Cranial polyneuropathy caused by herpes zoster infection: a retrospective single-center analysis

Pupić-Bakrač, Jure; Pupić‐Bakrač, Ana; Terkeš, Vedrana; Baraka, Ivan

doi:10.1007/s00405-020-06279-y

Cited by 9 publications

(12 citation statements)

References 20 publications

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“…The vestibulocochlear nerve is the most common cranial nerve associated with the syndrome [2]. The oculomotor, trigeminal, abducent, glossopharyngeal, and vagus nerves are also associated with RHS also reported in the literature as RHS with polyneuropathy [4,6,7]. Moreover, non-classical presentations such as RHS without the involvement of the facial nerve have also been reported [8].…”

Section: Discussionmentioning

confidence: 98%

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Ramsay Hunt Syndrome With Cranial Polyneuropathy and Delayed Facial Nerve Palsy: A Case Report

Al-Ani¹

2022

Cureus

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Herpes zoster oticus is a viral disease caused by the reactivation of the varicella-zoster virus at the geniculate ganglion. The hallmark of the condition is multiple unilateral erythematous vesicles, which are distributed over the auricle and preceded by severe otalgia. If these symptoms are associated with facial nerve palsy, the condition is called Ramsay Hunt syndrome (RHS) which is usually accompanied by vestibulocochlear abnormalities. A 42-year-old woman came to our clinic with sudden onset of right-sided severe otalgia and several erythematous vesicles on the auricle two days ago. She provided a history of dysphagia and hoarseness for 10 days. After two days, ipsilateral facial nerve paralysis was noted. The patient was immunocompetent with an unremarkable medical history. Physical examination revealed the following: the vesicles distributed over the right auricle, external auditory canal, and eardrum; right sensorineural deafness; deviated uvula to the left side; absent gag reflex on the right side; right vocal cord palsy; and lower motor facial nerve paralysis of House-Brackmann grade III. The pure tone audiogram confirmed the diagnosis of right-sided sensorineural deafness. Acyclovir therapy and prednisolone tablets at a loading dose were initiated. At the four-month follow-up, the presenting manifestations were improved. Here, we report a case of RHS with early glossopharyngeal and vagus nerve palsy, followed by pain, vesicular eruptions, sensorineural hearing loss, and delayed onset of facial nerve paralysis. The condition resolved completely on medical treatment with acyclovir and prednisolone.

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Section: Discussionmentioning

confidence: 98%

“…The prognosis of RHS is less favorable than Bell’s palsy [ 14 ]. The full recovery rate was reported to be 63.63% in patients with an RHS with cranial polyneuropathy [ 7 ]. Furthermore, the prognostic factor that seems as reported in the literature is the severity of the presenting features [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Ramsay Hunt Syndrome With Cranial Polyneuropathy and Delayed Facial Nerve Palsy: A Case Report

Al-Ani¹

2022

Cureus

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“…And it might involve multiple cranial nerve, which is herpes zoster-associated cranial polyneuropathy. [ 5 ] Concomitant involvement of the vestibulocochlear (CN VIII) or trigeminal nerve (CN V) is most commonly observed. [ 5 , 6 ] Consequently, various clinical symptoms, such as dizziness, tinnitus, hearing impairment, or facial pain can be present according to the involved nerve.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] Concomitant involvement of the vestibulocochlear (CN VIII) or trigeminal nerve (CN V) is most commonly observed. [ 5 , 6 ] Consequently, various clinical symptoms, such as dizziness, tinnitus, hearing impairment, or facial pain can be present according to the involved nerve. Glossopharyngeal (CN IX) or vagal (CN X) involvement may cause dysphagia, hoarseness, or cardiac manifestation.…”

