Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

Monsanto, Rafael da Costa; Bittencourt, Aline Gomes; Neto, Natal José Bobato; Beilke, Silvia Carolina Almeida; Lorenzetti, Fábio; Salomone, Raquel

doi:10.1055/s-0036-1584267

Cited by 76 publications

(78 citation statements)

References 20 publications

(101 reference statements)

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“…According to Sweeny et al [6] "RHS may initially be indistinguishable from Bell's Palsy…due to delayed development of vesicles after the onset of facial weakness." SC's symptoms were consistent with those of previous patients who have been diagnosed with RHS via research articles [4- 6,8,[11][12][13][14][15][16][17][18][19]. The severities and number of symptoms per patient varied, but were overall similar in nature.…”

Section: Discussionsupporting

confidence: 75%

Case Study for treatment considerations for patients with Ramsay Hunt Syndrome

Chockla¹

2019

Phys Ther Rehabil

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"Ramsay Hunt syndrome (RHS) is a rare neurological disorder characterized by paralysis of the facial nerve caused by varicella zoster virus [3]." RHS is not a diagnosis typically seen in physical therapy. Manifesting similar to Bell's palsy on inception, RHS affects the cranial nerves (CN) with a variety of symptoms that may include: tinnitus, hearing loss, difficulty with speech or swallowing, loss of balance, inner ear involvement, extremity weakness or involvement, and a myriad of other possible symptoms. The purpose of this case study is to enlighten therapists and readers to the possible treatment considerations of the side effects caused by RHS based on the patient's symptoms and presentation. Patient SC initially presented with shingles to cranial nerves (CN) V, VII, and VIII following a week long headache. Physical therapy (PT) was prescribed in hopes of facilitating and/or alleviating his symptoms of decreased balance and facial control. He responded very well to balance and vestibular training to regain control of his lower extremities to ambulate without his single point cane (SPC). He regained minimal control of his facial musculature with continued tinnitus. It is interesting to point out that he did respond well to electrical stimulation of his facial and cervical musculature while in the clinic with poor to fair carryover after and between treatment sessions.

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Section: Discussionsupporting

confidence: 75%

Case Study for treatment considerations for patients with Ramsay Hunt Syndrome

Chockla¹

2019

Phys Ther Rehabil

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“…Adjunctive steroid therapy can be helpful in the management of the facial paralysis of RHS [11]. A study on 80 RHS patients with different levels of severity treated with acyclovir-prednisone combination showed complete facial recovery, i.e., House grade I, in 52% patients, no matter what their pre-treatment gradings were [3].…”

Section: Discussionmentioning

confidence: 99%

“…A study on 80 RHS patients with different levels of severity treated with acyclovir-prednisone combination showed complete facial recovery, i.e., House grade I, in 52% patients, no matter what their pre-treatment gradings were [3]. Methylprednisolone has a higher affinity to glucocorticoid receptors, and a higher anti-inflammatory action when compared with the prednisone, prednisolone, or hydrocortisone [11].…”

Section: Discussionmentioning

confidence: 99%

“…Advanced age, initial House-Brackmann grades V or more, time before commencement of treatment, associated metabolic diseases, impairment of the cochleovestibular, or other cranial nerves, oropharynx lesions, dry eye, and lagophthalmus must be assessed at the initial physical examination, since they suggest worse prognosis of the facial palsy secondary to Ramsay Hunt syndrome [2,11].…”

Section: Discussionmentioning

confidence: 99%

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Ramsay Hunt Syndrome – A Diagnostic Dilemma

Sakthivel¹,

Singh²,

Smriti³

et al. 2017

JOENTR

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Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth. Ramsay Hunt Syndrome (RHS) is a rare, severe complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion. Ramsay Hunt syndrome is rare in children and affects both sexes equally. Incidence and clinical severity increases when host immunity is compromised. It is also accompanied by other frequent symptoms like tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus due to the close proximity of the geniculate ganglion to the vestibulocochlear nerve within the bony facial canal. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction.We describe a 23 year old female who was initially misdiagnosed as Bell's palsy and later developed vesicles on the pinna which led to a diagnosis of RHS and successfully treated with acyclovir and steroids.

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“…Since the common minor bleedings during HSVE are rarely identified, ischemic stroke rarely occurs (7,8). Ramsay-Hunt syndrome (RHS) is characterized by the re-activation of the latent varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve and facial nerve lesion secondary to outer ear way herpetic infection and presents with peripheral facial nerve paralysis in the clinic (9)(10)(11). Encephalitis, a neurological complication of VZV, which is a member of herpes virus family, can occur in the form of large or small vascular arteritis (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Stroke Status Developed After Herpes Viridae Infection: A Report of Two Cases

Turkogu

Bolaç²,

Dağıstan

et al. 2018

Arch Clin Infect Dis

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High mortality herpes simplex virus encephalitis (HSVE) presents with fever, headache, changes in personality, focal neurologic findings, and epileptic attacks. It causes common destruction in brain parenchyma with necrotic, inflammatory and hemorrhagic lesions, and neuron losses. Central nervous system vasculitis during HSV infection can develop strokes especially related to both hemorrhagic and ischemic reasons. Ramsay-Hunt syndrome (RHS) is characterized by the re-activation of the latent varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve; it presents with peripheral facial nerve paralysis. Neurogenic pulmonary edema is the situation of respiratory failure occurring hours after the serious neurogenic incident without other reasons causing lung edema, which is developed by increase in sympathetic activity, and progressed by increase in alveolar and interstitial fluid. In the current study, a patient with developed neurologic pulmonary edema with ischemic stroke status as a result of cerebral hematoma and middle cerebral artery (MCA) ischemia following HSVE was followed up and a patient that developed anterior cerebral artery (ACA) and MCA territory infarction after RHS was mentioned.

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Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

Cited by 76 publications

References 20 publications

Case Study for treatment considerations for patients with Ramsay Hunt Syndrome

Case Study for treatment considerations for patients with Ramsay Hunt Syndrome

Ramsay Hunt Syndrome – A Diagnostic Dilemma

Stroke Status Developed After Herpes Viridae Infection: A Report of Two Cases

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