A 1-year-10-month-old child developed left-sided Ramsay Hunt syndrome (RHS) without vesicles 1 month after an episode of varicella zoster infection. No ear symptoms, including hearing loss, tinnitus, or imbalance, were reported. The external ear and otoscopic examinations were unremarkable. He achieved adequate recovery with corticosteroid treatment. This case report discusses the unusual presentation of RHS without vesicles, the diagnostic dilemma in young children, varicella zoster virus hepatitis, treatment modalities, and the role of vaccination in its prevention.
Varicella Zoster Virus Infection ; Herpes Zoster Oticus ; Zoster Sine Herpete ; Chickenpox Vaccine

Ramsay Hunt syndrome with the complication of encephalitis or meningoencephalitis is rarely reported and uncommon in immunocompetent patients. The radiological manifestations of such cases usually involve the cerebellum and brainstem or exhibit the absence of any abnormality. We report a case of a 78-year-old immunocompetent man hospitalized with Ramsay Hunt syndrome, who later developed meningoencephalitis. The cerebrospinal fluid-study excluded other causes of meningoencephalitis, and the clinical diagnosis indicated varicella zoster virus meningoencephalitis. Magnetic resonance imaging revealed increased signal intensities in the bilateral temporal lobe, midbrain, and pons on T2-weighted imaging, and T2 fluid attenuated inversion recovery and contralateral asymmetric pachymeningeal enhancement. Contrast-enhanced T1-weighted imaging revealed ipsilateral facial nerve enhancement.
Aged ; Brain Stem ; Cerebellum ; Diagnosis ; Encephalitis ; Facial Nerve ; Herpes Zoster Oticus ; Herpesvirus 3, Human ; Humans ; Magnetic Resonance Imaging ; Meningoencephalitis ; Mesencephalon ; Pons ; Temporal Lobe

Herpes zoster oticus is one of complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion of the facial nerve, which is the most common presentation of herpes zoster in the head and neck region. However, VZV infection of the larynx has rarely been described in the literature compared with Herpes zoster oticus. Moreover, zoster laryngopharyngitis simultaneously occurred with recurred Herpes zoster oticus which has no newly developing motor dysfunction has not been reported yet. Therefore, these diseases are difficult to diagnose due to its rareness. However, distinctive appearances such as unilateral herpetic mucosal eruptions and vesicles are useful and essential in making a quick and accurate diagnosis. Thus, we report a characteristic case of zoster laryngopharyngitis simultaneously occurred with recurred Herpes zoster oticus not accompanied by any newly developing motor palsy.
Diagnosis ; Facial Nerve ; Geniculate Ganglion ; Head ; Herpes Zoster Oticus ; Herpes Zoster ; Herpesvirus 3, Human ; Larynx ; Neck ; Paralysis ; Vocal Cord Paralysis ; Vocal Cords

BACKGROUND: Many studies about herpes zoster exist in the Korean dermatologic literature. However, few studies have reported about facial herpes zoster and its complications. OBJECTIVE: The purpose of this study was to investigate the epidemiology, clinical features, and complications of facial herpes zoster. METHODS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. RESULTS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. Results: The most common site of involvement of facial herpes zoster was the ophthalmic branch of the trigeminal nerve (59.2%). Herpes zoster involving the ophthalmic and the maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of herpes zoster ophthalmicus than that observed with herpes zoster involving only the ophthalmic branch (odds ratio 7.373). Age and periorbital swelling were significantly correlated with herpes zoster ophthalmicus (p<0.001). Facial palsy was significantly correlated with otalgia and cutaneous ear involvement (p<0.001). Postherpetic neuralgia (PHN) occurred in 41% of patients with facial herpes zoster. Patients who received antiviral treatment within 3 days showed lower rates of PHN (35.8%) than patients who received treatment after 4 days (45.4%) (p=0.002). CONCLUSION: Facial herpes zoster is associated with several neurological complications. Variables including age, periorbital swelling, otalgia, and cutaneous ear involvement are useful predictors of complications and prognosis. Early institution of antiviral treatment and appropriate interdepartmental consultations are required for better treatment outcomes.
Ear ; Earache ; Epidemiology ; Facial Paralysis ; Herpes Zoster Ophthalmicus ; Herpes Zoster Oticus ; Herpes Zoster ; Humans ; Incidence ; Medical Records ; Neuralgia, Postherpetic ; Prognosis ; Referral and Consultation ; Retrospective Studies ; Trigeminal Nerve

Ramsay Hunt syndrome is a type of acute herpes zoster, which occurs by reactivation of the varicella-zoster virus at the geniculate ganglion. Clinical presentation of Ramsay Hunt syndrome includes a vesicular rash on the ear (herpes zoster oticus) or in the oral mucosa accompanied by acute peripheral facial nerve paralysis. Other cranial nerves such as V, IX, XI, and XII are often involved. Additional variability of the clinical picture of Ramsay Hunt syndrome is produced by varying patterns of skin involvement explained by individual anastomoses between cranial and cervical nerves. Combination treatment containing anti-viral agents and steroids is recommended for the treatment of Ramsay Hunt syndrome. Additionally, early diagnosis of Ramsay Hunt syndrome is a crucial factor to improve damaged nerves in Ramsay Hunt syndrome, which initiates treatment as soon as possible.
Cranial Nerves ; Ear ; Early Diagnosis ; Exanthema ; Facial Nerve ; Facial Paralysis ; Geniculate Ganglion ; Herpes Zoster ; Herpes Zoster Oticus ; Herpesvirus 3, Human ; Mouth Mucosa ; Paralysis ; Skin ; Steroids

