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Davis S, Thomas E, Lowery A, Kahue C, Gelbard A. Varicella Zoster Virus Reactivation Involving the Vagus Nerve. Ann Otol Rhinol Laryngol 2022:34894221111259. [PMID: 35833239 DOI: 10.1177/00034894221111259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To characterize the presentation, clinical course and functional outcomes of patients with varicella zoster virus (VZV) reactivation involving the vagus nerve. To highlight the role of otolaryngology in acute and long-term management of laryngopharyngeal VZV and its sequelae. METHODS Retrospective review of 3 patients with laryngopharyngeal VZV, managed at a tertiary referral center. RESULTS All cases presented with vesicular lesions involving mucosa of the laryngopharynx. Each experienced vocal fold hypomobility, among other otolaryngologic sequelae. All were treated with systemic antivirals and corticosteroids. Mucosal lesions resolved within 7 days of treatment initiation; functional deficits persisted for months to years. Dysphonia improved to a plateau at 3 months, while dysphagia took longer to resolve. One patient with disseminated disease experienced bilateral vocal fold paralysis requiring temporary tracheostomy. CONCLUSIONS Vagal neuropathy secondary to VZV reactivation is a rare clinical entity with a variety of laryngeal manifestations. Early initiation of systemic therapy and serial endoscopic evaluations are critical components of acute management when laryngopharyngeal involvement is suspected. Otolaryngologists should plan for long-term phonatory and deglutitive therapy in these cases, as neurologic sequelae can persist for months to years following initial insult. LEVEL OF EVIDENCE Level 4 (Case-series).
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Affiliation(s)
- Seth Davis
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evan Thomas
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anne Lowery
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Charissa Kahue
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander Gelbard
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Laryngology, Vanderbilt University Medical Center, Nashville, TN, USA
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2
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Tsai HS, Niu KY. A half tingling throat. BMJ 2022; 376:e067996. [PMID: 35210259 DOI: 10.1136/bmj-2021-067996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Hui-Shan Tsai
- Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuang-Yu Niu
- Department of Emergency Medicine, Chang Gung Memorial Hospital Keelung Branch and Chang Gung University College of Medicine, Keelung, Taiwan
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3
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Roy CF, Turkdogan S, Silver JA, Young J. Herpes Zoster of The Larynx: A Narrow Diagnostic and Therapeutic Window. EAR, NOSE & THROAT JOURNAL 2022:1455613221077594. [PMID: 35166603 DOI: 10.1177/01455613221077594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
We hereby present a rare case of laryngeal zoster presenting with unilateral odynophagia and hemifacial pain in an immunocompetent host. Visualization of the characteristic vesicles is challenging given their short-lived and at times delayed appearance; thus, laryngeal zoster may be a largely unrecognized cause of laryngitis and cranial neuropathies. Heightened awareness may improve prompt diagnosis, referral and initiation of antiviral therapy, while guiding patient counselling on the associated long-term sequelae such as voice and swallowing impairments, and post-herpetic neuralgia.
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Affiliation(s)
- Catherine F Roy
- Department of Otolaryngology Head and Neck Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
| | - Sena Turkdogan
- Department of Otolaryngology Head and Neck Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
| | - Jennifer A Silver
- Department of Otolaryngology Head and Neck Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
| | - Jonathan Young
- Department of Otolaryngology Head and Neck Surgery, 54473McGill University Health Centre, Montreal, QC, Canada
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4
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Hamdi OA, Jonas RH, Daniero JJ. Vocal Fold Paralysis Following COVID-19 Vaccination: Query of VAERS Database. J Voice 2022:S0892-1997(22)00017-0. [PMID: 35193788 PMCID: PMC8784575 DOI: 10.1016/j.jvoice.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Vocal fold paresis or paralysis (VFP) may severely affect quality of life due to dysphonia and respiratory distress. As an increasing percentage of the United States population receives the COVID-19 vaccination, the objective of this study is to determine the correlation of COVID-19 postvaccination recurrent laryngeal neuropathy and resulting VFP. METHODS The Vaccine Adverse Event Reporting System database was queried for patients exhibiting symptoms of VFP following COVID-19 vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, time of diagnosis and laterality. RESULTS Twenty patients were found to have laryngoscopy confirmed VFP following COVID-19 vaccination. Vaccinations for Pfizer-BioNTech, Moderna, and Janssen were reported. Of those reported, 13 patients were female (65.0%) and seven were male (35.0%), with a mean age of 61.8 years. The most common presenting symptom was a hoarse voice (30.0%). A majority of these cases were unilateral in nature (64.0%). Mean time from vaccination to symptom onset was 12.1 days and mean time from vaccination to diagnosis was 37.6 days. CONCLUSION For patients presenting with voice or swallowing complaints after receiving the COVID-19 vaccine, prompt evaluation by an otolaryngologist should occur. However, the potential VFP side effect of vaccination is very rarely cited in the literature and largely outweighed by the benefits of vaccination. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.
