Ramsay Hunt Syndrome in Asymptomatic COVID-19 Infection: A Case Report and a Literature Review.

(1) Background: COVID-19 infection has affected almost 6 million people worldwide. Geniculate Ganglion Zoster resulting in Ramsay Hunt Syndrome (RHS) has been rarely described in this context. (2) Methods: Here, a case of RHS in the context of asymptomatic COVID-19 infection is reported followed by a literature review of the previously published cases (PubMed research combining "COVID-19" and "Ramsay Hunt Syndrome" or their abbreviations/synonyms, searching for data published at any time till October 2023). (3) Results: Five cases have been previously published (age range: 25-67 years; n = 3 males). Three patients were known to be immunocompetent prior to infection, one was receiving corticotherapy for lung disease, and one had an unspecified immune status. RHS predominantly involved both facial and vestibulocochlear nerves, with one case exclusively involving the facial nerve as the presented case. Regarding facial nerve palsy, three were right-sided (like the current report) and two were left-sided. Two cases were asymptomatic to COVID-19 (like the present patient), one had mild fatigue, and two had classical COVID-19 symptoms preceding RHS symptoms. Workup included serological testing against Varicella Zoster Virus and PCR assays that can detect the viral DNA in saliva, blood, tears, exudates, and cerebrospinal fluid. The treatment combined antiviral and corticosteroid therapies which yielded heterogeneous outcomes that might be related to some demographic and clinical data. (4) Conclusions: RHS rarely occurs in the context of COVID-19. Early recognition is important. Management seems to be similar to the classical condition. Some data may help predict facial nerve recovery.

Venous sinus thrombosis leading to stroke in a patient with sickle cell disease on hydroxyurea and high hemoglobin levels: treatment with thrombolysis.

A 21-year-old man with homozygous sickle cell disease maintained on hydroxyurea for 1 year developed thrombosis of the superior sagittal, right transverse, and right sigmoid dural sinuses with a large venous infarct. He was successfully treated with endovascular thrombolysis. Investigation did not reveal any inherited or acquired hypercoagulable state. This patient however had consistently elevated hemoglobin levels both at the time of the initial event and on follow up. One year later he developed symptomatic avascular necrosis of the right hip. High hemoglobin levels resulting from hydroxyurea therapy may have contributed to development of complications in this patient.

The correlation between muscle and nerve fiber conduction velocities in thenar muscle is lost in case of carpal tunnel syndrome.

OBJECTIVE AND METHODS: This study investigated the relationship between muscle fiber conduction velocity (MFCV) and motor nerve conduction velocity (MNCV) in thenar muscle of 20 normal subjects and of 20 patients suffering from a moderate carpal tunnel syndrome. Our goal was to confirm the positive correlation between MFCV and MNCV and to assess the influence of carpal tunnel syndrome on this relationship. MFCV was calculated in voluntarily contracted thenar muscle using a multi-channel surface recording and a spike-triggered averaging technique. RESULTS: MFCV values ranged between 2.6 and 7.2 m/s (mean+/-SEM: 4.5+/-0.3) in normal subjects and between 3.5 and 6.9 m/s (4.7+/-0.2) in patients. Subjects and patients did not differ regarding MFCV values, but a correlation between MFCV and MNCV was found in normal subjects (P=0.0005) and not in patients (P=0.54). CONCLUSIONS: A correlation between muscle and nerve conduction velocities existed in healthy subjects but was lost in case of moderate carpal tunnel syndrome. MFCV appeared to be insensitive to focal nerve conduction slowing.