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Mancini A, Chirico F, Inchingolo AM, Piras F, Colonna V, Marotti P, Carone C, Inchingolo AD, Inchingolo F, Dipalma G. Osteonecrosis of the Jaws Associated with Herpes Zoster Infection: A Systematic Review and a Rare Case Report. Microorganisms 2024; 12:1506. [PMID: 39203349 PMCID: PMC11356100 DOI: 10.3390/microorganisms12081506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/12/2024] [Accepted: 07/18/2024] [Indexed: 09/03/2024] Open
Abstract
The investigation's goal was to obtain further knowledge about the connection between Herpes Zoster infection and dentistry therapy for the osteonecrosis of the jaws, combining the review with a case report relevant to the purpose. It is important to study this association because it is a possible additional factor to be considered in the causes of the osteonecrosis of the jaws. We limited our search to English-language papers published between 1 January 2004 and 7 June 2024 in PubMed, Scopus, and Web of Science that were relevant to our topic. In the search approach, the Boolean keywords "Herpes Zoster AND osteonecros*" were used. Results: This study analyzed 148 papers from Web of Science, PubMed, and Scopus, resulting in 95 articles after removing duplicates. Of these, 49 were removed because they were off topic, and 46 were confirmed. This study includes a qualitative analysis of the final 12 articles, removing 34 articles that were off topic. The literature highlights severe oral complications from Herpes Zoster reactivation, emphasizing the need for early diagnosis, comprehensive management, and multidisciplinary care. Treatment strategies include antiviral therapy, pain management, surgical debridement, and antibiotics. Immunocompromised individuals require vigilant monitoring and balanced immunosuppressive therapy. Further research is needed to enhance therapeutic approaches.
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Affiliation(s)
- Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.); or (A.M.I.); or (F.P.); or (V.C.); or (P.M.); or (C.C.); or (A.D.I.); or (G.D.)
| | - Fabrizio Chirico
- U.O.C. Maxillofacial Surgery, University of Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy;
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.); or (A.M.I.); or (F.P.); or (V.C.); or (P.M.); or (C.C.); or (A.D.I.); or (G.D.)
| | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.); or (A.M.I.); or (F.P.); or (V.C.); or (P.M.); or (C.C.); or (A.D.I.); or (G.D.)
| | - Valeria Colonna
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.); or (A.M.I.); or (F.P.); or (V.C.); or (P.M.); or (C.C.); or (A.D.I.); or (G.D.)
| | - Pierluigi Marotti
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.); or (A.M.I.); or (F.P.); or (V.C.); or (P.M.); or (C.C.); or (A.D.I.); or (G.D.)
| | - Claudio Carone
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.); or (A.M.I.); or (F.P.); or (V.C.); or (P.M.); or (C.C.); or (A.D.I.); or (G.D.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.); or (A.M.I.); or (F.P.); or (V.C.); or (P.M.); or (C.C.); or (A.D.I.); or (G.D.)
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.); or (A.M.I.); or (F.P.); or (V.C.); or (P.M.); or (C.C.); or (A.D.I.); or (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.); or (A.M.I.); or (F.P.); or (V.C.); or (P.M.); or (C.C.); or (A.D.I.); or (G.D.)
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Litt J, Cunningham AL, Arnalich-Montiel F, Parikh R. Herpes Zoster Ophthalmicus: Presentation, Complications, Treatment, and Prevention. Infect Dis Ther 2024; 13:1439-1459. [PMID: 38834857 PMCID: PMC11219696 DOI: 10.1007/s40121-024-00990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024] Open
Abstract
Herpes zoster (HZ) is caused by reactivation of latent infection of varicella zoster virus (VZV) in sensory (cranial, dorsal root) ganglia. Major risk factors for HZ are increasing age and immunosuppression. HZ ophthalmicus (HZO) is a subset of HZ with involvement of the ophthalmic division of the fifth cranial trigeminal nerve. Approximately 4-20% of patients with HZ develop HZO. Approximately 50% of patients with HZO develop ocular disease, among whom up to 25% develop chronic or recurrent disease. Common manifestations of ocular disease include conjunctivitis, keratitis, and uveitis, whereas optic neuropathy and retinitis are uncommon. Due to the potential for vision impairment, ocular involvement requires urgent ophthalmic consultation. Early recognition and timely treatment with antivirals may prevent ocular complications. HZO is preventable by vaccination against HZ. Vaccine efficacy/effectiveness studies have been largely conducted for HZ with few studies assessing HZO. Both the recombinant adjuvanted vaccine (RZV) and live-attenuated vaccine (ZVL) significantly reduce the incidence of HZ and HZO in older adults. RZV is more effective than ZVL. Data on the effectiveness of vaccines for prevention of recurrent disease in patients with HZO are limited; however, vaccination is recommended. Despite recommendations to vaccinate individuals likely to benefit from an HZ vaccine, coverage for adults remains suboptimal. Barriers to vaccination include patient beliefs about HZ or HZ vaccines, and factors related to healthcare providers. In particular, the lack of a recommendation from their primary care physician is often cited by patients as a reason for remaining unvaccinated. By encouraging vaccination against HZ, physicians not only prevent HZ and HZO but also potential vision loss due to HZO.Graphical abstract available for this article.