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Affiliation(s)
- Osama A Hamdi
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Rachel H Jonas
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - James J Daniero
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
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5
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Zamzam SM, Hanafy RG. Impact of COVID-19 on vocal cord mobility: a case series study. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2021. [PMCID: PMC8446466 DOI: 10.1186/s43163-021-00157-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The World Health Organization (WHO) has declared the pandemic of COVID-19 infection in March 2020, most of cases presented with mild symptoms, and a significant number of cases showed variable neurological pictures. Vocal cord paralysis with no clear cause is termed as idiopathic vocal cord paralysis and supposed to be caused by viral infection. This is a case series study; data were collected prospectively from patients presented to the ENT clinic of Kasr Alainy (Cairo university) and Railway hospitals. Patients presented with defective vocal cord movement with concurrently or recently passed COVID-19 infection were reported from March 2020 to April 2021. Results Authors have reported 6 cases of vocal cord paralysis mainly unilateral due to COVID-19 infection as an only clear cause within 14 months. Age ranges from 39 to 69 years, 2 males and 4 females. Patients presented with different clinical scenarios. Follow-up of the cases showed spontaneous recovery in 5 cases and one case underwent cord medialization. Conclusion Viral infection could be an underlying cause of idiopathic laryngeal cord paralysis; in the new era of the COVID-19 pandemic, physicians all over the world noticed variable neurological pictures; in this study, we presented 6 cases of vocal cord paralysis mainly unilateral supposed to be due to COVID-19 infection; all cases showed spontaneous recovery apart from one case that needed medialization of the cord.
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6
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Ananthapadmanabhan S, Soodin D, Sritharan N, Sivapathasingam V. Ramsay Hunt syndrome with multiple cranial neuropathy: a literature review. Eur Arch Otorhinolaryngol 2021; 279:2239-2244. [PMID: 34687339 DOI: 10.1007/s00405-021-07136-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ramsay Hunt Syndrome (RHS) is a neurotological disorder involving the reactivation of the varicella-zoster virus (VZV) in the geniculate ganglion of the facial nerve (Sweeney and Gilden in J Neurol Neurosurg Psychiatry 71:149-154, 2001). The characteristic presentation involves ipsilateral lower motor neuron type facial paresis, auricular pain with or without hearing impairment, and vesicular lesions of the external auditory canal and outer ear. Involvement of the facial and vestibulocochlear nerve is typical in RHS, whilst multiple cranial neuropathies are rare and associated with poorer prognosis and systemic complications (Arya et al. in Am J Case Rep 19:68-71, 2017; Shinha and Krishna in IDCases 2:47-48, 2015; Shim et al. in Acta Otolaryngol 131:210-215, 2011; Coleman et al. in J Voice 26:e27-e28, 2012; Morelli et al. in Neurol Sci 29:497-498, 2008;). Likely mechanisms involved in the pathogenesis of cranial polyneuropathy include direct peri-neural and trans-axonal spread of viral inflammation between contiguous cranial nerves and haematogenous dissemination between nerves with shared blood supply. Impairments in speech, swallowing, hearing, and oculo-protection can contribute to morbidity and requires a multidisciplinary approach to patient care. METHODS We present a rare case of RHS with multiple cranial neuropathies followed by a comprehensive review of current literature with regard to the pathophysiology, diagnostic workup, and the management strategies employed in these patients. CONCLUSION RHSs with multiple cranial neuropathies are important to recognise as they are associated with significant morbidity and poor prognosis. A multidisciplinary approach to patient management is required to address the several complications that can arise from cranial nerve deficits, especially in regard to speech and swallow.
