Successful response of non-recovering Ramsay Hunt syndrome to intravenous high dose methylprednisolone

Journal of the Neurological Sciences
Donatella DonatiPasquale Annunziata

Abstract

Ramsay Hunt syndrome (RHS) is a frequent cause of facial palsy. It is a consequence of the infection of geniculate ganglion by herpes zoster or herpes simplex virus. In the lack of randomized controlled trials, RHS is empirically treated by a combination therapy of antiviral agents and steroids given orally. However, RHS has, per se, a poorer prognosis than idiopathic facial palsy (Bell's palsy). We describe a case series of two patients with RHS unsuccessfully treated with antiviral drugs and oral corticosteroids, showing an almost complete recovery after late administration of intravenous (i.v.) high dose methylprednisolone. Both patients had all recognized negative prognostic factors including age of onset, a high grade facial weakness, absence of R1 and R2 response at blink reflex test, and in the first case, the involvement of greater superficial petrosal nerve. We propose that i.v. high dose methylprednisolone should be considered, even as a late treatment option, in patients with RHS non recovering after standard antiviral and oral steroid therapy as well as presenting clinical features suggestive of a poor prognosis.

References

Jul 30, 2010·Clinical Neurology and Neurosurgery·Arslan OzgurOdabasi Zeki
Jul 5, 2011·Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology·Susan CoulsonVictoria Oey

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Citations

May 21, 2014·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Dong-Woo ShinOh-Sang Kwon
Dec 3, 2014·Semergen·M E Gómez SánchezJ Pardal Fernández
Sep 10, 2016·American Journal of Physical Medicine & Rehabilitation·Donghwi ParkJu Seok Ryu
Feb 22, 2017·Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery·K WasanoK Ogawa
Mar 30, 2020·Postgraduate Medical Journal·Jeyasakthy Saniasiaya
Nov 19, 2020·Revista Da Sociedade Brasileira De Medicina Tropical·Melissa de Sousa Melo CavalcanteJorge Augusto de Oliveira Guerra
May 23, 2019·ORL; Journal for Oto-rhino-laryngology and Its Related Specialties·Yunsoo SohSeung Geun Yeo

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