Herpes Zoster Auris Associated with Facial Nerve Palsy and Auditory Nerve Symptoms: A Case Report with Histopathological Findings

Abstract

A typical case of herpes zoster auris is described. Sections of the teniporal bone of tlie clinically affected side show extensive lynipliocytic or round cell infiltration of the facial nerve throughout its length and of the auditory nerve. There is considerable perivascular "cuffing" by lymphocytes in tlie modiolus, in the perineural tissue of the facial nerve, the cliorda tympani and the skin of the external auditory meatus.The vestibular, spiral and geniculate ganglia contain numerous normallooking neurones, although there is scattered lymphocytic infiltration of the surrounding nerve tissue. There are no necrotic changes in the ganglia. This case is in complete accordance with the main histopathological findings in four cases previously described : there is profuse and widespread lymphocytic infiltration in the facial nerve. This is in striking contrast to tlie microscopical findings in Bell's palsy.Tlie syndrome bearing Rainsay Hunt's name is based on a niore extensive lesion of the facial nerve and other nerves and parts of tlie central nervous system than is implied by the somewhat misleading term "gcniculate ganglionitis". It is essential that patients suffering from herpes zoster auris-for which the term "cephalic zoster' 'is considered to be a niore appropriate one-should be fully examined including lumbar puncture, and that in fatal cases, the brain and spinal cord should be obtained, if possible, for histopathological analysis.Herpes zoster (herpes froin herpein to creep, zoster a sword belt), zone or shingles never presents a difficult diagnosis. Its aetiology and to some extent pathology, particularly of cephalic zoster have been considered obscure.The paucity of histophathological reports prompts us to describe the findings in the temporal bones of a woman who died of carbon monoxide poisoning following intractable tinnitus caused by a severe attack of herpes zoster auris with facial palsy. I1 might be useful first to survey our knowledge of the aetiology of herpes Acta Otolaryng. (Stockh.) 63 Acta Otolaryngol Downloaded from informahealthcare.com by Nyu Medical Center on 08/05/15 For personal use only. England Acta Otolaryngol Downloaded from informahealthcare.com by Nyu Medical Center on 08/05/15 For personal use only.

Herpes zoster oticus: Correlations between Clinical and MRI Findings

“…Aleksic et al [4] subsequently reported histopathologic alterations in the geniculate ganglion, while Denney-Brown et al [3] found a normal geniculate ganglion, and suggested that a lower motor neuritis might be the cause of the facial nerve palsy. In 1967 Backley et al [21] reported diffuse pathological changes extensively involving the Fallopian canal and suggested the presence of suprageniculate and transgeniculate nervous anastomoses as the route of inflammation to the vestibular and cochlear nerves. Finally, in 1983 Etholm and Schuknecht [5] found degeneration of the facial, cochlear and vestibular nerve trunks in the IAC, but a normal geniculate ganglion.…”

“…This infection may sometimes spread, eventually involving the 8th cranial nerve with resultant tinnitus, hearing loss, and vertigo [21,22]. Varicella zoster is the most common zoster infection affecting the head and neck after herpes zoster ophthalmicus [2], and is the second most common cause of facial paralysis [23].…”

Swelling of the Intratemporal Facial Nerve in Ramsay Hunt Syndrome

“…In ammation of the facial nerve and the appearance of vesicles on the pinna are thought to be induced by reactivation of dormant VZV infection in the geniculate ganglion (3 -5). Temporal bone histopathologic studies of RH syndrome have demonstrated diffuse, pronounced round-cell in ltration in the degenerated intratemporal facial nerve (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). In the early stage of RH syndrome, gadoliniumenhanced MRI frequently demonstrates signs of inammation of the facial nerve around the geniculate ganglion (17 -20).…”

Characteristics of hearing loss in patients with herpes zoster oticus

“…Inflammation of the facial nerve due to reactivation of varicella-zoster virus (VZV) is a known cause of RHS, and perivascular, perineural, or intraneural aggregations of round cells in the facial nerve have been observed in patients with RHS. [1] Neurological complications include changes in cerebrospinal fluids, peripheral motor neuropathy, aseptic meningitis, and cranial polyneuropathy. [2] Among these, vestibulocochlear symptoms such as vertigo, hearing loss, and tinnitus most commonly occur in patients with RHS.…”