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Affiliation(s)
| | - Dilshard Soodin
- Department of Otolaryngology, Nepean Hospital, Kingswood, NSW, 2747, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Nepean Hospital, Kingswood, NSW, 2747, Australia.,Department of Otolaryngology, Westmead Hospital, Westmead, NSW, 2145, Australia
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Wang Z, Lotina T, Malaty J. Uncommon presentation and complications of herpes zoster infection involving the cervical, vagus and accessory nerves which caused a delay in diagnosis and treatment. BMJ Case Rep 2021; 14:14/5/e241881. [PMID: 33962929 PMCID: PMC8108672 DOI: 10.1136/bcr-2021-241881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 70-year-old man with a history of invasive anal squamous cell carcinoma treated with excision and chemoradiation presented to the emergency department with right-sided neck pain and submandibular lymphadenopathy. CT imaging of the head and neck was unrevealing. The patient eventually developed cranial nerves X and XI dysfunction, manifesting as severe vocal cord paralysis (dysphonia), dysphagia, asymmetric palate elevation/deviation and trapezius muscle atrophy, in addition to scalene muscle atrophy. After an extensive workup, the patient's symptoms were determined to be due to sequelae of varicella zoster infection, which was confirmed with antibody titers. The patient's dysphagia and dysphonia eventually improved with vocal cord medialisation injection and Botox injection. However, despite delayed treatment with acyclovir and valacyclovir, the patient continued to have neuropathic pain and exhibit signs of CN X and CN XI paresis, in addition to scalene muscle atrophy.
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Affiliation(s)
- Ziqi Wang
- University of Florida Health, Gainesville, Florida, USA
| | - Thomas Lotina
- Department of Community Health and Family Medicine, University of Florida Physicians Family Practice Medical Group, Gainesville, Florida, USA
| | - John Malaty
- Department of Community Health and Family Medicine, University of Florida Physicians Family Practice Medical Group, Gainesville, Florida, USA
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8
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Talmor G, Nguyen B, Din-Lovinescu C, Paskhover B, Kaye R. Vocal Fold Immobility Following Vaccination. Ann Otol Rhinol Laryngol 2020; 130:609-613. [PMID: 33063519 DOI: 10.1177/0003489420965633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Vocal fold immobility (VFI) may severely affect quality of life due to dysphonia and respiratory distress. Many etiologies of this disorder have been evaluated, however the relationship between VFI and vaccination has yet to be explored. The objective of this study was to identify the relationship between VFI and vaccine administration. METHODS The Vaccine Adverse Event Reporting System (VAERS) database was queried for patients exhibiting symptoms of VFI following vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, laterality, outcomes, and adverse events were documented. RESULTS Twenty-two patients were found to have VFI following vaccination. Of those reported, 13 patients were female (59.1%) and 8 were male (36.4%) with an average age of 48.4 years. Vaccinations for influenza, shingles, pneumococcus, and hepatitis B were reported. A majority of these cases were unilateral in nature (73.3%). Mean lag time from vaccination to symptom onset was 6.3 days (range 0-45 days). Five adverse events were reported, with 4 patients requiring intubation and tracheostomy. CONCLUSION Vaccine administration may be associated with VFI and physicians should be cognizant of this potential adverse event. This is a rare complication with less reported cases than other post-vaccination cranial neuropathies. The difficulty in establishing an initial diagnosis and need for specialized evaluation by an otolaryngologist may result in under-reporting of such events. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.
