First described in 1907 by James Ramsay Hunt, Ramsay Hunt syndrome is a recurrence (reactivation) of varicella-zoster virus (VZV) affecting the geniculate ganglion, secondary to a decrease in cell-mediated immunity. T...First described in 1907 by James Ramsay Hunt, Ramsay Hunt syndrome is a recurrence (reactivation) of varicella-zoster virus (VZV) affecting the geniculate ganglion, secondary to a decrease in cell-mediated immunity. The strict definition of Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by erythematous vesicular rash on the ear. We report a 57-year-old female immunocompetent patient complaining of otalgia, small vesicles on the Ramsey Hunt Zone. She does not complain fever, hearing loss, nausea, vomiting or dizziness. There was no peripheral facial nerve palsy, no reduction of taste sensation, no ataxia or nystagmus, Romberg sign was negative. Our patient targets two of the three criteria needed for the diagnosis of Ramsay Hunt syndrome. She began to take Acyclovir-Steroid (AS) therapy very early with good outcome. This suggests that prompt diagnosis and management improve outcome and prevent occurrence of nerve palsy in Ramsay Hunt syndrome.展开更多
Objective: To discuss the diagnostic, therapeutic, and evolutionary aspects of a case of herpes zoster oticus associated with facial palsy in HIV conditions. Case Study: We report the case of a 32-year-old married fem...Objective: To discuss the diagnostic, therapeutic, and evolutionary aspects of a case of herpes zoster oticus associated with facial palsy in HIV conditions. Case Study: We report the case of a 32-year-old married female beautician patient admitted with severe right otalgia associated with a fever that had been evolving for three days. The addition of homolateral otorrhea and headache was noted. The initial examination on admission noted a vesicular rash of the pinna and the external third of the right external auditory canal with a normal tympanic membrane. The evolution was marked 48 hours later by the appearance of a right facial palsy grade V. The CT scan of the rock showed a mastoid and maxillary sinus hypodensity. The paraclinical exploration found a positive retroviral serology to HIV 1 and 2. The diagnosis retained was a Ramsay Hunt syndrome on HIV condition associated with ipsilateral maxillary sinusitis and mastoiditis. The treatment administered was a combination of amoxicillin/clavulanic acid injection of 3 g per day + oral aciclovir 200 mg, acetaminophen 1 g injectable every 6 h, betamethasone 4mg per day, vitamin B complex, artificial tear. Therapeutic inclusion in the HIV/AIDS national program was performed. The evolution was marked by the total regression of the facial palsy after six months of treatment. Conclusion: Otogenic diseases in HIV remain a problem in our context where the circumstances of discovery are most often fortuitous, hence the need to search for the serological status in front of any suspicion of viral infection in adults. The status may constitute a triggering factor or a factor of the severity of the pathology or of the symptoms such as facial palsy or deafness in our case. Early and adapted management has been shown to improve the prognosis.展开更多
Background: Tolosa Hunt Syndrome is an inflammatory condition of unknown etiology of the cavernous sinus and superior orbital fissure. Because of the difficulty in establishing histological evidence, his diagnosis is ...Background: Tolosa Hunt Syndrome is an inflammatory condition of unknown etiology of the cavernous sinus and superior orbital fissure. Because of the difficulty in establishing histological evidence, his diagnosis is based on a set of arguments established by the International Headache Society. MRI allows indirect visualization of the granuloma and plays a key role in diagnosis and follow-up. Aim: To illustrate High-field MRI contribution in Tolosa-Hunt Syndrome (THS). Cases Presentation: Two patients, a 25-year-old female and a 40-year-old male were recruited in this retrospective case report study at the Radiology service of Fann University Hospital (Dakar Senegal). The first patient has been suffering from a right retro-orbital pain and diplopia for 2 months and the second from a painful oculomotor nerve palsy for 3 months. Blood tests, lumbar puncture, thyroid hormone levels and an infectious screen were done. Screening for converting enzymes, and serum antibodies were also done. They underwent a high field MRI (Siemens 1.5T) with T1, T2, FLAIR, T2*, diffusion B1000, TOF polygon, CISS 3D and T1 gadolinium sequences in the 3 planes space. No significant abnormality was detected in blood tests or CSF analysis. Screening for converting enzymes and serum antibodies screen were also negative. For each patient, MRI examinations showed a non tumoral thickening of the right cavernous sinus, suggesting a granulomatous involvement. Tolosa Hunt Syndrome was evoked firstly. They were put on corticotherapy at high doses with a spectacular regression of symptoms. The Criteria of the International Headache Society of THS were met in both patients. Conclusion: High-field MRI is a significant diagnostic tool in the assessment of painful ophthalmoplegia. It allows a direct visualization of the granuloma of the cavernous sinus and assesses its course throughout the disease.展开更多
We describe herein a patient who presented with painful ophthalmoplegia and was ultimately diagnosed via magnetic imaging resonance studies and successfully treated for Tolosa-Hunt syndrome. Tolosa-Hunt syndrome is a ...We describe herein a patient who presented with painful ophthalmoplegia and was ultimately diagnosed via magnetic imaging resonance studies and successfully treated for Tolosa-Hunt syndrome. Tolosa-Hunt syndrome is a rare, reversible and painful ophthalmoplegia characterized by recurrent unilateral orbital pain, ipsilateral oculomotor paralysis and prompt response to steroids. Specific criteria for its diagnosis exist and are discussed herein. Individuals affected may display signs of select cranial nerve palsies, ptosis, facial numbness, diplopia, midrosis, and proptosis. Appropriate recognition of the disease can allow for immediate intervention and thus decrease the length and severity of symptoms especially as symptoms may not spontaneously resolve without treatment which leads to unnecessary suffering through pain, anxiety, and decreased vision. We describe the case presentation and keys for diagnosis emergency medicine that physicians should know for this potentially devastating condition.展开更多
文摘First described in 1907 by James Ramsay Hunt, Ramsay Hunt syndrome is a recurrence (reactivation) of varicella-zoster virus (VZV) affecting the geniculate ganglion, secondary to a decrease in cell-mediated immunity. The strict definition of Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by erythematous vesicular rash on the ear. We report a 57-year-old female immunocompetent patient complaining of otalgia, small vesicles on the Ramsey Hunt Zone. She does not complain fever, hearing loss, nausea, vomiting or dizziness. There was no peripheral facial nerve palsy, no reduction of taste sensation, no ataxia or nystagmus, Romberg sign was negative. Our patient targets two of the three criteria needed for the diagnosis of Ramsay Hunt syndrome. She began to take Acyclovir-Steroid (AS) therapy very early with good outcome. This suggests that prompt diagnosis and management improve outcome and prevent occurrence of nerve palsy in Ramsay Hunt syndrome.