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Affiliation(s)
- John Litt
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Anthony L Cunningham
- Westmead Institute for Medical Research and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Francisco Arnalich-Montiel
- Cornea Unit, Department of Ophthalmology, Ramón y Cajal University Hospital, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Ceu San Pablo, Campus de Montepríncipe, Boadilla, Spain
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Cheng L, Lin Y, Yang J, Wang Q, Hu R, Li X, Wang H, Xu W. Clinical Characteristics and Prognosis of Herpes Zoster Laryngitis With Vocal Fold Immobility. J Voice 2024:S0892-1997(24)00172-3. [PMID: 38906743 DOI: 10.1016/j.jvoice.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To investigate the clinical characteristics and prognosis of herpes zoster laryngitis with vocal fold immobility. STUDY DESIGN Retrospective study. METHODS Clinical characteristics, laryngeal signs on strobolaryngoscopy, imaging examination findings, and outcomes of patients were analyzed retrospectively. RESULTS This study included 17 patients (11 males [64.7%] and six females [35.3%]), with a mean age of 63.3 ± 6.7 years. The primary symptoms were hoarseness (94.1%), dysphagia (76.5%), pharyngalgia on one side (76.5%), and aspiration (70.6%). No patient had skin herpes of the head and neck. The duration of symptoms was 5-30 days (median: 10 days). Twelve patients (70.6%) were in an immunocompromised state before the disease. Strobolaryngoscopy showed congestion and swelling of the mucosa on one side of the larynx, with whitish eruptions on the supraglottic mucosa and ipsilateral vocal fold immobility. Five patients (29.4%) exhibited signs of ipsilateral accessory nerve injury. The imaging examination showed supraglottic inflammatory changes in 12 patients (70.6%). Among the 14 patients whose treatment could be clearly described, only one patient received antiviral treatment, whereas others received neurotrophic and symptomatic treatment. Notably, all patients demonstrated good outcomes because their symptoms eventually returned to normal. CONCLUSION Herpes zoster laryngitis is caused by varicella-zoster virus infection of the vagus nerve. It is characterized by laryngeal herpetic changes on one side and unilateral vocal fold immobility. The inducement of the disease tends to be associated with the abnormal immune state of patients. It can be easily misdiagnosed because of the absence of skin herpetic changes. Regardless of antiviral therapy, patients generally exhibit a favorable outcome.
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Affiliation(s)
- Liyu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuhong Lin
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jingjing Yang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qingcui Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rong Hu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xueyan Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Haizhou Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wen Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Niemeyer CS, Harlander-Locke M, Bubak AN, Rzasa-Lynn R, Birlea M. Trigeminal Postherpetic Neuralgia: From Pathophysiology to Treatment. Curr Pain Headache Rep 2024; 28:295-306. [PMID: 38261232 PMCID: PMC10940365 DOI: 10.1007/s11916-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant challenges due to its persistent and debilitating nature. This review explores the clinical characteristics of TG-PHN, analyzes its pathophysiological underpinnings, and addresses existent and potential therapies. RECENT FINDINGS TG-PHN is one of the most common and complex PHN locations. It has distinguishing clinical and pathophysiological characteristics, starting with viral triggered injuries to the trigeminal ganglion (TG) and peripheral tissue and involving the ascending and descending brain modulation pathways. Current therapies include vaccines, oral and topical medications, and interventional approaches, like nerve blocks and neurostimulation. This review covers TG-PHN's clinical and physiological components, treatment options, and potential future targets for improved management. By exploring the complexities of this condition, we aim to contribute to developing more effective and targeted therapies for patients suffering from trigeminal PHN.
