Subject(s)
Herpes Zoster Oticus/complications , Myoclonic Cerebellar Dyssynergia/diagnosis , Acyclovir/administration & dosage , Aged , Herpesvirus 3, Human/pathogenicity , Humans , Male , Myoclonic Cerebellar Dyssynergia/drug therapy , Myoclonic Cerebellar Dyssynergia/virology , Prednisolone/administration & dosageABSTRACT
A 57-year-old man developed 3 days of left facial pain and swelling with left-sided hearing loss followed by a painful, unilateral, erythematous, and vesicular rash on the left anterior two-thirds of the tongue, external auditory canal, lip, and face typical of varicella-zoster virus reactivation (figure). Reactivation in the geniculate ganglion or facial nerve is uncommon and typically causes tongue and auricular lesions or facial palsy and was described by Hunt in 1907.(1) The patient received IV acyclovir and oral prednisone with rapid improvement in pain and resolution of lesions and improvement of hearing over 1 month.
Subject(s)
Myoclonic Cerebellar Dyssynergia/diagnosis , Tongue/pathology , Geniculate Ganglion , Herpes Zoster/complications , Herpesvirus 3, Human/pathogenicity , Humans , Male , Middle Aged , Myoclonic Cerebellar Dyssynergia/physiopathology , Myoclonic Cerebellar Dyssynergia/virologyABSTRACT
We report an immunocompetent patient with the Ramsay Hunt syndrome (RHS) followed days later by brainstem disease. Extensive virological studies proved that varicella zoster virus (VZV) was the causative agent. Treatment with intravenous acyclovir resulted in prompt resolution of all neurological deficits except peripheral facial palsy. This case demonstrates that after geniculate zoster, brainstem disease may develop even in an immunocompetent individual and effective antiviral therapy can be curative.
Subject(s)
Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Brain Stem/drug effects , Herpesvirus 3, Human/isolation & purification , Myoclonic Cerebellar Dyssynergia/complications , Bell Palsy/drug therapy , Bell Palsy/virology , Brain Stem/pathology , Brain Stem/physiopathology , Brain Stem/virology , Facial Paralysis/drug therapy , Facial Paralysis/virology , Female , Gadolinium/metabolism , Hearing Loss, Sudden/drug therapy , Hearing Loss, Sudden/virology , Herpesvirus 3, Human/drug effects , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Myoclonic Cerebellar Dyssynergia/drug therapy , Myoclonic Cerebellar Dyssynergia/pathology , Myoclonic Cerebellar Dyssynergia/physiopathology , Myoclonic Cerebellar Dyssynergia/virology , Nystagmus, Pathologic/drug therapy , Nystagmus, Pathologic/virology , Treatment OutcomeABSTRACT
We describe here a 71-year-old man who had herpes zoster encephalitis. He developed high fever, headache and disturbance of consciousness on 1st, May, 1998. On admission, neurological examination revealed disturbance of consciousness with restlessness and meningeal signs. Brain MRI (T 1 and T 2 weighted images) demonstrated high signal lesions in the left temporal lobe and cerebellar vermis. VSV encephalitis was diagnosed based on CSF pleocytosis, high serum and CSF titers of VZV antibody and EEG abnormality. During hospitalization, Ramsay-Hunt syndrome, herpes zoster generalisatus and acute pancreatitis developed. To our knowledge, the characteristic combination of the clinical signs in this case is very rare. We discussed the pathogenic mechanisms of these conditions, and this case was considered to have VZV encephalitis, and to be associated with right facial nerve palsy and pancreatitis, in spite of the absence of immunological deficiency.
