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Treatment of Ramsay-Hunt's syndrome with multiple cranial nerve involvement and severe dysphagia: A case report.

Abstract Ramsay-Hunt's syndrome (RHS) is a disorder characterized by facial paralysis, herpetic eruptions on the auricle, and otic pain due to the reactivation of latent varicella zoster virus in the geniculate ganglion. A few cases of multiple cranial nerve invasion including the vestibulocochlear nerve, glossopharyngeal nerve and vagus nerve have been reported. However, there has been no report about RHS with delayed onset multiple cranial nerve involvement causing severe aspiration, and a clinical course that improved after more than one year of dysphagia rehabilitation and percutaneous endoscopic gastrostomy (PEG). Here, we report on a 67-year old male with delayed onset swallowing difficulty after 16 days of RHS development.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29703055
OWN - NLM
STAT- MEDLINE
DCOM- 20180507
LR  - 20180516
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 17
DP  - 2018 Apr
TI  - Treatment of Ramsay-Hunt's syndrome with multiple cranial nerve involvement and
      severe dysphagia: A case report.
PG  - e0591
LID - 10.1097/MD.0000000000010591 [doi]
AB  - RATIONALE: Ramsay-Hunt's syndrome (RHS) is a disorder characterized by facial
      paralysis, herpetic eruptions on the auricle, and otic pain due to the
      reactivation of latent varicella zoster virus in the geniculate ganglion. A few
      cases of multiple cranial nerve invasion including the vestibulocochlear nerve,
      glossopharyngeal nerve and vagus nerve have been reported. However, there has
      been no report about RHS with delayed onset multiple cranial nerve involvement
      causing severe aspiration, and a clinical course that improved after more than
      one year of dysphagia rehabilitation and percutaneous endoscopic gastrostomy
      (PEG). Here, we report on a 67-year old male with delayed onset swallowing
      difficulty after 16 days of RHS development. PATIENT CONCERN: Severe aspiration
      during swallowing. DIAGNOSIS: Severe dysphagia caused by RHS with multiple
      cranial nerve involvement. INTERVENTION: Application of percutaneous endoscopic
      gastrostomy (PEG) and rehabilitation therapy of dysphagia. OUTCOMES: After 13
      months from symptom onset, his PAS improved from 7 to 2 in follow-up
      video-fluoroscopic swallowing study (VFSS). Then, he was re-admitted, and the PEG
      tube was removed and oral feeding was started. LESSONS: This case gives us the
      lesson that optimal doses of acyclovir and corticosteroids are important to
      prevent progression of multiple cranial involvement in RHS, and swallowing
      difficulty in RHS patients with multiple cranial nerve involvement can be
      improved through long-term rehabilitation even if there is no improvement for
      more than one year.
FAU - Kim, Jong Min
AU  - Kim JM
AD  - Department of Rehabilitation Medicine, Daegu Fatima Hospital.
FAU - Lee, Zeeihn
AU  - Lee Z
AD  - Department of Rehabilitation Medicine, Daegu Fatima Hospital.
FAU - Han, Seungwoo
AU  - Han S
AD  - Division of Rheumatology, Department of Internal Medicine, Kyungpook National
      University School of Medicine, Daegu, Korea.
FAU - Park, Donghwi
AU  - Park D
AD  - Department of Rehabilitation Medicine, Daegu Fatima Hospital.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Antiviral Agents)
RN  - X4HES1O11F (Acyclovir)
SB  - AIM
SB  - IM
MH  - Acyclovir/*administration & dosage
MH  - Adrenal Cortex Hormones/administration & dosage
MH  - Aged
MH  - Antiviral Agents/*administration & dosage
MH  - Combined Modality Therapy
MH  - Cranial Nerve Diseases/*therapy/virology
MH  - Deglutition Disorders/*therapy/virology
MH  - Exercise Therapy/methods
MH  - Gastrostomy/methods
MH  - Herpes Zoster Oticus/complications/*drug therapy
MH  - Humans
MH  - Male
MH  - Respiratory Aspiration/therapy/virology
MH  - Treatment Outcome
PMC - PMC5944505
EDAT- 2018/04/29 06:00
MHDA- 2018/05/08 06:00
CRDT- 2018/04/29 06:00
PHST- 2018/04/29 06:00 [entrez]
PHST- 2018/04/29 06:00 [pubmed]
PHST- 2018/05/08 06:00 [medline]
AID - 10.1097/MD.0000000000010591 [doi]
AID - 00005792-201804270-00087 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(17):e0591. doi: 10.1097/MD.0000000000010591.