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Affiliation(s)
- Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Brandon Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Corina Din-Lovinescu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Boris Paskhover
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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9
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Yagi H, Horita S, Komura M, Sakai Y, Mukosaka F. Pharyngolaryngeal herpes zoster: A pediatric case. Pediatr Int 2020; 62:990-992. [PMID: 32715557 DOI: 10.1111/ped.14213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Hideya Yagi
- Department of Pediatrics, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Seiki Horita
- Department of Pediatrics, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Mao Komura
- Department of Pediatrics, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Yuta Sakai
- Department of Pediatrics, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Fumiya Mukosaka
- Department of Pediatrics, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
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10
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Zhou J, Li J, Ma L, Cao S. Zoster sine herpete: a review. Korean J Pain 2020; 33:208-215. [PMID: 32606265 PMCID: PMC7336347 DOI: 10.3344/kjp.2020.33.3.208] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
Zoster sine herpete (ZSH) is one of the atypical clinical manifestations of herpes zoster (HZ), which stems from infection and reactivation of the varicella-zoster virus (VZV) in the cranial nerve, spinal nerve, viscera, or autonomic nerve. Patients with ZSH display variable symptoms, such as neuralgia, however, different from HZ, ZSH show no zoster, which makes clinical diagnosis difficult. ZSH not only causes initial symptoms, such as neuropathic pain in the affected nerve, Bell palsy, and Ramsay Hunt syndrome, but also postherpetic neuralgia and fatal complications such as VZV encephalitis and stroke. The misdiagnosis of ZSH and tardy antiviral treatment may lead to severe ZSH sequelae. We review the publications related to ZSH, especially its diagnosis with VZV DNA and/or anti-VZV immunoglobulin (IgG and IgM). More work about ZSH, especially ZSH epidemiological survey and guidelines for its diagnosis and treatment, are needed because most of the present studies are case reports.
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Affiliation(s)
- Junli Zhou
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Juan Li
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lulin Ma
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Song Cao
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
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11
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Bhatt NK, Pipkorn P, Paniello RC. Association between Upper Respiratory Infection and Idiopathic Unilateral Vocal Fold Paralysis. Ann Otol Rhinol Laryngol 2018; 127:667-671. [PMID: 30124061 DOI: 10.1177/0003489418787542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Unilateral vocal fold paralysis (UVFP) without an identifiable cause is termed idiopathic unilateral vocal fold paralysis (IUVFP). Some authors have postulated that select cases of IUVFP have a viral etiology, but the causality has not been established. We set out to review institutional cases of IUVFP and determine if there is a correlation between upper respiratory infection symptoms and presentation of IUVFP. METHODS Cases of IUVFP were reviewed over a 10-year period (2002-2012). The history was investigated to review presenting symptoms. We specifically reviewed for symptoms of upper respiratory infection at the onset of UVFP and tallied the frequency. Symptoms included sore throat, laryngitis, cough, influenza, bronchitis, pneumonia, otalgia, and sinusitis. The seasonal onset (if possible) was determined based on the history provided from the initial consultation. STUDY DESIGN Case series. RESULTS Overall, 107 patients presented with IUVFP; 35.5% of patients reported symptoms of upper respiratory infection at the onset of UVFP. Among these individuals, pharyngitis/laryngitis was the most common presenting symptom; 34.2% reported cough. In total, 40.0% of patients with IUVFP reported an onset of symptoms between December and February. CONCLUSIONS This study suggests that symptoms of upper respiratory infection frequently occur with the presentation of IUVFP. The onset of symptoms tended to occur between December and February. The mechanism of viral-mediated UVFP has not been established. Future studies to explore this pathophysiology are needed.
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Affiliation(s)
- Neel K Bhatt
- 1 Department of Otolaryngology - Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- 1 Department of Otolaryngology - Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Randal C Paniello
- 1 Department of Otolaryngology - Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA
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12
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Muhle P, Suntrup-Krueger S, Dziewas R, Warnecke T. Pharyngeal dysphagia due to Varicella zoster virus meningoradiculitis and full recovery: Case report and endoscopic findings. SAGE Open Med Case Rep 2018; 6:2050313X18756560. [PMID: 29468067 PMCID: PMC5813848 DOI: 10.1177/2050313x18756560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/10/2018] [Indexed: 12/26/2022] Open
Abstract
Varicella zoster virus reactivation is a rare cause of pharyngeal dysphagia with long-term sequelae persisting in most cases. A 76-year-old immunocompetent woman presented with a 4-week history of dysphagia and dysphonia. Brain magnetic resonance imaging displayed a negative finding. Fiberoptic endoscopic evaluation of swallowing showed a severe dysphagia leading to a percutaneous gastrostomy eventually. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis and polymerase chain reaction amplified Varicella zoster virus DNA. Eight months after Acyclovir treatment and despite a persisting impairment of the recurrent laryngeal nerve, regular swallowing function was regained and percutaneous gastrostomy could be removed.
