Cranial Polyneuropathy in Ramsay Hunt Syndrome Manifesting Severe Pharyngeal Dysphagia: a Case Report and Literature Review

Lee, Kwang Min; Jeong, Ha Min; Lee, Hak Seung; Kim, Minsu

doi:10.12786/bn.2017.10.e13

Cited by 3 publications

(5 citation statements)

References 18 publications

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“…Majority of these cases required supplemental feeding through alternative routes such as nasogastric feeding or PEG feeding. Almost all patients with dysphagia eventually recovered enough to allow oral intake except for two cases [3]. Of those that did recover, the majority sufficiently improved within 2 months of presentation to allow oral intake.…”

Section: Discussionmentioning

confidence: 92%

“…This persisted for 3 months following the acute infection and gradually improved with dysphagia rehabilitation. Across literature, dysphagia was evident in only 11 cases of RHS [3]. Majority of these cases required supplemental feeding through alternative routes such as nasogastric feeding or PEG feeding.…”

Section: Discussionmentioning

confidence: 99%

“…This was consistent in this case, where our patient was older and only recovered sufficiently enough to enable oral intake after a delayed recovery phase lasting 5 months. Poor prognostic factors for recovery of dysphagia include an age above 80 years and the presence of more than three cranial nerves involved [3]. Dysphagia rehabilitation techniques included the Masako manouvre to increase base of tongue propulsion to posterior pharyngeal wall movement to subsequently reduce pharyngeal residue and the shaker exercise (modified due to vertigo) to assist hyoid movement, epiglottic deflection and clearance through the upper oesophageal sphincter [4].…”

Section: Discussionmentioning

confidence: 99%

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Ramsay Hunt Syndrome with Cranial Polyneuropathy and Dysphagia

Cheng¹,

Jones²,

Kinarivala³

et al. 2022

JCR

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Background: Ramsay Hunt syndrome (RHS) is an infective complication caused by the varicella zoster virus (VZV). It is characterised by both sensory and motor manifestations of the facial nerve. Other previously reported symptoms have included tinnitus, hearing loss, nausea, vertigo and nystagmus. In this instance, we describe a rare case of RHS resulting in cranial polyneuropathy with multiple cranial nerve involvement of VII, VIII, IX and X. Case Report: A 83-year-old male presented with a three-week history of occasional coughing with oral intake. He was noted on presentation to have vesicular lesions over the external auditory canal with a facial paresis. Superficial swabs from the lesions confirmed the presence of varicella zoster virus. He also developed vertigo from vestibular dysfunction, severe dysphagia with prolonged recovery and subsequent need for enteral nutrition for a period of 5 months. Conclusion: This case report highlights the need to be vigilant and screen for other cranial nerve involvement in patients presenting with RHS. This is particularly important given the potential to early treatment which may improve neurological recovery and subsequent outcomes such as dysphagia.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ramsay Hunt Syndrome with Cranial Polyneuropathy and Dysphagia

Cheng¹,

Jones²,

Kinarivala³

et al. 2022

JCR

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“…Facial nerve palsy is identified by facial weakness on the afflicted side, such as diminished forehead wrinkling, difficulty to close eyes, drooping corner of the mouth, and loss of motor control of facial muscles, resulting in decreased tears and saliva on the affected side (Lee et al, 2017). In this case, patient had paresis to the right side.…”

Section: Discussionmentioning

confidence: 94%

“…The involvement leads to various symptoms of neurological deficits. Although the mechanism is unclear, vasculitis in the carotid, middle meningeal, and ascending pharyngeal arteries which could be infected by the direct perineural spread of the VZV along anastomotic pathways, may participate in to the development of cranial polyneuropathy in RHS (Lee et al, 2017) RHS diagnosis is mainly based on patient's history, physical examination and additional examinations. RHS clinical symptoms are otalgia, nausea, vomiting, lack of hearing and tasting (Jeon et al, 2018;Crouch et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Ramsay hunt syndrome with multiple cranial nerve involvement

Shavira

Sari

Saiboo

et al. 2022

ijhs

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Ramsay Hunt Syndrome (RHS) is characterized by vesicles in external auditory canal, ear discomfort, and facial nerve palsy in the periphery. RHS which affects multiple cranial nerve involvement has rarely happened. This study is about RHS case that affect right multiple cranial nerves VI, VIII, IX, X. A 46-year old male patient complaint of crust and pain from right ear lobe. There were complaints of decreased hearing ability, tinnitus, difficulty to swallow, double vision, incapability of closing the right eyelid, and a facial slight palsy to the right. Multiple yellowish crusts and erosions were identified. Tzanck and Polymerase Chain Reaction test were not performed. Patient was diagnosed RHS with right multiple cranial nerves VI, VIII, IX, X, received Acyclovir and Prednisone tablets for 7 days. Patient improved. This finding showed that a detailed history taking, physical and additional examinations are required for accurate diagnosis for RHS multiple cranial nerve involvement.

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