Trigeminal herpes zoster and Ramsay Hunt Syndrome with a lesion in the spinal trigeminal nucleus and tract

Hung, Chia Wei; Wang, Shuu Jiun; Lirng, Jiing Feng; Fuh, Jong Ling

doi:10.1007/s00415-010-5487-6

Cited by 23 publications

(13 citation statements)

References 3 publications

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“…9 However, in our patient, the visible facialtrigeminal anastomosis, Vidian nerve, and sphenopalatine ganglion all failed to show abnormal enhancement, rein- forcing the possibility of a central transaxonal viral propagation pathway between cranial nerve VII and V via STNT. 5 This hypothesis of VZV transaxonal spread was also supported by postmortem detection of VZV in the STNT 10 and the absence of anti-VZV antibodies in CSF, as seen in our case.…”

Section: Discussionsupporting

confidence: 65%

“…[3][4][5][6] Our case is particularly interesting because reported cases of VZV infection with a IX th cranial neuropathy are also infrequent. 7 The glossopharyngeal nerve is responsible for general somatic sensation of the middle ear, a region of the external auditory canal near the external auditory meatus, the posterior one-third of the tongue, and the upper pharynx.…”

Section: Discussionmentioning

confidence: 97%

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Long-Term MRI Signal Change in the Spinal Trigeminal Nucleus and Tract After Ramsay Hunt Syndrome and Trigeminal Herpes Zoster

Clerk-Lamalice¹,

Savage²,

Fisch³

2015

neurograph

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Ramsay Hunt syndrome is a rare neurologic disorder caused by varicella zoster virus (VZV). The association with trigeminal herpes zoster is rare and only a few cases have been reported in the literature. We report a case of a VZV infection affecting first the glossopharyngeal nerve before subsequently causing Ramsay Hunt syndrome, trigeminal herpes zoster, VIII cranial nerve neuropathy, C2 neuropathy, and postherpetic neuralgia. MR imagingsignal intensity-intensity abnormalities were seen and followed in the spinal trigeminal nucleus and tract (STNT).

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 97%

Long-Term MRI Signal Change in the Spinal Trigeminal Nucleus and Tract After Ramsay Hunt Syndrome and Trigeminal Herpes Zoster

Clerk-Lamalice¹,

Savage²,

Fisch³

2015

neurograph

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“…Previously, among the Herpesviridae, only varicellazoster virus, [3][4][5] which causes both trigeminal herpes zoster and Ramsay Hunt syndrome, was shown to be associated with abnormal lesions involving the STNT on MRI. However, previous reports did not discuss expected pathologic changes in abnormal lesions.…”

mentioning

confidence: 99%

Pearls & Oy-sters: Trigeminal neuropathy associated with herpes labialis

et al. 2012

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PEARLS• Herpes labialis is a common disease, but there are very few reports on herpes labialis-related trigeminal neuropathy.• Trigeminal neuropathy can be associated with frequently recurring herpes labialis, and abnormal lesions may appear concurrently in the spinal trigeminal nucleus and tract (STNT) on MRI.CASE REPORT A previously healthy 41-year-old woman with recurrent herpes labialis since her 20s noticed a herpes labialis lesion on the left side of the lower lip. After 2 days, she experienced the acute onset of tingling and a swollen sensation of the left side of the face, beginning at the V3 division of the trigeminal nerve and progressing to involve the V1 and V2 divisions over the course of 2 days. A dermatologist diagnosed herpes labialis and prescribed acyclovir 1,000 mg in 2 divided doses for 5 days. However, the symptoms did not improve after the lesion disappeared. The left side of the tongue perceived a bitter taste 8 days after the onset of symptoms. Examinations on the following day revealed decreased pinprick, temperature, and light touch sensations in the 3 divisions of the left trigeminal nerve, as well as tingling and a swollen sensation in the affected region. A swollen sensation was also present in her inner cheek. Corneal reflexes and trigeminal motor function were normal. The results of other neurologic examinations were normal. T2-weighted MRI revealed a hyperintense lesion, corresponding to the left STNT ( figure, A and B). The lesion was surrounded by edema and showed slight contrast enhancement with gadolinium ( figure, C). Examination of the CSF showed 0.7 cells/L and a protein content of 22 mg/dL; herpes simplex virus (HSV) DNA was negative on PCR.After the diagnosis of trigeminal neuropathy associated with herpes labialis and treatment with IV methylprednisolone (1,000 mg) for 3 days, the lack of facial sensation improved rapidly, but slight tingling (especially in the V3 division) and dysgeusia remained. After that, the patient's symptoms gradually resolved spontaneously and disappeared about 3 weeks after onset. T2-weighted images after resolution of all symptoms showed that the edematous lesion had disappeared, whereas the hyperintense lesion corresponding to the STNT partially remained ( figure, D).Three months later, the patient had recurrence of a herpetic lesion on the opposite side of the lower lip, but did not experience trigeminal sensory disturbance at that time.DISCUSSION In our patient, the viral reactivation at the trigeminal ganglion led to widespread facial symptoms and abnormal signal intensity on MRI, corresponding to the STNT. The STNT receives primary afferent fibers from the trigeminal, facial, glossopharyngeal, and vagus nerves. Therefore, the dysgeusia in our patient might have been caused by retrograde impulses from the inflamed STNT to the facial and glossopharyngeal nerve.Four patients with herpes labialis-related sensory disturbances have been documented previously. 1,2Only 2 of these patients had extensive sensory disturbances involving 3 divisions of...

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“…On the other hand, reactivation of Varicella-zoster virus (VZV) in the geniculate ganglion also induces facial palsy in Ramsay Hunt syndrome. The MRI findings revealed hyperintense lesions in the nuclei, suggesting edematous changes [25]. The degeneration of the facial nerve nucleus causes permanent dysfunction of the facial nerve.…”

Section: Discussionmentioning

confidence: 99%