these patients is immunocompromise (malignancy). Immunocompromised have a 20-100 times greater risk. Tzank results in accordance with diagnostic of herpes zoster. The most recommended therapy is combination of antiviral and corticosteroid. Conclusion: The case of herpes zoster oticus with facial nerve paresis (Ramsay Hunt Syndrome) in immunocompromised has been published. The result of therapy was satisfying. The prognosis qua ad vitam ad bonam, ad sanam dubia ad malam, ad cosmetics dubia ad bonam. Keywords: Ramsay Hunt Syndrome, Herpes Zoster Oticus, Facial Nerve Paresis, Immunokopromised.