Ramsay-Hunt syndrome in the differential diagnosis of stroke

Abstract

AAn 82-year-old man with a medical history of diabetes, hypertension, and right hemispheric stroke 4 years previously, presented to the emergency department complaining of pain in the right ear, otorrhea, and hypoacusis for 5 days. His spouse also mentioned symptoms of drooling and aggravation of previous defi cits, namely dysarthria, facial asymmetry, and left hemiparesis. Due to the suspicion of a new stroke event, a neurological evaluation was requested, which revealed right peripheral facial palsy (Figure A), ipsilateral hypoacusis, and spastic left hemiparesis with impaired deambulation without support. An ear inspection revealed various blistering lesions and cicatricial tissue on the right external auditory canal ( Figure B). Routine blood analysis was normal, and cerebral computed tomography showed no recent lesions, particularly ischemic or hemorrhagic lesions. The cerebrospinal fluid investigation revealed pleocytosis (75 cells, 95% of which were mononuclear), normal glucose and protein values, and negative results for the microbiological investigation, including unsuccessful isolation of varicella zoster virus (VZV). The patient was treated with acyclovir (800mg 5 times daily) and

Facial paralysis due to Ramsay Hunt syndrome - A rare condition

“…Examination of cerebrospinal fluid and gadolinium-enhanced MRIs have proved no diagnostic or prognostic value, 4 although a positive polymerase chain reaction (PCR) test for VZV is used for confirmation. 5 Proper physical examination and history is essential because in many cases, when facial paralysis is noted at the ER, the first hypothesis is that of stroke, which leads to misdiagnosis and wrong treatment and can cause sequelae, such as permanent hearing loss.…”

“…4,5 Usually, prednisone (duration and dose varies a lot but usually is 1 mg/kg/day for 5-7 day) is combined with intravenous or oral acyclovir (or similar drugs) concomitantly. It is essential to refer patients to rehabilitation after the acute phase for motor physiotherapy, biofeedback and massage therapy.…”

The experience of using sodium aminodihydrophthalazinedione in the complex treatment of a patient with Ramsey – Hunt syndrome

“…Направление дифференциально-диагностического поиска определяется особенностями клинической картины у конкретного пациента. Чаще синдром Рамсея -Ханта приходится дифференцировать с наружным отитом, острым средним отитом, рожистым воспалением, параличом Белла [14], в редких случаях с инсультом [15].…”

Relato de caso: Síndrome de Ramsay Hunt

“…Epidemiologia de aproximadamente 5 casos/100.000 indivíduos adultos e pacientes idosos imunossuprimidos (Gondivkar et al, 2010;Gallego et al, 2016). Apenas 10% dos pacientes com paralisia facial total recuperarão a função do nervo facial completa e somente 66% dos pacientes com paralisia incompleta recuperarão totalmente a função facial (Costa & Veiga, 2013;Vale So et al, 2019).O objetivo desse trabalho é relatar um caso clínico de uma paciente com SRH além de uma avaliação sistêmica dessa patologia, desde seus sinais e sintomas clínicos, até a conduta terapêutica e prognóstica…”