摘要
目的提高对以舌咽、迷走、位听神经损害为首发症状的Ramsay Hunt综合征的认识,在临床中早期诊断,早期治疗,避免误诊、误治。方法回顾性分析2015年6月至2019年8月作者医院收治的6例以舌咽、迷走、位听神经损害为首发症状的Ramsay Hunt综合征患者,对其临床资料进行分析总结。结果6例患者中男、女各3例,年龄34~70岁,平均(57.2±12.1)岁。4例患者首发症状为声音嘶哑和咽痛,2例为眩晕、恶心呕吐,均在首发症状3~14 d后发现周围性面瘫。6例患者病程中均有耳痛、咽痛,3例有听力下降,2例有疱疹。6例患者面神经神经传导提示病变侧面神经运动传导潜伏期较对侧延长,5例患者病变侧面神经运动波幅较对侧下降。3例患者电测听提示轻度感音神经性耳聋。4例患者电子喉镜提示病变侧喉黏膜出现散在点状白色伪膜,2例患者声带不同程度麻痹。6例患者均经过抗病毒联合糖皮质激素治疗,疗程结束时,所有病例耳痛、咽痛均减轻或缓解,2例耳后疱疹均消失,2例听力部分恢复。随访12个月后,痊愈4例,2例遗留部分面瘫和声嘶。结论部分Ramsay Hunt综合征可以声音嘶哑、咽痛、眩晕为首发症状,耳痛可以提高诊断的敏感性,喉镜检查多有阳性发现,经抗病毒联合糖皮质激素治疗,多数患者远期预后良好。
Objective To improve the understanding of Ramsay Hunt syndrome with glossopharyngeal and vagus nerve damage as the first symptoms,and to facilitate.Early diagnosis and early treatment in clinical practice.Methods The clinical data of 6 patients with Ramsay Hunt syndrome with glossopharyngeal and vagus nerve damage as the first symptoms from June 2015 to August 2019 were analyzed retrospectively.Results In the six patients,three were male and three were female,aged 34 to 70 years,with a mean age of(57.2±12.1)years.Four patients had hoarseness and sore throat as their first symptoms,two had vertigo,nausea and vomiting,and all the patients had peripheral facial palsy detected 3 to 14 d after their first symptoms.All the six patients had otalgia and sore throat,three had hearing loss,and two had herpes during the course of the disease.In the 6 patients,the facial nerve conduction indicated that the latency of the involved side was prolonged compared with the contralateral side,and in 5 patients,the amplitude of the involved side was decreased compared with the contralateral side.Three patients had mild sensorineural deafness on electrical audiometry,4 patients had scattered white pseudomembranes in the laryngeal mucosa of the involved side,and 2 patients had varying degrees of vocal fold paralysis.All the patients were treated with antiviral therapy combined with glucocorticoids.At the end of the treatment,ear pain,pharynx pain relieved or eased in all the patients,herpes posterior to the ear disappeared in 2 cases,listening partially recovered in 2 cases.After 12 months of follow-up,4 patients were cured and 2 patients had partial facial palsy and hoarseness.Conclusions Some patients with Ramsay Hunt syndrome may have hoarseness,sore throat,and vertigo as the presenting symptoms;otalgia may increase the sensitivity of diagnosis;laryngoscopy mostly has positive findings;with antiviral combined with glucocorticoid therapy,most patients have a good long-term prognosis.
作者
刘丽娟
张洁
孔双艳
刘海成
邢岩
LIU Lijuan;ZHANG Jie;KONG Shuangyan;LIU Haicheng;XING Yan(不详;Department of Neurology,Aviation General Hospital,Beijing 100012,China)
出处
《中国神经免疫学和神经病学杂志》
CAS
北大核心
2021年第4期307-311,共5页
Chinese Journal of Neuroimmunology and Neurology