Peripheral Facial Nerve Research Articles

Continuous hemicrania as the initial manifestation of Ramsay Hunt syndrome: a case report

IntroductionRamsay-Hunt syndrome, also called otic zoster, is a rare complication of herpes zoster. The syndrome is characterized by peripheral facial nerve palsy and an erythematous vesicular eruption in the ear or mouth. Preceding the appearance of the vesicles, unilateral otalgia or neck pain may occur more commonly. However, persistent hemicrania is infrequent in the pre-eruptive phase.ObjectivesTo present an atypical case of Ramsay Hunt syndrome with continuous unilateral headache preceding the onset of other symptoms and signs of the syndrome.Case reportReport of a 69-year-old woman who presented subacute onset of moderate to severe left hemicrania with no autonomic signs. Eight days after the start and continuous headache maintenance, she presented with peripheral facial paralysis. After four days, she noticed the presence of vesicles in the left ear and odynophagia. She developed nausea with several episodes of vomiting and severe imbalance that made it impossible for her to walk unassisted. On physical examination, she presented vesicles in the left ear and oropharynx, left peripheral facial palsy (House Brackmann grade IV), left hypoacusis, nystagmus, and vestibular gait. Diagnostic tests for screening several metabolic diseases and diagnosis of infection (including HIV) were unremarkable. Brain computed tomography and cerebrospinal fluid analysis showed no abnormalities.ConclusionsRamsay-Hunt syndrome mainly involves the facial and vestibulocochlear nerves, causing peripheral facial palsy, otalgia, hypoacusis, and, less frequently, imbalance. Although pain is a frequent manifestation of the pre-eruptive phase of RHS, unilateral headache is not common in this scenario. On the other hand, it is a prevalent complaint in the emergency department and has several different etiologies. Hence, diagnosing RHS when patients present exclusively unilateral headaches is challenging for clinicians. Physicians must consider RHS a vital differential diagnosis of sided-locked headaches, avoiding diagnostic errors and treatment delays.

Ramsay Hunt Syndrome with Pharyngolaryngeal Involvement Mimicking Acute Stroke: A Case Report.

Ramsay Hunt syndrome is a clinical manifestation of the reactivation of latent varicella zoster virus in the geniculate ganglion after acute infection. It is commonly associated with an acute peripheral facial nerve paralysis, auricular vesicular eruption and acute sensorineural hearing loss. However, in some rare cases the involvement of other cranial nerves, especially the glossopharyngeal and vagal is described. We present a 56-year-old male patient who was diagnosed with acute pharyngitis. Two days later, the patient developed dysarthria, hoarseness, and left side facial weakness. Considering a patient's history of cardiovascular events, the acute stroke was suspected. Magnetic resonance imaging ruled out an acute cerebrovascular accident. The patient's otalgia aggravated and he reported hearing loss. Clinical examination revealed facial paralysis affecting the left side of the face, erythematous rash on the left auricle, multiple vesicles present on patient's left tympanic membrane, ulcerous lesion on the left side of the soft palate and ipsilateral velopharyngeal palsy. Indirect laryngoscopy revealed ulcerous lesions in the left side of the epiglottis and left vocal cord paralysis. The patient was diagnosed with Ramsay Hunt syndrome with cranial polyneuropathy. Oral acyclovir and oral prednisolone were administered. Seven months after discharge, facial paralysis improved to lower grade and flexible laryngoscopy showed that the left vocal cord had resumed normal movement. Ramsay Hunt syndrome can be accompanied by involvement of other cranial nerves. Previous history of hypertensive crises and myocardial infarction may influence a diagnosis of Ramsay Hunt syndrome, especially when it has atypical presentation. However, this diagnosis should be considered in patients with unilateral multiple cranial nerve palsies.

Peripheral Facial Nerve Paralysis After Real-Time Ultrasound-Guided Percutaneous Biopsy: A Case Report and Literature Review

Advancements in Case Studies Peripheral Facial Nerve Paralysis After Real-Time Ultrasound-Guided Percutaneous Biopsy: A Case Report and Literature Review Yanling Zheng1, Yingying Qi2, Di Li2, Xinyu Liu3 and Cun Liu1* 1University of Jinan, Jinan, China 1Central Hospital Affiliated to Shandong First Medical University, Jinan, China 1Zhengzhou University, Zhengzhou, China *Corresponding author: Cun Liu, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, Shandong Province, China Submission:February 13, 2023;Published: February 20, 2023 DOI: 10.31031/AICS.2023.03.000572 ISSN 2639-0531Volume3 Issue5

Transient profound hearing loss and severe facial nerve palsy in schwannomas within the internal acoustic canal: A case report.

