Meningitis and Ramsay-Hunt syndrome in a 17-year old girl.

INTRODUCTION: Ramsay Hunt syndrome (RHS) is a rare manifestation of varicella-zoster virus (VZV) reactivation in geniculate ganglion. It usually manifests with a characteristic triad of symptoms including ipsilateral ear pain, vesicles in the external auditory canal, and facial nerve palsy. CASE: We present a case report showing RHS additionally manifested by meningitis and involvement of VIII cranial nerve. Clinical course was complicated by acute kidney injury induced by acyclovir therapy. RESULTS: Despite the involvement of the geniculate ganglion and vestibulocochlear nerve in the course of herpes zoster, and the occurrence of acute kidney injury, the patient fully recovered. CONCLUSIONS: A complete recovery of cranial nerves VII and VIII in the course of RHS can be achieved.

Test battery of cranial nerves VII and VIII for assessing herpes zoster oticus.

OBJECTIVE: This study adopted a test battery of cranial nerves (CNs) VII and VIII comprising a facial nerve function test, audiometry, a caloric test, and ocular and cervical vestibular-evoked myogenic potential (oVEMP and cVEMP, respectively) tests to assess the function of CNs VII and VIII comprehensively so as to predict facial nerve recovery in patients with herpes zoster oticus (HZO). STUDY DESIGN: Case series with chart review. SETTING: University hospital. METHODS: A total of 20 patients with HZO underwent a test battery of CNs VII and VIII. Registering the unaffected nerve bundles in the internal auditory canal was based on the number of normal results in the test battery of CNs VII and VIII. Fair facial nerve recovery is defined as the improvement of facial paresis to facial nerve grades I to II/VI. RESULTS: In 20 patients with HZO, 6, 7, 3, and 4 patients had 0, 1, 2, and 3 unaffected nerve bundles, respectively. A significantly positive correlation was identified between the number of unaffected nerve bundles and fair facial nerve recovery. Similarly, a statistically significant predictor of fair facial nerve recovery was noted for unaffected nerve bundles (odds ratio, 15.42) but not for grading of the facial nerve (odds ratio, 0.49). CONCLUSION: Grading of the facial nerve alone fails to predict the outcome of facial paresis in patients with HZO mainly because it overlooks the involvement of CN VIII. Alternatively, a combined test battery of CNs VII and VIII may serve as a strong predictor for facial nerve recovery.

Ramsay Hunt syndrome presenting as a cranial polyneuropathy.

Ramsay Hunt syndrome is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions V, VI, IX, and X cranial nerves are affected as well. We present a case of a Ramsay Hunt syndrome with involvement of V, VII, and VIII cranial nerves.

[Detection of latent herpes simplex virus in human vestibular ganglia].

Viral infections are considered to be one of the possible etiologies of vestibular neuronitis. Herpes simplex virus type 1 (HSV-1) is a likely candidate agent as this virus has a strong neurotropism, and can establish latent infections in the nervous system. However the existence of infections in the vestibular ganglia has not been established. In this study, 31 vestibular ganglia from autopsied adults were investigated. Polymerase chain reaction (PCR) was used to detect HSV-1 viral genomes, and reverse transcription-PCR (RT-PCR) and in situ hybridization (ISH) methods were employed to demonstrate latency associated transcripts (LAT) of HSV-1, which has been known to be latency specific. HSV-1 DNA was detected in 6 of 10 (60%) vestibular ganglia using the PCR method, and HSV-1 LAT was detected in 5 of 8 (63%) vestibular ganglia using the RT-PCR method. However, ISH showed that only 1 of 13 (7.7%) vestibular ganglia was HSV-1 LAT positive. In total only 1 of 3,830 (0.03%) neurons from 13 vestibular ganglia was found to be positive. The results indicate with certainty that HSV-1 does produce latent infections in human vestibular ganglia, and that the percentage of HSV-1 infected neurons is less than that of trigeminal ganglia. The results of this study also suggest that the rare presence of HSV-1 LAT in the ganglia may possibly correspond to the less frequent occurrence of vestibular neuronitis resulting from reactivation of HSV-1.

Ramsay Hunt syndrome with unilateral polyneuropathy involving cranial nerves V, VII, VIII, and XII in a diabetic patient.

Ramsay Hunt syndrome is a rare complication of the varicella zoster virus, defined as a peripheral facial palsy that typically results from involvement of the facial and auditory nerves. Ramsay Hunt syndrome can be associated with cranial nerves V, VI, IX, and X but rarely with XII. We describe an atypical case of Ramsay Hunt syndrome with multiple cranial nerve involvement of nerves V, VII, VIII, and XII. Antiviral drugs, antibiotics, insulin, and traditional Chinese drugs were administered immediately after admission. After 3 months of combination therapy, the patient had recovered satisfactorily. Herpes zoster can cause severe infections in diabetic patients and should be treated as soon after detection as possible. Ramsay Hunt syndrome should be recognized as a polycranial neuritis characterized by damage to sensory and motor nerves. In addition to facial and vestibular nerve paralysis, Ramsay Hunt syndrome may also involve cranial nerves V and XII.