Síndrome de Ramsay-Himt en Pediatría: Reporte de cuatro casos y revisión de la literatura

Abstract

Ramsay Hunt syndrome in children: Four cases and review Ramsay-Hunt Syndrome (RHS) is a rare affection characterized by peripheral facial paralysis (PFP), skin eruption in the auricular canal and cochleovestibular symptoms. It is produced by varicella-zoster virus (VZV) reactivation at the geniculate ganglia. We report four patients between 3 and 17 years-old with RHS. Earache was the first symptom in two cases and three had cochleovestibular compromise. The direct immunofluorescence from the vesicular lesion was positive for VZV in two of them. All patients received treatment with acyclovir and in three cases, this was associated with steroids. Three children had complete resolution of the PFP. RHS is an infrequent disease in the pediatric population and it should be suspected in children with PFP, erythema, vesicles and/or auricular pain. Early treatment with acyclovir therapy could improve the recovery rate of facial nerve palsy.

Ramsay Hunt's Syndrome in Pediatric Age

“…However, when oral acyclovir is used, the dose should be higher compared with that used for intravenous infusion, since only 15 to -25% of the ingested dose will be absorbed through the gastrointestinal tract. 1,3,7 In our case, despite the initial delay in recognizing the syndrome, treatment was started within the recommended time frame after the appearance of skin lesions. It was decided to prolong acyclovir therapy due to CNS involvement.…”

“…This way, the incorrect diagnosis of Bell's palsy is avoided. 7 The cytochemical, microbiological, and virological analysis of CSF may be useful to confirm the coexistence of viral meningitis or to exclude other disease entities. Magnetic resonance imaging (MRI), with gadolinium administration, is one of the most helpful investigations for identification/confirmation of the affected facial nerve, in addition to being very useful for the exclusion of tumors or other neurological syndromes.…”

“…1,7 Audiological studies may be necessary, particularly in follow-up, when the vestibulocochlear nerve is affected. 7 Several therapies have been proposed for the treatment of RHS. However, according to the literature, treatment should always include high-dose corticosteroids and antiviral agents.…”

“…Antivirals reduce the VZV replication, preventing further proliferation and spread of the virus in the affected nerve. 1,2,7,8 Therapy should be started within 72 hours after the first lesions appears, and maintained for a period of 7 to 10 days. 2,7 Studies indicate that there are no significant differences between the ad-ministration of acyclovir orally or intravenously.…”

Síndrome de Ramsay Hunt após otoplastia

“…Diagnosis is fundamentally clinical 5 . Complementary tests may corroborate or confirm the diagnosis.…”