Vestibular schwannoma is the most common intracranial schwannoma and constitutes ~8% of all intracranial tumors in adults with an estimated incidence rate of ~1.3/100.000. Facial nerve schwannomas and cochlear nerve schwannomas are rare, and information regarding incidence rates of these is still missing in the literature. All three variants of nerve origin present most frequently with unilateral hearing loss, unilateral tinnitus and disequilibrium. Facial nerve palsy is a common finding in facial nerve schwannomas but a rare finding with vestibular schwannomas. The symptoms are normally persistent and often progress over time, leading to therapeutic interventions that predispose to quality of life-reducing morbidities, e.g., deafness and/or imbalance. The case report describes a 17-year-old male who, during a 1-month period, presented with profound unilateral hearing loss and severe facial nerve palsy followed by complete remission. An MRI scan showed a 5×8-mm schwannoma within the internal acoustic canal. Profound hearing loss together with concomitant severe peripheral facial nerve palsy in small schwannomas within the internal acoustic canal may show spontaneous and total remission within weeks of symptom debut. This knowledge, as well as possible remission of objective findings, should be considered before interventions with potential severe morbidity are suggested.

A Study on Patients with Bell’s Palsy and Ramsay Hunt Syndrome

Peripheral facial nerve palsy is more frequent in Bell’s palsy and Ramsay Hunt syndrome. We performed a retrospective review of the data of 67 patients with Bell’palsy (29 males, 38 females; median age, 63 years) and 18 patients with Ramsay Hunt syndrome (6 males, 12 females; median age, 53.5 years) diagnosed between April 2015 and March 2020. In the patient group with Bell’s palsy, the initial paralysis score was ≤ 8 in 21 patients (31.3%), 10–18 in 28 patients (41.8%), and ≥ 20 in 18 patients (26.9%), and the final paralysis score was 40 in 45 patients (65.7%), 36 to 38 in 11 patients (16.4%), 32 to 34 in 2 patients (3.0%), 20 to 30 in 7 patients (10.4%), and 10–18 in 2 patients (3.0%). Bell’s palsy was cured in 56 of 67 the patients, corresponding to a cure rate of 83.6%. In the patient group with Ramsay Hunt syndrome, the initial paralysis score was ≤ 8 in 9 patients (50.0%), 10–18 in 6 patients (33.3%), and ≥ 20 in 3 patients (16.7%) and the final paralysis score was 40 in 8 patients (44.4%), 36–38 in 3 patients (16.7%), 32–34 in 2 patients (11.1%), 20–30 in 2 patients (11.1%), and 10–18 in 2 patients (11.1%). Ramsay Hunt syndrome was cured in 11 of the 18 patients, corresponding to a cure rate of 61.1%. The findings of electroneurography were found to be associated with cure/non-cure in patients with Bell’s palsy, whereas the initial paralysis score was significantly associated with the prognosis in patients with Ramsay Hunt syndrome.

Two Cases of Bilateral Simultaneous Facial Nerve Palsy

Peripheral facial nerve palsy is a common disease encountered by otolaryngologists, but rarely occurs in both sides at the same time. Causative diseases include Bell’s palsy, Guillain-Barre syndrome, trauma, otitis media, Ramsay Hunt syndrome, sarcoidosis, etc. During the past 10 years, a total of 528 patients with facial nerve palsy visited our department, and only 2 (0.4%) had simultaneous bilateral palsy.