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Affiliation(s)
- Paul Muhle
- Department of Neurology, University Hospital Muenster, Münster, Germany
| | | | - Rainer Dziewas
- Department of Neurology, University Hospital Muenster, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Münster, Germany
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13
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Steele L, Ghedia R, Ahmad H, Mace A. Ramsay Hunt syndrome with cranial polyneuropathy with features of supraglottitis. BMJ Case Rep 2017; 2017:bcr-2017-221135. [PMID: 28784901 DOI: 10.1136/bcr-2017-221135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 67-year-old woman presented with a 1-week history of left otalgia and a 1-day history of odynophagia, pain extending into the face and neck, and a productive cough. Flexible nasendoscopy showed features of supraglottitis, with swollen arytenoids and pooling of saliva in the piriform fossae. Laboratory investigations revealed a mildly raised C reactive protein. A CT scan of the neck supported the diagnosis of supraglottitis and pharyngitis, with thickening of the mucosa of the left piriform fossae and left oropharynx. Standard supraglottitis treatment was instigated, but on day 4 of the admission, a vesicular rash and features of cranial nerve involvement (V, VII, VIII, X) developed. A revised diagnosis of Ramsay Hunt syndrome with cranial polyneuropathy was made and later confirmed by varicella zoster virus PCR. After 4 weeks, facial nerve function normalised, but features of other cranial nerve palsies were persistent.
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Affiliation(s)
- Lloyd Steele
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Hena Ahmad
- Imperial College Healthcare NHS Trust, London, UK
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Bharadwaj S, Moffat AC, Wood B, Bharadwaj A. Herpetic cranial polyneuritis mimicking brain stem infarction-an atypical presentation of Ramsay Hunt syndrome. BMJ Case Rep 2016; 2016:bcr-2016-215182. [PMID: 27251418 DOI: 10.1136/bcr-2016-215182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
An elderly man presented with severe right ear pain and discharge, hoarseness and dysphagia causing significant involuntary weight loss. Extensive investigations by varied specialties only highlighted right vocal cord palsy and right parotid lymphadenitis. Reassessment on transfer to a rehabilitation ward noted clinically subtle right Ramsay Hunt syndrome with multiple lower cranial nerve involvement. We illustrate a case of varicella zoster virus cranial polyneuritis with bulbar symptoms mimicking bulbar stroke, requiring percutaneous endoscopic gastrostomy feeds, with significant clinical and radiological recovery over 1 year.
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Affiliation(s)
- Sneha Bharadwaj
- Department of Geriatric Medicine, Fremantle Hospital, Perth, Western Australia, Australia
| | | | - Brad Wood
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Avinash Bharadwaj
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Perth, Western Australia, Australia
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15
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Taniguchi D, Nakahara Ph D T, Nakajima S, Nakazato T, Mikasa M, Furukawa Ph D Y. [Successful treatment with acyclovir and a corticosteroid for lower cranial polyneuropathy in zoster sine herpete: a case report]. Rinsho Shinkeigaku 2015; 55:932-5. [PMID: 26511031 DOI: 10.5692/clinicalneurol.cn-000781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 62-year-old woman developed meningitis as well as acute paralysis of glossopharyngeal, vagus, and accessory nerves on the right side and also had dysfunction of the left hypoglossal nerve. Although there was no evidence of a typical cutaneous or mucosal herpetic lesion, PCR detection of varicella zoster virus (VZV)-DNA in cerebrospinal fluid confirmed the clinical diagnosis of polyneuritis cranialis due to VZV infection and zoster sine herpete. After starting intravenous acyclovir and methylprednisolone, her hypoglossal nerve palsy disappeared within a day and all other symptoms and signs dramatically improved. A rapid improvement observed in our patient suggests that the right cranial polyneuropathy could be caused by inflammation associated with epineurial edema (where the ninth, tenth, and eleventh cranial nerves pass through the right jugular foramen), whereas the exact mechanism of the twelfth cranial nerve involvement on the contralateral side is unknown. Our clinical findings indicate that acute lower cranial polyneuropathy in patients with zoster sine herpete should be treated immediately with combined administration of acyclovir and an anti-inflammatory corticosteroid.
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Affiliation(s)
- Daisuke Taniguchi
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center
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