To examine the neurophysiologic status in patients with idiopathic facial nerve palsy (Bell's palsy) and Ramsay Hunt syndrome (herpes zoster oticus) within 7 days from onset of symptoms, by comparing the amplitude of compound muscle action potentials (CMAP) of facial muscles in electroneuronography (ENoG) and transcranial magnetic stimulation (TMS).
The facial nerve conduction study using ENoG and TMS was performed in 42 patients with Bell's palsy and 14 patients with Ramsay Hunt syndrome within 7 days from onset of symptoms. Denervation ratio was calculated as CMAP amplitude evoked by ENoG or TMS on the affected side as percentage of the amplitudes on the healthy side. The severity of the facial palsy was graded according to House-Brackmann facial grading scale (H-B FGS).
In all subjects, the denervation ratio in TMS (71.53±18.38%) was significantly greater than the denervation ratio in ENoG (41.95±21.59%). The difference of denervation ratio between ENoG and TMS was significantly smaller in patients with Ramsay Hunt syndrome than in patients with Bell's palsy. The denervation ratio of ENoG or TMS did not correlated significantly with the H-B FGS.
In the electrophysiologic study for evaluation in patients with facial palsy within 7 days from onset of symptoms, ENoG and TMS are useful in gaining additional information about the neurophysiologic status of the facial nerve and may help to evaluate prognosis and set management plan.
Citations
In herpes zoster infection, neurological complications may be overlooked because pain is a more prominent symptom and because peripheral polyneuropathy associated with weakness is rare. A 57-year-old male visited our hospital, complaining of pain and skin eruptions on the right flank. He was diagnosed as having herpes zoster and the symptoms were alleviated by administration of acyclovir for a week. After three weeks, the herpes zoster relapsed. He was re-admitted and diagnosed with chronic myeloid leukemia (CML), and imatinib mesylate was prescribed for five weeks. Ten weeks after the onset of herpes zoster, bilateral foot drops and numbness of the right foot dorsum developed. Through an electrodiagnostic study, he was diagnosed as having peripheral polyneuropathy that was suspected to be caused by neural invasion by varicella zoster virus. After administration of famciclovir, not only the pain but also the neurologic symptoms improved. We herein report a case of peripheral polyneuropathy that was supposed to be related to herpes zoster.
Citations
Ramsay-Hunt syndrome is caused by varicella zoster virus infection in the geniculate ganglion of the facial nerve. It is characterized by facial palsy, otic pain, and herpetic vesicles around the auricle and external auditory canal. Additionally, symptoms may develop related to other cranial nerve involvement, such as dizziness or hearing loss by the vestibulocochlear nerve being invaded. We report a rare case of a Ramsay-Hunt syndrome patient who developed dysphagia due to multiple cranial nerve involvement including the glossopharyngeal nerve and vagus nerve.
Citations
Objective: To assess the clinical manifestation of acute herpes zoster associated pain (AHP) and postherpetic neuralgia (PHN) and nerve block effect in AHP and PHN.
Method: We assessed twenty eight patients by physical examination and pain questionairre, and nerve block effect in thirty one patients. We injected local anesthetics and triamcinolone into nerve root or trunk in study group, and saline in control group. The effect was assessed by visual analogue scale.
Result: 1. Clinical manifestation: There was high incidence in thoracic dermatome. AHP and PHN patients expressed "sharp" pain. Pain rating index of AHP and PHN were 32.9, 33.0. 2. Nerve block effect: There was no nerve block effect in AHP (p＞0.05) and PHN (p＞0.05), but four patients of PHN patients in study group had significant pain relief, who suffered from pain during 2 month, 10 month, 6 years, 8 years.
Conclusion: AHP and PHN had variable clinical manifestation but no difference between them. There was no nerve block effect in AHP and PHN but we can consider nerve block as a additive method for pain relief of PHN because some patients responded to nerve block and there was no significant complication in nerve block.
Widespread neurological disorders following herpes zoster are rare. These include radiculopathy, myelitis, contralateral hemiparesis, encephalitis and postherpetic neuralgia. Herpes zoster can be easily diagnosed by the appearance of the vesicular eruption following a dermatomal distribution, and the associated radiculopathy can be confirmed by electromyography. We present clinical symptoms, signs and electrodiagnostic findings of two cases of radiculopathy related to herpes zoster infection.
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