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Affiliation(s)
- Christy S Niemeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Harlander-Locke
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachael Rzasa-Lynn
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marius Birlea
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Heidari ME, Nazemi P, Feizabad E, Beiranvand F, Afzali M. Cranial nerve involvement among COVID-19 survivors. Front Neurol 2023; 14:1182543. [PMID: 37602247 PMCID: PMC10436332 DOI: 10.3389/fneur.2023.1182543] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction COVID-19 was first reported in November 2019 in China and rapidly spread across the globe. COVID-19 causes neurologic symptoms and complications, which may persist even after recovery in patients. The objective of this research was to determine the involvement of cranial nerves in COVID-19 survivors. Method This was a retrospective study. The study was conducted between March and July of 2022. The analysis included 98 patients with a certain positive polymerase chain reaction. SPSS software version 19 was utilized for data analysis. Results The average age of the participants was 40.47 years (8.81). The olfactory nerve was found to be the most frequently involved cranial nerve (36.7%). Over 20% of participants had a taste disorder. The findings from the regression analysis indicated that lung involvement and age have a direct and significant relationship with cranial nerve involvement and can serve as its predictors (p = 0.001). Conclusion It seems that cranial nerve involvement was sustained in COVID-19 patients who survived. In addition, elderly patients and patients with severe illnesses were more likely to show cranial symptoms. It is necessary to monitor COVID-19 survivors for neurological symptoms.
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Affiliation(s)
| | - Pershang Nazemi
- Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Feizabad
- Community Medicine Specialist, Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Beiranvand
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Afzali
- Department of Neurology, School of Medicine, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Upreti G, Rathod K. Zoster Polyneuritis Cranialis and Intracranial Vasculopathy. Indian J Otolaryngol Head Neck Surg 2023; 75:971-974. [PMID: 37275114 PMCID: PMC10235217 DOI: 10.1007/s12070-022-03235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022] Open
Abstract
A case report of varicella zoster virus (VZV) producing cranial polyneuropathy with intracranial vasculopathy afflicting the internal carotid artery, in a 45-year lady is presented. The clinical features included appearance of zosteriform rash in the left external auditory canal and concha, affliction of ophthalmic and maxillary divisions of V, VI, VII, VIII, IX and X cranial nerves. Contrast MRI brain demonstrated attenuated flow void in the left internal carotid artery. The diagnosis was confirmed with raised level of IgG VZV antibody in serum and detection of VZV IgG antibody in CSF, although PCR for VZV DNA in CSF was negative. The significance lies in atypical presentation, the diagnostic dilemma it poses, poor prognosis of cranial nerve function and the need for multidisciplinary approach to patient management and rehabilitation.
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Affiliation(s)
- Garima Upreti
- Department of Otorhinolaryngology and Head-Neck Surgery, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat India
- Present Address: Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rajkot, Gujarat India
| | - Khevna Rathod
- Department of Otorhinolaryngology and Head-Neck Surgery, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat India
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Mueller A, Carvalho H, Montenegro D. Herpes Zoster Ophthalmicus Complicated by Unilateral Ptosis and Abducens Nerve Palsy: A Case Report. Cureus 2022; 14:e25311. [PMID: 35755545 PMCID: PMC9226857 DOI: 10.7759/cureus.25311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 12/18/2022] Open
Abstract
Herpes zoster ophthalmicus (HZO) is a viral condition that presents as a painful vesicular rash in the trigeminal nerve dermatome. In some cases, self-limiting extraocular muscle palsies may occur several weeks after the onset of HZO and last for weeks to months. A 71-year-old man developed a debilitating binocular horizontal diplopia and ptosis about four weeks after the onset of HZO symptoms. He had no uveitis, keratitis, or changes in visual acuity. Examination revealed left abducens palsy and ptosis. Symptoms resolved within eight weeks without any intervention.
