The Ramsay-Hunt syndrome It consists of a peripheral-type facial paralysis (PFP), caused by the herpes zoster virus. In addition, it is associated with an involvement of the external auditory canal and the tympanic membrane..
Ramsay-Hunt syndrome is an infectious medical condition that is also the second cause of peripheral facial paralysis without traumatic origin. The clinical presentation of this pathology is very varied, being frequent to find it classified into four stages.
However, some of the symptoms and medical complications that occur as a result of Ramsay-Hunt syndrome may include: facial paralysis, headache, nausea, elevated body temperature, hearing loss, tinnitus, vertigo, among others..
On the other hand, in the case of the diagnosis of this pathology, the medical history and physical examination are essential. In addition, it is also possible to perform various complementary tests to specify the clinical findings..
Treatment of Ramsay-Hunt syndrome usually includes the administration of corticosteroids and antivirals. The essential objective of medical interventions is to avoid secondary medical sequelae.
Article index
It is a rare neurological disorder characterized by facial paralysis, involvement of the external auditory canal and the tympanic membrane.
Different names have been used in the medical literature to designate this pathology. Currently, Ramsay-Hunt syndrome (SRH) is the term used to refer to the set of symptoms that occur as a sequence of facial nerve involvement due to herpes zoster infection.
This medical condition was initially described by the physician James Ramsay Hunt, in 1907. In one of his clinical reports they presented a case characterized by facial paralysis and herpetic lesions in the auditory canal..
This pathology can also be called otic herpes zoster and is considered a polyneuropathy caused by a neurotrophic virus.
The term polyneuropathy is used to refer to the presence of an injury to one or more nerves, regardless of the type of injury and the anatomical area affected. On the other hand, neurotropic viruses are pathological agents that essentially attack the nervous system (SN).
Thus, Ramsay-Hunt syndrome specifically affects the facial nerve. The facial nerve or cranial nerve VII, is a nerve structure that has the function of controlling a large part of the functions of the facial area..
In addition, the facial nerve is a paired structure that runs through a bony canal, in the skull, below the ear area, towards the facial muscles..
When any pathological event (trauma, degeneration, infection, etc.) leads to the development of lesions or inflammation in the facial nerve, the muscles responsible for controlling facial expression can become paralyzed or weakened.
When the herpes zoster virus reaches the facial nerve and adjacent regions, a wide variety of signs and symptoms may appear skin, muscle, sensory, etc..
Ramsay-Hunt syndrome is the second leading cause of atraumatic peripheral facial palsy (PFP). Statistical studies estimate that Ramsay-Hunt syndrome covers 12% of facial paralysis, approximately 5 cases per 100,000 inhabitants per year..
Regarding sex, there are no significant differences, therefore, it affects men and women equally.
Although anyone who has had chickenpox can develop this pathology, it is more common among adults. Specifically, it can be observed more frequently in the second and third decades of life..
Ramsay-Hunt syndrome is an infrequent or rare pathology in children..
The clinical manifestations of Ramsay-Hunt syndrome are varied, the symptoms can be grouped into several categories:
Apart from this grouping, the characteristic symptoms of Ramsay-Hunt syndrome usually vary from one case to another. In most cases, there may be a prodromal phase characterized by the presence of:
On the other hand, various skin lesions also appear on the external pinna and in the posterior areas of the tympanic membrane:
In addition, of the signs and symptoms detailed above, facial paralysis is one of the most serious and notable.
In the patient affected by Ramsay-Hunt syndrome, it is possible to observe a decrease or absence of facial mobility, half of the face is paralyzed or "drooping".
Therefore, many people tend to have various deficits associated with the muscles that control facial expression: inability to close their eyes, smile, frown, raise eyebrows, speak and / or eat..
On the other hand, the herpes zoster virus in addition to the facial nerve or cranial nerve VII, can also affect the vestibulocochlear nerve, cranial nerve VIII.
The vestibulocochlear nerve plays an essential role in controlling additive function and balance. Thus, when some of its two branches (cochlear or vestibular) are affected, various sensory symptoms may appear:
Specifically, the symptoms products of vestibulocochlear nerve involvement are specified in:
Because the clinical presentation of Ramsay-Hunt syndrome is very varied, it is usually classified into 4 stages (clinical ramsay-Hunt classification):
Ramsay-Hunt syndrome is caused by the Varicella-Zoster virus (VZV). This virus is the cause of chickenpox and shingles.
Various experimental studies indicate that once chickenpox has been contracted, the virus can remain dormant for decades. However, due to some conditions (stress, fever, tissue damage, radiation therapy, immunosuppression), it can reactivate and, in some cases, lead to the development of Ramsay-hunt syndrome..
The diagnosis of Ramsay-Hunt syndrome is usually confirmed through history and clinical examination, complementary tests, and neuroimaging techniques..
The clinical history of the patient must include the family and personal medical history, the record of symptoms, time of presentation and evolution of the pathology, in addition to other aspects.
The clinical examination should be based on a thorough examination of the symptoms present. In addition, it is also essential to carry out a neurological examination, to determine the presence of nerve damage.
As for the complementary tests that are usually used, cytodiagnosis or serological study of the virus, they are essential to determine the presence of an infection caused by the varicella-zoster virus..
In the case of imaging tests, magnetic resonance imaging or computed tomography, they are useful to confirm the presence of neurological damage.
In addition to these, other types of complementary tests are also used, such as audiometries, brain stem evoked potentials, or electroneurography of the facial nerve, to assess the degree of hearing impairment and the degree of facial nerve involvement.
The treatment used in Ramsay-Hunt syndrome focuses on stopping the infectious process, reducing symptoms and pain, and also reducing the risk of developing neurological and physical sequelae in the long term..
Pharmacological interventions usually include:
On the other hand, other non-pharmacological therapeutic interventions can also be used, such as surgical decompression..
This type of surgical approach is still very controversial, it is usually restricted to cases that do not respond to drug treatment in at least a time greater than 6 weeks.
Antiviral drugs and corticosteroids are generally the treatment of choice for most cases of Ramsay-Hunt syndrome..
The clinical evolution of Ramsay-Hunt syndrome is usually worse than expected in other facial paralyzes. Approximately, a set of cases that range from 24-90% of the total, usually show significant medical sequelae.
Although, with good medical intervention, both facial paralysis and hearing loss are temporary, in some cases it can become permanent.
In addition, the muscle weakness caused by facial paralysis, prevents the efficient closing of the eyelid and, therefore, external agents can cause eye injuries. Eye pain or blurred vision may appear as one of the medical sequelae.
In addition, severe cranial nerve involvement can also cause persistent pain, long after the other signs and symptoms have resolved..
Yet No Comments