文摘Objective: To discuss the diagnostic, therapeutic, and evolutionary aspects of a case of herpes zoster oticus associated with facial palsy in HIV conditions. Case Study: We report the case of a 32-year-old married female beautician patient admitted with severe right otalgia associated with a fever that had been evolving for three days. The addition of homolateral otorrhea and headache was noted. The initial examination on admission noted a vesicular rash of the pinna and the external third of the right external auditory canal with a normal tympanic membrane. The evolution was marked 48 hours later by the appearance of a right facial palsy grade V. The CT scan of the rock showed a mastoid and maxillary sinus hypodensity. The paraclinical exploration found a positive retroviral serology to HIV 1 and 2. The diagnosis retained was a Ramsay Hunt syndrome on HIV condition associated with ipsilateral maxillary sinusitis and mastoiditis. The treatment administered was a combination of amoxicillin/clavulanic acid injection of 3 g per day + oral aciclovir 200 mg, acetaminophen 1 g injectable every 6 h, betamethasone 4mg per day, vitamin B complex, artificial tear. Therapeutic inclusion in the HIV/AIDS national program was performed. The evolution was marked by the total regression of the facial palsy after six months of treatment. Conclusion: Otogenic diseases in HIV remain a problem in our context where the circumstances of discovery are most often fortuitous, hence the need to search for the serological status in front of any suspicion of viral infection in adults. The status may constitute a triggering factor or a factor of the severity of the pathology or of the symptoms such as facial palsy or deafness in our case. Early and adapted management has been shown to improve the prognosis.
文摘Background: Tolosa Hunt Syndrome is an inflammatory condition of unknown etiology of the cavernous sinus and superior orbital fissure. Because of the difficulty in establishing histological evidence, his diagnosis is based on a set of arguments established by the International Headache Society. MRI allows indirect visualization of the granuloma and plays a key role in diagnosis and follow-up. Aim: To illustrate High-field MRI contribution in Tolosa-Hunt Syndrome (THS). Cases Presentation: Two patients, a 25-year-old female and a 40-year-old male were recruited in this retrospective case report study at the Radiology service of Fann University Hospital (Dakar Senegal). The first patient has been suffering from a right retro-orbital pain and diplopia for 2 months and the second from a painful oculomotor nerve palsy for 3 months. Blood tests, lumbar puncture, thyroid hormone levels and an infectious screen were done. Screening for converting enzymes, and serum antibodies were also done. They underwent a high field MRI (Siemens 1.5T) with T1, T2, FLAIR, T2*, diffusion B1000, TOF polygon, CISS 3D and T1 gadolinium sequences in the 3 planes space. No significant abnormality was detected in blood tests or CSF analysis. Screening for converting enzymes and serum antibodies screen were also negative. For each patient, MRI examinations showed a non tumoral thickening of the right cavernous sinus, suggesting a granulomatous involvement. Tolosa Hunt Syndrome was evoked firstly. They were put on corticotherapy at high doses with a spectacular regression of symptoms. The Criteria of the International Headache Society of THS were met in both patients. Conclusion: High-field MRI is a significant diagnostic tool in the assessment of painful ophthalmoplegia. It allows a direct visualization of the granuloma of the cavernous sinus and assesses its course throughout the disease.
文摘We describe herein a patient who presented with painful ophthalmoplegia and was ultimately diagnosed via magnetic imaging resonance studies and successfully treated for Tolosa-Hunt syndrome. Tolosa-Hunt syndrome is a rare, reversible and painful ophthalmoplegia characterized by recurrent unilateral orbital pain, ipsilateral oculomotor paralysis and prompt response to steroids. Specific criteria for its diagnosis exist and are discussed herein. Individuals affected may display signs of select cranial nerve palsies, ptosis, facial numbness, diplopia, midrosis, and proptosis. Appropriate recognition of the disease can allow for immediate intervention and thus decrease the length and severity of symptoms especially as symptoms may not spontaneously resolve without treatment which leads to unnecessary suffering through pain, anxiety, and decreased vision. We describe the case presentation and keys for diagnosis emergency medicine that physicians should know for this potentially devastating condition.