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Patil A, Goldust M, Wollina U. Herpes zoster: A Review of Clinical Manifestations and Management. Viruses 2022; 14:192. [PMID: 35215786 PMCID: PMC8876683 DOI: 10.3390/v14020192] [Citation(s) in RCA: 127] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 01/27/2023] Open
Abstract
The Varicella-zoster virus (VZV) or human herpes virus 3 is a neurotropic human alpha herpes virus responsible for chickenpox/varicella and shingles/Herpes zoster (HZ). This review will focus on HZ. Since HZ is secondary to varicella, its incidence increases with age. In children and youngsters, HZ is rare and associated to metabolic and neoplastic disorders. In adults, advanced age, distress, other infections (such as AIDS or COVID-19), and immunosuppression are the most common risk factors. HZ reactivation has recently been observed after COVID-19 vaccination. The disease shows different clinical stages of variable clinical manifestations. Some of the manifestations bear a higher risk of complications. Among the possible complications, postherpetic neuralgia, a chronic pain disease, is one of the most frequent. HZ vasculitis is associated with morbidity and mortality. Renal and gastrointestinal complications have been reported. The cornerstone of treatment is early intervention with acyclovir or brivudine. Second-line treatments are available. Pain management is essential. For (secondary) prophylaxis, currently two HZV vaccines are available for healthy older adults, a live attenuated VZV vaccine and a recombinant adjuvanted VZV glycoprotein E subunit vaccine. The latter allows vaccination also in severely immunosuppressed patients. This review focuses on manifestations of HZ and its management. Although several articles have been published on HZ, the literature continues to evolve, especially in regard to patients with comorbidities and immunocompromised patients. VZV reactivation has also emerged as an important point of discussion during the COVID-19 pandemic, especially after vaccination. The objective of this review is to discuss current updates related to clinical presentations, complications, and management of HZ.
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Affiliation(s)
- Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai 400706, India;
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany;
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, 01067 Dresden, Germany
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Fratalia L, Larner AJ. Cervical herpes zoster: an unusual cause of headache. J R Coll Physicians Edinb 2021; 51:390-391. [PMID: 34882143 DOI: 10.4997/jrcpe.2021.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Andrew J Larner
- Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool L9 7LJ, UK,
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Antonescu F, Butnariu I, Cojocaru FM, Anghel DN, Mihai ED, Tuţă S. Zoster Cranial Polyneuropathy in a COVID-19 Patient. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934658. [PMID: 34788266 PMCID: PMC8607048 DOI: 10.12659/ajcr.934658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/18/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ramsay Hunt syndrome is a rare form of herpes zoster caused by the reactivation of the varicella-zoster virus in the geniculate ganglion. The main clinical manifestations are peripheral facial palsy, vesicular rash in the ear, and ipsilateral auricular pain, and sometimes vertigo. COVID-19 is a new multisystemic infectious disease that, in addition to common respiratory manifestations, it is known to affect the immune system, primarily depressing cellular immunity. CASE REPORT A 54-year-old woman was admitted to our hospital with an acute vestibular syndrome and diplopia. She had been diagnosed 3 years prior with interstitial lung disease for which she was taking methylprednisolone. At admission, she tested positive for SARS-CoV-2. In the following days, she developed a sixth nerve palsy on the left side and a right peripheral facial palsy on the right side, followed by a typical zoster rash on the ipsilateral ear. One month later, she developed acute severe hearing loss on the right side. There were no COVID-19 symptoms during her stay in our hospital. The MRI showed Gd enhancement of both facial nerves. Under antiviral and corticoid treatment, the evolution was favorable, with marked improvement at 6 months. CONCLUSIONS COVID-19 increases the risk for herpes zoster infection, probably through induced depression of the cellular immunity. Our case suggests Ramsay Hunt syndrome can be the presenting symptom and sometimes the only symptom of COVID-19. This also seems to be true for other cranial neuropathies, and we recommend testing these patients even if there are no other manifestations.
