The Natural History of Facial Paralysis in Herpes Zoster

Devriese, P. P.; Moesker, W. H.

doi:10.1111/j.1365-2273.1988.tb01134.x

Cited by 98 publications

(57 citation statements)

References 10 publications

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“…This infection may sometimes spread, eventually involving the 8th cranial nerve with resultant tinnitus, hearing loss, and vertigo [21,22]. Varicella zoster is the most common zoster infection affecting the head and neck after herpes zoster ophthalmicus [2], and is the second most common cause of facial paralysis [23]. Many reports have extensively described the pathophysiology of this condition.…”

Section: Discussionmentioning

confidence: 99%

Herpes zoster oticus: Correlations between Clinical and MRI Findings

Berrettini

Bianchi²,

Segnini³

et al. 1998

Eur Neurol

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Many gadolinium-enhanced magnetic resonance imaging (MRI) studies focusing on the anatomy and pathology of the 7th cranial nerve have already been published. However, only scattered cases of herpes zoster oticus (HZO) have been described and only the MRI appearance of the soft temporal bone structures has been reported. Enhanced MRI was performed in 4 patients with HZO observed at the Department of Otorhinolaryngology of the University of Pisa. A good correlation was found between the clinical data and MRI findings in both the acute and chronic stages of the disease. The 2 cases with complete facial palsy presented prominent and diffuse enhancement of the 7th and 8th cranial nerves on postcontrast MRI, while the patient with grade III facial palsy showed more limited nerve enhancement. The patient with grade II facial palsy presented no MRI abnormalities. In our series, enhancement limited to the geniculate ganglion and to the labyrinthine segment of the facial nerve indicates a good prognosis while a widespread enhancement correlates with a poor prognosis. In conclusion, MRI with contrast may be useful during the acute stage of HZO because it can confirm the diagnosis and can provide prognostic information on the facial function.

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Section: Discussionmentioning

confidence: 99%

Herpes zoster oticus: Correlations between Clinical and MRI Findings

Berrettini

Bianchi²,

Segnini³

et al. 1998

Eur Neurol

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“…Yet, in the children in the present study, zoster oticus with facialnerve paralysis constituted a considerable number of the complications; 7 children had persistent facial-nerve paralysis after they were discharged from hospitalization. It has been reported that facial paralysis due to zoster oticus has a less favorable prognosis than does Bell palsy [12].…”

mentioning

confidence: 99%

Immunocompetent Children Account for the Majority of Complications in Childhood Herpes Zoster

Grote¹,

Kries²,

Rosenfeld³

et al. 2007

J INFECT DIS

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In a 2-year-long active surveillance conducted in all German pediatric hospitals, the incidence of hospitalization because of herpes zoster and the clinical picture of complications in children were assessed. Herpes zoster resulted in hospitalization of 244 children, 78 of whom were considered to be immunocompromised. Zoster ophthalmicus (n ‫؍‬ 29), meningoencephalitis (n ‫؍‬ 22), and zoster oticus (n ‫؍‬ 23) (11 cases had Ramsay Hunt syndrome) accounted for 59% of all complications (n ‫؍‬ 115). The incidence of hospitalization suggests that at least 1 in every 100 children with herpes zoster is hospitalized and that at least 1 in every 250 immunocompetent children with herpes zoster is hospitalized with complications.Herpes zoster (HZ) results from reactivation of latent varicellazoster virus infection that has been acquired with chickenpox. Although HZ may account for relevant morbidity in adults [1], which is related primarily to postherpetic neuralgia and ophthalmic zoster, HZ in children is believed to be benign unless the child is immunocompromised [2]. We performed a populationbased study to assess the incidence of hospitalization due to HZ, to assess the relative proportions of healthy and immunocompromised children who were hospitalized, and to describe the clinical features of associated complications.Methods and subjects. Active surveillance for HZ in children Ͻ17 years of age who were admitted to hospitals for treatment of HZ was conducted during the 2-year period of January 2003 through December 2004; the surveillance included all German pediatric hospitals. Information on each child was ascertained via a detailed questionnaire.A case of HZ was defined as either hospitalization because of HZ or hospitalization because of any other reason if, 6 days after admission, HZ was identified as the underlying cause. Cases of HZ that erupted while a child was hospitalized for other reasons were excluded. Complications were reported in the following categories: skin infection, ophthalmic zoster, zoster oticus, generalized zoster, and other complications. If meningitis or encephalitis was reported, the diagnosis was summarized as "meningoencephalitis." Children were considered to be immunocompromised if they either received immunosuppressive therapy or had conditions characterized by immunodeficiency.To assess underreporting, a second source was in place in a defined region-North-Rhine Westphalia (NRW), the most populous federal state of Germany (3,248,227 children 17 of age years during 2003 [http://www.destatis.de]). This second source was based on reports from ϳ10,000 general practitioners and pediatricians in primary care. Because these 2 sources can be assumed to be independent and confined to a closed catchment area, capture-recapture incidence estimation was applied.To compare these estimates with the 10th edition of the International Classification of Diseases (ICD10) inpatient-discharge records of HZ (B01.0 -B01.9) or any diagnostic position, all 68 pediatric hospitals in NRW were requested to provide ...