BACKGROUND AND OBJECTIVES: We aimed to assess the clinical significance of dizziness associated with acute peripheral facial palsy (APFP). SUBJECTS AND METHODS: Medical records of patients who visited an otorhinolaryngology clinic at a university hospital and were admitted for treatment of APFP between 2014 and 2016 were thoroughly reviewed. RESULTS: In total, 15.3% (n=15) of patients had dizziness. Continuous, rotatory dizziness without exacerbating factors was most common and frequently accompanied by nausea/vomiting. Dizziness disappeared within 1 week during the hospitalization period. Patients with Ramsay Hunt syndrome (31.0%) had dizziness more frequently than those with Bell’s palsy (8.7%). In addition, higher hearing thresholds and pain around the ear was reported more often in dizzy patients (p < 0.05). Logistic regression analysis revealed that the initial House-Brackmann grade of facial paralysis was solely associated with final recovery, but dizziness was not associated with prognosis. CONCLUSIONS: Patients with APFP may have transient dizziness in the early stage, which may be more frequently accompanied by worse hearing thresholds and/or pain around the ear. However, these symptoms including dizziness seem to be unrelated to final prognosis.
Bell Palsy ; Dizziness ; Ear ; Facial Paralysis ; Hearing ; Herpes Zoster Oticus ; Hospitalization ; Humans ; Logistic Models ; Medical Records ; Otolaryngology ; Paralysis ; Prognosis

BACKGROUND: Herpes zoster of the head and neck commonly presents with Ramsay Hunt syndrome. However, vesicular eruptions may occur on the pharyngeal or laryngeal area with multiple lower cranial-nerve (CN) palsy. CASE REPORT: We report on the case of a 54-year-old man with herpes zoster of the pharynx and larynx with multiple CN palsy and persistent hiccups. He initially developed progressive dysphagia, hoarseness, and persistent hiccups (CN IX and X). After admission, Dizziness, hearing impairment, and peripheral facial palsy (CN VII and VIII) were complicated. The results of a polymerase chain reaction test of saliva and vesicular fluid from the ear and throat were strongly positive for varicella zoster virus. The progression of CN palsy was in an ascending sequence. CONCLUSION: We suggest that the sequence of CN palsy may be either ascending or descending, depending on the initial site of involvement.
Cranial Nerve Diseases ; Cranial Nerves ; Deglutition Disorders ; Dizziness ; Ear ; Facial Paralysis ; Head ; Hearing Loss ; Herpes Zoster Oticus ; Herpes Zoster ; Herpesvirus 3, Human ; Hiccup ; Hoarseness ; Humans ; Laryngitis ; Larynx ; Middle Aged ; Neck ; Paralysis ; Pharynx ; Polymerase Chain Reaction ; Saliva

Primary clinical features of rash and neurological complications due to varicella zoster virus (VZV) reactivation are rare in a healthy population, especially in immunocompetent children. Early diagnosis and prompt treatment are delayed often due to their rarity. We present four immunocompetent children with VZV reactivation resulting in aseptic meningitis and herpes zoster affecting multiple cranial and spinal nerves. We reviewed the clinical manifestations, laboratory findings, treatment options and outcome of aseptic meningitis associated VZV reactivation. All patients presented with the typical skin lesion of VZV reactivation and definitive laboratory findings of central nervous system infection, without systemic inflammation. Initial manifestations of VZV reactivation included Ramsay Hunt syndrome, herpes zoster ophthalmicus, and herpes zoster affecting the left thoracic dermatomes 4–5. Intravenous acyclovir was administered and all patients recovered fully without any significant sequelae. VZV reactivation can lead to various neurological complications in immunocompetent children. Early recognition and treatment with acyclovir are important for improving the outcome of neurologic complications of VZV reactivation.
Acyclovir ; Central Nervous System Infections ; Chickenpox ; Child* ; Early Diagnosis ; Exanthema ; Herpes Zoster Ophthalmicus ; Herpes Zoster Oticus ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Inflammation ; Meningitis, Aseptic* ; Skin ; Spinal Nerves

Ramsay Hunt syndrome (RHS) is characterized by herpes zoster oticus, facial nerve palsy, and vestibulocochlear symptoms. Dysphagia caused by the involvement of multiple cranial nerves (CNs) in RHS is very rare. We encountered a rare case presented with severe dysphagia due to cranial polyneuropathy involving trigeminal nerve (CN V), facial nerve (CN VII), vestibulocochlear nerve (CN VIII), glossopharyngeal nerve (CN IX), vagus nerve (CN X), and hypoglossal nerve (CN XII) in RHS. This case report suggested that the prognosis for dysphagia in RHS seems favorable, and swallowing rehabilitation therapy could be beneficial in expediting tube removal.
Cranial Nerves ; Deglutition ; Deglutition Disorders* ; Facial Nerve ; Glossopharyngeal Nerve ; Herpes Zoster Oticus* ; Hypoglossal Nerve ; Paralysis ; Polyneuropathies* ; Prognosis ; Rehabilitation ; Trigeminal Nerve ; Vagus Nerve ; Vestibulocochlear Nerve

Herpes zoster oticus, also called Ramsay-Hunt syndrome, involves the geniculate ganglion and presents with facial nerve palsy, sensorineural hearing loss, vestibular dysfunction, and auricular vesicular lesion. In this case, the patient presented with isolated vestibular dysfunctions without facial palsy and hearing impairment, and these findings were confirmed by electrophysiologic studies including video head impulse testing. Clinicians should be aware of this variation, and differentiate it from vestibular neuritis which usually does not require intensive antiviral therapies.
Facial Nerve ; Facial Paralysis* ; Geniculate Ganglion ; Head Impulse Test ; Hearing Loss* ; Hearing Loss, Sensorineural ; Hearing* ; Herpes Zoster Oticus* ; Herpes Zoster* ; Humans ; Paralysis ; Vestibular Neuronitis*