Section: Discussionmentioning

confidence: 99%

A case report of refractory otalgia after Ramsay Hunt syndrome successfully treated by applying pulsed radiofrequency to the great auricular nerve

et al. 2021

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Rationale: Ramsay Hunt syndrome is a type of herpes zoster infection involving geniculate ganglion and facial nerve. Unilateral facial palsy, otalgia, and painful vesicular rash on the auricle and external auditory canal are the typical symptoms. Although postherpetic neuralgia (PHN) is a devastating complication of herpes zoster infection, PHN following Ramsay Hunt syndrome has rarely been reported. Patient concerns: A 55-year-old immunocompetent female patient visited our pain clinic, for left-sided refractory otalgia (PHN) that persisted for 3 months after she was diagnosed with Ramsay Hunt syndrome. Although facial palsy and tinnitus had recovered within 2 to 4 weeks after symptom onset, the patient had been experiencing a persistent and severe otalgia radiating to mandibular angle, temporal and upper cervical area of neuropathic nature. Diagnoses: The patient's pain persisted despite conservative medication and administration of ultrasound-guided stellate ganglion block, facial nerve block, and great auricular nerve block several times. Interventions: The patient was treated with the application of ultrasound-guided pulsed radiofrequency (PRF) to the great auricular nerve. Outcomes: The patient experienced significant pain reduction more than 50% on a numeric rating scale after 2 weeks of PRF treatment. Lessons: Chronic otalgia might be a type of PHN after Ramsay Hunt syndrome with cervical nerve involvement. PRF treatment to the great auricular nerve can be a therapeutic option for refractory otalgia following Ramsay Hunt syndrome.

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“…The pathogenesis of ophthalmoplegia in HZO is not completely understood, and 2 main pathogenic processes have been identified so far, cranial neuropathy and orbital inflammation. Several mechanisms for the development of CN III, IV, and/or VI neuropathy have been proposed: (a) VZV spreads to contiguous ganglia, (b) VZV spreads to contiguous nuclei in the brainstem, (c) VZV spreads through the synapse, (d) microinfarction of CNs due to occlusive vasculitis induced by VZV, (e) meningeal inflammation at certain locations of the CN pathways, and (f) demyelinating process 7 . Orbital inflammation on the other hand is suggested to occur due to contiguous spread of VZV through the (a) cavernous sinus, (b) superior orbital fissure, and (c) orbital rim, manifesting as orbital myositis or orbital apex syndrome 8 .…”

mentioning

confidence: 99%

Herpes Zoster Opthalmicus–Related Ophthalmoplegia: Anatomical, Pathogenetic, and Therapeutic Perspectives

Pupić‐Bakrač

Pupić-Bakrač

Gabrić

et al. 2022

Journal of Craniofacial Surgery

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Objective: To investigate the anatomical, pathogenetic, and pharmacological characteristics of herpes zoster ophthalmicus (HZO)-related ophthalmoplegia. Methods: Case report-based systematic review was performed.Results: This study included 96 patients (54 [56.25%] women and 42 [43.75%] men [P = 0.221]). The mean age at presentation was 64.32 ± 17.48 years. All the patients included in the study had HZO-related ophthalmoplegia, with rash presenting as initial symptom in 87 (90.62%) cases, and diplopia in 9 (9.38%) cases. Thirty-seven (38.54%) patients achieved complete recovery, whereas 59 (61.46%) patients had permanent ophthalmoplegia. Females recovered in 26/54 cases and males in 11/42 cases (P = 0.028). Recovery rates after peroral versus intravenous antivirals (15/38 versus 19/46) and > 10 days versus ≤10 days antiviral treatment (22/54 versus 12/30) did not significantly differ (P = 0.865 and P = 0.947, respectively). immunocompetent patients treated with corticosteroids had significantly better recovery rates compared to immunodeficient counterparts (17/34 [50.00%] and 5/22 [22.73%], respectively [P = 0.041]). Conclusions: The outcome of HZO-related ophthalmoplegia is associated with gender, immune status, corticosteroid use, and time of antiviral treatment initiation.

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Cranial polyneuropathy caused by herpes zoster infection: a retrospective single-center analysis

Cited by 9 publications

References 20 publications

Ramsay Hunt Syndrome With Cranial Polyneuropathy and Delayed Facial Nerve Palsy: A Case Report

Ramsay Hunt Syndrome With Cranial Polyneuropathy and Delayed Facial Nerve Palsy: A Case Report

A case report of refractory otalgia after Ramsay Hunt syndrome successfully treated by applying pulsed radiofrequency to the great auricular nerve

Herpes Zoster Opthalmicus–Related Ophthalmoplegia: Anatomical, Pathogenetic, and Therapeutic Perspectives

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