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“…Compared with Bell palsy, Ramsay Hunt syndrome generally has more severe paralysis at onset, and patients are less likely to recover completely. 8 …”

Section: Discussionmentioning

confidence: 99%

“…Of the patients with partial facial nerve function at disease onset, 66% recovered completely, whereas only 10% of those who presented with complete loss of function recovered completely. 8 In another retrospective study of 26 patients treated with acyclovir and steroids, age greater than 60 years, diabetes mellitus, essential hypertension and associated vertigo were identified as prognostic factors for worse outcome and decreased chance of recovery.…”

Section: Natural Historymentioning

confidence: 99%

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Ramsay Hunt syndrome presenting as simple otitis externa

Kim

Bhimani²

2008

CJEM

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Ramsay Hunt syndrome is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection occurs in the geniculate ganglion, causing otalgia, auricular vesicles and peripheral facial paralysis. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. We report the case of a patient who was diagnosed with simple otitis externa after presenting to the emergency department (ED) with a 3-day history of rightsided otalgia. Her condition subsequently evolved to include right-sided auricular vesicles and right-sided facial weakness. She presented to the ED again after 2 days and was correctly diagnosed with Ramsay Hunt syndrome. We describe the clinical presentation, diagnostic findings and management of this uncommon but important entity. RÉSUMÉLe syndrome de Ramsay Hunt est une complication rare du zona (herpès zoster). La réactivation de l'infection latente du virus zona-varicelle survient dans le ganglion géniculé, causant une otalgie, des éruptions vésiculeuses sur l'oreille ainsi qu'une paralysie faciale périphérique. Comme ces symptômes sont parfois absents au début de cette affection, un mauvais diagnostic est occasionnellement posé. Nous présentons le cas d'une patiente ayant reçu un simple diagnostic d'otite externe après s'être présentée à l'urgence avec des antécédents d'otalgie du côté droit au cours des trois jours précédents. Son état a évolué, donnant lieu à des éruptions vésiculeuses sur l'oreille du côté droit et à une faiblesse faciale du côté droit. Deux jours plus tard, lors d'une autre visite à l'urgence, on a posé le bon diagnostic de syndrome de Ramsay Hunt. Nous décrivons la présenta-tion clinique, le diagnostic et la prise en charge de cette complication rare, mais grave.

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The Natural History of Facial Paralysis in Herpes Zoster

Cited by 98 publications

References 10 publications

Herpes zoster oticus: Correlations between Clinical and MRI Findings

Herpes zoster oticus: Correlations between Clinical and MRI Findings

Immunocompetent Children Account for the Majority of Complications in Childhood Herpes Zoster

Ramsay Hunt syndrome presenting as simple otitis externa

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