gms | German Medical Science

GMS Current Posters in Otorhinolaryngology - Head and Neck Surgery

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V. (DGHNOKHC)

ISSN 1865-1038

Ramsay Hunt syndrome with multicranial nerve involvement – our experience

Poster Hals

Suche in Medline nach

  • corresponding author Petar Kolev - Ministry of Interior Medical Institute, Sofia, Bulgaria
  • Stefan Stoyanov - Ministry of Interior Medical Institute, Sofia, Bulgaria
  • Kosta Kostov - Ministry of Interior Medical Institute, Sofia, Bulgaria
  • Tzvetelina Ivanova - Ministry of Interior Medical Institute, Sofia, Bulgaria

GMS Curr Posters Otorhinolaryngol Head Neck Surg 2015;11:Doc221

doi: 10.3205/cpo001186, urn:nbn:de:0183-cpo0011861

Veröffentlicht: 16. April 2015

© 2015 Kolev et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Abstract

Ramsay Hunt syndrome is defined as an acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle (also termed herpes zoster oticus), and/or mucous membrane of the oropharynx. VZV (varicella zoster virus) infection/reactivation involving the geniculate ganglion of CN VII within the temporal bone is the main pathophysiological mechanism of Ramsay Hunt syndrome. The primary infection is usually acquired early in life and remains latent until it is reactivated later, where symptoms emerge, usually in association with an immune deficiency or suppression.

Ramsay Hunt syndrome presenting with multiple cranial neuropathies is rare. Possible mechanisms for the RHS–related polyneuropathy include formation of an anatomical chain from the adjacent nerve ganglia; a direct perineural spread of the virus along anastomotic pathways, or from a vasculitis in which the virus spreads through the small branches of the infected carotid artery, middle meningeal artery, and ascending pharyngeal artery that supply blood to cranial nerves V, VII, IX, X, XI, and XII.

The aim of this paper is to present two clinical cases of Ramsay Hunt syndrome with atypical unilateral multicranial nerve involvement – V, VII, VIII, IX, X and XI CN.

The methods used included a full neurological examination, ENT examination, CBC, basic metabolic panel, CSF analysis, serological tests, EMG, EEG, CT and MRI brain imaging.

Both patients were treated successfully by a 14-day course of 5 x 800 mg p.o. acylcovir plus low-dosed corticosteroids.

In conclusion, a diagnosis of RHS should be considered in patients with unilateral multiple cranial nerve palsies, as early antiviral and steroid treatment

significantly improves the prognosis.

Der Erstautor gibt keinen Interessenkonflikt an.