Abstract
Ramsay Hunt syndrome (RHS) is an acute peripheral facial nerve paralysis typically accompanied by erythematous vesicular lesions of the auricular skin. The etiology is considered to be geniculate ganglionitis due to reactivation of varicella-zoster virus (VZV). Encephalitis is a rare but serious complication of VZV reactivation. Clarifying the regional and temporal evolution of the lesions on magnetic resonance imaging (MRI) would help with understanding the pathology of the lesion, but this information is lacking in encephalitis with RHS. Therefore, here, we reviewed sequential MR images in three RHS cases complicated by brainstem lesions. All the regions of the lesions represent specific neuronal structures—the ipsilateral solitary nucleus (SN) and spinal trigeminal nucleus and tract (STNT) in case 1; bilateral SN, ipsilateral STNT, and vestibular nucleus in case 2; ipsilateral SN and vestibular nucleus in case 3—and this seems to account for the persistent robust symptoms. Case 1 initially showed no abnormalities on MRI and cases 2 and 3 showed weak signals on the first MRI which subsequently plateaued. These observations suggest the timeframe within which it becomes possible to detect regional and temporal evolution, namely, that the distribution of the affected regions expands between weeks 2 and 5 after onset of facial paralysis. These observations and the findings of a literature review indicate that the SN, STNT, and vestibular nucleus are relatively prone to developing encephalitis after RHS.
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References
Bradshaw MJ, Venkatesan A (2016) Herpes simplex virus-1 encephalitis in adults: pathophysiology, diagnosis, and management. Neurotherapeutics 13:493–508
Calabria F, Zappini F, Vattemi G, Tinazzi M (2014) Pearls & Oy-sters: an unusual case of varicella-zoster virus cerebellitis and vasculopathy. Neurology 82:e14–e15
Clerk-Lamalice O, Savage J, Fisch C (2015) Long-term MRI signal change in the spinal trigeminal nucleus and tract after Ramsay Hunt syndrome and trigeminal herpes zoster. Neurographics 5:68–71
Hu S, Walker M, Czartoski T, Cheng A, Forghani B, Gilden DH, Garden GA (2004) Acyclovir responsive brain stem disease after the Ramsay Hunt syndrome. J Neurol Sci 217:111–113
Kaski D, Davies N, Seemungal BM (2012) Varicella-zoster virus meningo-rhombencephalitis presenting as Ramsey Hunt. Neurology 79:2291–2292
Kim JH, Chung PW, Oh S, Hong SB, Chung C-S, Jung CW, Kim ST, Hong SD, Seo D-W (2007) Ramsay Hunt syndrome complicated by a brainstem lesion. J Clin Virol 39:322–325
Mizock BA, Bartt R, Agbemazdo B (2000) Herpes zoster oticus with pontine lesion: segmental brain-stem encephalitis. Clin Infect Dis 30:229–230
Nagel MA, Gilden D (2014) Neurological complications of VZV reactivation. Curr Opin Neurol 27:356–360
Nagel M, Cohrs R, Mahalingam R, Wellish M, Forghani B, Schiller A, Safdieh J, Kamenkovich E, Ostrow L, Levy M (2008) The varicella zoster virus vasculopathies clinical, CSF, imaging, and virologic features. Neurology 70:853–860
Nogueira RG, Seeley WW (2003) Ramsay Hunt syndrome associated with spinal trigeminal nucleus and tract involvement on MRI. Neurology 61:1306–1307
Ricigliano VA, Saraceno L, Cavalli M, Rodegher M, Meola G (2017) Slowly progressing varicella zoster brainstem encephalitis complicating Ramsay Hunt syndrome in an immunocompetent patient: case report and review of the literature. J Neurovirol 23:922–928
Sawlani V (2009) Diffusion-weighted imaging and apparent diffusion coefficient evaluation of herpes simplex encephalitis and Japanese encephalitis. J Neurol Sci 287:221–226
Shen Y-Y, Dai T-M, Liu H-L, Wu W, Tu J-L (2015) Ramsay hunt syndrome complicated by brainstem encephalitis in varicella-zoster virus infection. Chin Med J 128:3258
Wackym PA (1997) Molecular temporal bone pathology: II. Ramsay Hunt syndrome (herpes zoster oticus). Laryngoscope 107:1165–1175
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All patients provided written informed consent, and the institutional review board at Nagoya City University approved this retrospective study.
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Inagaki, A., Toyoda, T., Mutou, M. et al. Ramsay Hunt syndrome associated with solitary nucleus, spinal trigeminal nucleus and tract, and vestibular nucleus involvement on sequential magnetic resonance imaging. J. Neurovirol. 24, 776–779 (2018). https://doi.org/10.1007/s13365-018-0673-x
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DOI: https://doi.org/10.1007/s13365-018-0673-x