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Man With Facial Nerve Palsy and Ear Pain

2015; Elsevier BV; Volume: 67; Issue: 1 Linguagem: Inglês

10.1016/j.annemergmed.2015.04.010

1097-6760

Mustafa Serinken, Cenker Eken, Onur Dal, Murat Kutlu,

Trigeminal Neuralgia and Treatments

A male patient aged 61 years presented to the emergency department with headache, left ear pain, and odynophagia. His physical examination revealed encrusted vesicular lesions and swelling in the left ear (Figure 1). The patient also had a flattened left nasolabial fold and weakness at the left side of the mouth and left eyelid, suggesting Bell’s palsy (Figure 2).Figure 2Appearance of the patient’s face, with a flattened left nasolabial fold and weakness of the left side of the mouth and left eyelid.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Ramsay Hunt syndrome. Ramsay Hunt syndrome was first described in 1907 by James Ramsay Hunt in a patient with otalgia related to cutaneous and mucosal rashes that he suggested were related to infection of the geniculate ganglion as a result of human herpes virus 3 (varicella zoster virus). The syndrome is defined as an acute peripheral facial neuropathy accompanied by erythematous vesicular rash in the ear canal, auricle (also termed herpes zoster oticus), or mucous membrane of the oropharynx.1Goldani L.Z. Ferreira da Silva L.F. Dora J.M. Ramsay Hunt syndrome in patients infected with human immunodeficiency virus.Clin Exp Dermatol. 2009; 34: e552-e554Crossref PubMed Scopus (8) Google Scholar, 2Bhagra A. Stead L.G. Ramsay Hunt syndrome: a rare entity.Ann Emerg Med. 2006; 47 (579, 584)Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar It is generally more severe than a simple Bell’s palsy and more likely to conclude with permanent sequelae and may be accompanied by multiple cranial nerve involvement.3Angles E.M. Nelson S.W. Higgins G.L. A woman with facial weakness: a classic case of Ramsay Hunt syndrome.J Emerg Med. 2013; 44: e137-e138Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Antiviral agents and steroids are the common drugs used for the treatment of Ramsay Hunt syndrome. Corneal irritation and injury as a result of Bell’s palsy should also be taken into consideration. Carbamazepine may be considered in the existence of idiopathic geniculate neuralgia.3Angles E.M. Nelson S.W. Higgins G.L. A woman with facial weakness: a classic case of Ramsay Hunt syndrome.J Emerg Med. 2013; 44: e137-e138Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 4Al-Hussaini A. Latif F. Berry S. Ear pain, vesicular rash, and facial palsy.BMJ. 2014; 349: 7572Crossref Scopus (2) Google Scholar