Prognostic Factors in Herpes Zoster Oticus (Ramsay Hunt Syndrome)

Coulson, Susan; Croxson, Glen; Adams, Roger; Oey, Victoria

doi:10.1097/mao.0b013e3182255727

Cited by 63 publications

(69 citation statements)

References 23 publications

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“…In a literature review and one randomized, controlled study on 15 patients Uscategui et al demonstrated a statistically significant difference between combined acyclovircorticosteroid therapy and treatment with corticosteroids alone [47]. This evaluation stands in contrast to the study results of other authors [28,29,46,48,49]. Kinishi et al treated 91 RHS patients with combined acyclovir-corticosteroid therapy.…”

Section: Therapy and Prognosiscontrasting

confidence: 53%

“…In a study on the temporal sequence of occurrence of dermatological and neurological findings in RHS by Coulson et al acute neuralgiform pain in Hunt's zone was the initial symptom of the disease in over half of the patients, followed by peripheral facial nerve paresis observed as first symptom in about 20 % of patients. In only 2 % of patients RHS manifested first with cutaneous lesions of the external ear [29]. After conclusion of the acute phase of the disease, the further course of RHS is determined by various residual symptoms.…”

Section: Clinical Findingsmentioning

confidence: 99%

“…The effectiveness of corticosteroid therapy can be explained by their pharmacological effects on inflammatory edema and the resulting decompression of neurogenic structures within the facial nerve canal in the petrosal bone [6,22,51]. The above data has led to the recommendation initiate combined acyclovir-corticosteroid therapy as early as possible [28,29,45,49,50]. …”

Section: Therapy and Prognosismentioning

confidence: 99%

“…Neurological symptoms of involvement of the trigeminal nerve manifest as weakness of the masticatory muscles as well as in taste and sensitivity disturbance in the areas innervated by the individual branches of the trigeminal nerve in the form of hyper-or hypesthesia as well as possibly even hypalgesia [9,18,20]. Involvement of other cranial nerves, in particular the abducens nerve, the glossopharyngeal nerve or the vagus nerve, is only rarely observed in RHS [6,18,29]. Clinical symptoms of abducens nerve paresis manifests as motility disturbances of the eye with double vision, while paresis of the glossopharyngeal nerve and the vagus nerve lead to swallowing and taste disturbances or to vasovagal reactions, e. g. cardiac arrhythmia [8,18,[30][31][32].…”

Section: Clinical Findingsmentioning

confidence: 99%

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Ramsay Hunt syndrome

Wagner

Klinge

Sachse

2012

J Deutsche Derma Gesell

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Keywords• herpes zoster oticus • zoster sine herpete • facial palsy • cranial nerve lesions • acyclovir-corticosteroid therapy SummaryRamsay Hunt syndrome is defined as herpes zoster oticus associated with an acute peripheral facial nerve paresis and quite often with other cranial nerve lesions. The combination of motor, sensory and autonomic involvement leads to a variety of neurological damage patterns, i. e. facial muscle paresis, hearing and balance disorders, sensory problems and disturbances of taste as well as lacrimal and nasal secretion. Additional variability of the clinical picture of Ramsay Hunt syndrome is produced by varying patterns of skin involvement explained by individual anastomoses between cranial and cervical nerves. Knowledge of these findings and an early diagnosis of Ramsay Hunt syndrome are important as prognosis of cranial nerve damage depends on the time at which acyclovir-corticosteroid therapy is started.

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Section: Therapy and Prognosiscontrasting

confidence: 53%

Section: Clinical Findingsmentioning

confidence: 99%

Section: Therapy and Prognosismentioning

confidence: 99%

Section: Clinical Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Ramsay Hunt syndrome

Wagner

Klinge

Sachse

2012

J Deutsche Derma Gesell

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“…Post-herpetic neuralgia has been reported in as many as 50% of RHS patients [38]. The main prognostic factor seems to be the severity of the initial symptoms [39]. The US and Japan have now implemented varicella zoster vaccination Post-herpetic neuralgia in 50% of RHS patients…”

Section: Prognosismentioning

confidence: 99%

Ramsay Hunt syndrome revisited–emphasis on Ramsay Hunt syndrome with multiple cranial nerve involvement

Rasmussen¹,

Lykke²,

Toft³

et al. 2014

Virol Discov

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Introduction: The Ramsay Hunt syndrome is characterized by herpetic lesions combined with peripheral facial nerve palsy. The disease is caused by a reactivation of the varicella zoster virus and can be deceiving since the herpetic lesions are not always present (zoster sine herpete) and might mimic other severe neurological illnesses. This article reviews the various forms of Ramsay Hunt syndrome and how they can give rise to diagnostic and therapeutic challenges. Material and method: Studies on the assessment and treatment of Ramsay Hunt syndrome were found by conducting a thorough literature search in PubMed, Medline, The Cochrane Library database and Google Scholar using the search words «varicella», «zoster», «ramsay hunt», «oticus», «cranial nerve», «facial nerve» and combinations thereof. The bibliographies of substantial articles were subsequently assessed. Results: About 12% of all peripheral facial nerve palsies are caused by varicella zoster virus. In more than 50% pain is the initial symptom making the diagnosis difficult. Female gender, and in general age above 50 years, renders patients more susceptible to Ramsay Hunt syndrome. The main prognostic factor is the severity of the initial symptoms. The occurrence rate of associated cranial polyneuropathy has been reported to be 1.8-3.2% and cranial nerves VII, VIII, IX are the ones most commonly affected. The full recovery rate is reported to be as low as 27.3% when multiple cranial nerves are involved. Combination therapy comprising of antiviral drugs and corticosteroids is recommened and should be initiated within 72 hours. Vaccination against varicella zoster virus is an interesting new development that might reduce the incidence of varicella zoster virus associated disease altogether. Conclusion: Ramsay Hunt syndrome is a difficult and severe diagnosis with a low full recovery rate. Extensive randomized trials are urgently needed to verify the optimal treatment and the efficacy of varicella zoster virus vaccine in both naïve and herpes zoster patients.

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