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Affiliation(s)
- Florian Antonescu
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioana Butnariu
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Florentina Melania Cojocaru
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Daniela Nicoleta Anghel
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | | | - Sorin Tuţă
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Kim YS, Son JS, Lee H, Doo AR. A case report of refractory otalgia after Ramsay Hunt syndrome successfully treated by applying pulsed radiofrequency to the great auricular nerve: A CARE-compliant article. Medicine (Baltimore) 2021; 100:e27285. [PMID: 34596124 PMCID: PMC8483850 DOI: 10.1097/md.0000000000027285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Ramsay Hunt syndrome is a type of herpes zoster infection involving geniculate ganglion and facial nerve. Unilateral facial palsy, otalgia, and painful vesicular rash on the auricle and external auditory canal are the typical symptoms. Although postherpetic neuralgia (PHN) is a devastating complication of herpes zoster infection, PHN following Ramsay Hunt syndrome has rarely been reported. PATIENT CONCERNS A 55-year-old immunocompetent female patient visited our pain clinic, for left-sided refractory otalgia (PHN) that persisted for 3 months after she was diagnosed with Ramsay Hunt syndrome. Although facial palsy and tinnitus had recovered within 2 to 4 weeks after symptom onset, the patient had been experiencing a persistent and severe otalgia radiating to mandibular angle, temporal and upper cervical area of neuropathic nature. DIAGNOSES The patient's pain persisted despite conservative medication and administration of ultrasound-guided stellate ganglion block, facial nerve block, and great auricular nerve block several times. INTERVENTIONS The patient was treated with the application of ultrasound-guided pulsed radiofrequency (PRF) to the great auricular nerve. OUTCOMES The patient experienced significant pain reduction more than 50% on a numeric rating scale after 2 weeks of PRF treatment. LESSONS Chronic otalgia might be a type of PHN after Ramsay Hunt syndrome with cervical nerve involvement. PRF treatment to the great auricular nerve can be a therapeutic option for refractory otalgia following Ramsay Hunt syndrome.
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Affiliation(s)
- Ye Sull Kim
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital and Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Ji-Seon Son
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital and Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Hyungseok Lee
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital and Medical School, Jeonju, South Korea
| | - A. Ram Doo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital and Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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Luís MEV, Hipólito-Fernandes CD, Lopes Moniz J, Ferreira JT. The Neurotropic Varicella Zoster Virus: a Case of Isolated Abducens Nerve Palsy without Skin Rash in a Young Healthy Woman. Strabismus 2021; 29:168-173. [PMID: 34241572 DOI: 10.1080/09273972.2021.1948073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Varicella Zoster Virus (VZV) is a neurotropic virus whose reactivation can affect the central nervous system (CNS) and manifest as different neurological syndromes usually with dermatological involvement. Extraocular muscle palsies are not commonly described associated with VZV and their presence in the absence of a typical zoster rash is even rarer. METHODS Case report of a young immunocompetent patient with unilateral abducens nerve palsy, as an isolated manifestation of VZV infection. RESULTS A 25-year-old healthy female presented to the emergency department with a subacute onset of painless horizontal binocular diploplia, over a month. Ophthalmological and neurological examination revealed an isolated right abducens nerve palsy, and polymerase chain reaction of the cerebrospinal fluid identified a VZV infection. There was no skin rash involvement. Other infectious, inflammatory, and autoimmune diseases were excluded. Treatment with intravenous acyclovir and dexamethasone improved but not completely resolved the diplopia and strabismus. The patient was submitted to a medial rectus recession surgery. DISCUSSION VZV manifestations in the CNS can occur in healthy young individuals and can manifest in the absence of the typical skin rash. Isolated sixth nerve palsy is a very rare manifestation of VZV infection. Young patients with isolated ocular motor mononeuropathies, even with cardiovascular risk factors, benefit from a CNS-based approach and MRI and lumbar puncture should be considered. Reports show that extraocular muscle palsy associated with VZV is a transient condition and resolve partially or completely after few weeks.
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Affiliation(s)
| | | | | | - Joana Tavares Ferreira
- Ophthalmology Department, Hospital CUF Descobertas, Lisbon.,Neuro-Ophthalmology Department; Centro Hospitalar Universitário De Lisboa Norte, Lisbon
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Ti.: "High" vagus nerve lesions in varicella Zoster infection. eNeurologicalSci 2021; 23:100337. [PMID: 33898793 PMCID: PMC8055547 DOI: 10.1016/j.ensci.2021.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/20/2022] Open
Abstract
“High” vagus nerve lesions are rare and refer to the region of the nerve from the jugular foramen through the branching of the auricular (Arnold's branch) and the pharyngeal branch. Rapid onset of vagus nerve palsy is observed predominantly in trauma, and rarely in inflammation. An insidious onset points to a neoplastic cause. The acute “high” vagus nerve lesion is characterized by a unilateral paralysis of the recurrent laryngeal nerve, an incomplete paresis of the soft palate and a transient inability to swallow. This is a case description of a 79-year-old woman who presented with painful swelling of the left ear and occipital headache, followed by inability to swallow for 3 weeks. A markedly elevated Varicella Zoster titer suggested a herpes virus infection. Cranial nerve Vagus nerve High vagus nerve acute swallowing disorder
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McInnis-Smith K, McInnis CP. Herpes zoster in an immunocompetent host with C6 dermatitis and abducens nerve palsy. Can J Ophthalmol 2021; 56:e160-e162. [PMID: 33775592 DOI: 10.1016/j.jcjo.2021.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
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Imaging manifestations on sequential magnetic resonance imaging in pharyngolaryngeal involvement by varicella zoster virus. J Neurovirol 2021; 27:186-190. [PMID: 33534132 DOI: 10.1007/s13365-021-00953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/03/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
Clarifying temporal changes in magnetic resonance imaging (MRI) offers a good chance to understand the pathology of neural lesions; however, such information is scarce in varicella zoster virus (VZV) neuropathies for the glossopharyngeal and vagus nerves. Here, we present the changes in sequential MR images of such a pathology over a period of 12 months from symptom onset.A 27-year-old woman with difficulty in swallowing and hoarseness due to a palatal palsy and arytenoid fixation on the left presented 2 days after onset. MRI revealed a lesion which largely filled the left jugular foramen on T2-weighted images (T2-WI) with high diffusion-weighted imaging (DWI) signals, which has never been previously described, on the 3rd day after onset. The DWI signals were highest on day 3, then deteriorated over 2 months until the signal was only detectable at the intracranial level, but not in the jugular foramen. The glossopharyngeal nerve had returned to normal by 2 months.The time course of the glossopharyngeal and vagus nerve swelling detected on T2-WI suggests that nerve swelling reduces over several months, even though the paralytic symptoms persist. Furthermore, the high DWI signal suggests that nerve swelling was caused by edematous swelling of the nerve fibers, rather than fiber disruption with water displacement in the extracellular space. These findings may provide good clues to speculate on the dynamically changing pathology of VZV neuropathies of the glossopharyngeal and vagus nerves.
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Pupić-Bakrač J, Pupić-Bakrač A, Terkeš V, Baraka I. Cranial polyneuropathy caused by herpes zoster infection: a retrospective single-center analysis. Eur Arch Otorhinolaryngol 2020; 278:517-523. [PMID: 32776261 DOI: 10.1007/s00405-020-06279-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Cranial polyneuropathy (CP) is a rare complication of herpes zoster (HZ) infection. This entity often produces situations of a diagnostic dilemma, as can be seen in a wide spectrum of clinical presentations. The aim of this study was to report the clinical characteristics, treatment, and outcomes of 11 patients from a single-institution experience. METHODS A retrospective analysis of patients treated for HZ CP over a 12-year period was performed. RESULTS The present study included 11 patients with CP caused by HZ infection-7 (63.63%) females, and 4 (36.36%) males. The mean age at presentation was 63 years (range, 38-85 years). Cranial nerve VII was affected in nine (81.82%) cases, CN VIII in six (54.55%) cases, CN V in five (45.45%) cases, CN III and IX in two (18.18%) cases, and CN VI and X in one (9.09%) case. The treatment of choice was acyclovir in all patients, while corticosteroids were administered in six (54.55%) patients. Complete CN recovery was observed in seven (63.63%) patients, while four (36.36%) patients suffered from permanent CN damage-two (18.18%) CN VII, one (9.09%) CN VII and VIII, and one (9.09%) CN VI. CONCLUSION Herpes zoster CP presents an interesting diagnostic and therapeutic challenge. Successful management of these patients depends on a thorough knowledge of the anatomy and topodiagnostic of CNs. Early administration of antiviral agents is crucial in terms of responsiveness to treatment and expedite recovery.
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Affiliation(s)
- Jure Pupić-Bakrač
- Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Bože Peričića 5, 23 000, Zadar, Croatia.
| | - Ana Pupić-Bakrač
- Department of Ophthalmology, General Hospital Zadar, Bože Peričića 5, 23 000, Zadar, Croatia
| | - Vedrana Terkeš
- Department of Infectology, General Hospital Zadar, Bože Peričića 5, 23 000, Zadar, Croatia
| | - Ivan Baraka
- Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Bože Peričića 5, 23 000, Zadar, Croatia
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