Moebius syndrome: A case report from Indonesia

Introduction: Moebius syndrome is a neurological condition characterized by congenital facial uniplegia or diplegia due to peripheral type facial nerve paresis and lateral eye movement paresis due to abducens nerve paresis resulting in strabismus. Incidence of Moebius syndrome is 0.27/100,000 live births and often associated with abortion attempts. The following is a case report of Moebius syndrome in Indonesia of a 14-year-old girl with a history of attempted abortion by her mother. Case Report: A 14-year-old girl came with facial muscle complaints in the form of difficulty in raising both eyebrows and closing the mouth since birth. These complaints cause difficulty in eating and drinking. Complaints accompanied by abnormality of the limbs and the number of finger in toes and hands. The patient’s mother had a history of attempted abortion by taking the chemical disinfectant chloroxylenol 4.8% and other drugs. There was bilateral facial nerve paresis and cognitive impairment. On examination of brain magnetic resonance imaging (MRI), it was within normal limits. The patient was planned for physiotherapy and consulted to orthopedics. Conclusion: Moebius syndrome is a collection of rare neurological clinical manifestations in children. Exposure to chemicals during pregnancy can be the etiology of this syndrome in addition to genetics. Management of Moebius syndrome is limited to supportive and symptomatic approach.

Peripheral facial nerve palsy in children: clinical manifestations, treatment and prognosis.

Sudden onset of unilateral weakness of the upper and lower muscles of one side of the face is defined as peripheral facial nerve palsy. Peripheral facial nerve palsy is often idiopathic and sometimes it could be due to infectious, traumatic, neoplastic, and immune causes. This study aimed to report the clinical manifestation, evaluation, and prognosis in children with peripheral facial nerve palsy. 57 children under 18years of age diagnosed with peripheral facial nerve palsy at Çukurova University, Balcalı Hospital, between January 2018 and September 2021, were included in the study. The mean age of the children at the time of diagnosis was 9.6 ± 7, 4years. Thirty-two (56.1%) of the patients were female and 25 (43.9%) were male. A total of 57 patients were diagnosed with peripheral facial nerve palsy and categorized into many groups by etiology: idiopathic Bell's palsy in 27 (47.5%), infectious in 11 (19.2%), traumatic in 6 (10.5%), and others (due to congenital, immune, neoplastic, Melkersson-Rosenthal syndrome, drug toxicity, and iatrogenic causes) in 13 (22.8%). Forty-six of the children achieved full recovery under oral steroids within 1-7months. Four patients with acute leukemia, myelodysplastic syndrome, Mobius syndrome and trauma did not recover and two patients (schwannoma, trauma) showed partial improvement. Five patients could not come to follow-up control. Peripheral facial nerve palsy is a rare condition in children with different causes. It could be idiopathic, congenital, or due to infectious, traumatic, neoplastic, and immune reasons. So, when a child presents with facial palsy, a complete clinical history and a detailed clinical examination are recommended. Giving attention to the red flag is very important. Peripheral facial nerve palsy in children is considered to have a good prognosis.

Coexistance of Probable Neurosarcoidosis and Generalized Myasthenia Gravis: Case Report

Objective NA. Background Sarcoidosis is an immune mediated disorder characterized by the formation of non-necrotizing granulomas in multiple organs. The broad range of manifestations of sarcoidosis in the nervous system includes cranial neuropathy, meningitis or myelopathy. Generalized Myasthenia Gravis is a neuromuscular disorder characterized by the formation of antibodies against the acetylcholine receptor, and typically presents with muscle weakness and fatigue. Association of Myasthenia Gravis and Neurosarcoidosis is infrequent. Design/Methods NA. Results Case report: A thirty-five year old woman, natural from Senegal was admitted to the hospital with a two month history of left peripheral facial nerve palsy, progressive dysphonia and dysphagia, associated with fever, headache and asthenia. Examination revealed, left facial numbness and weakness (V and VII nerve) and right vocal cord paresis (X nerve). Chest ray showed bilateral hilar lymphadenopathy and cranial MRI revealed enhancement of both Meckel cavum, bilateral trigeminal nerves and canalicular segment of the left facial nerve. CSF examination detected elevated protein and lymphocytic pleocytosis. For further study a PET/TC was done which revealed supradiaphragmatic and infradiaphragmatic hypermetabolic adenopathies. Biopsy of an adenopathy was performed objecting non-caseating granulomas consistent with the diagnosis of probable neurosarcoidosis. Moreover, the patient explained weakness and muscle fatigue since she was 18 years old, which was observed at proximal limb muscles. Acetylcholine receptor antibodies were detected and electromyographic study showed a decremental response to repeated nerve stimulation. Conclusions It is well known that autoimmune disorders may coexist in some patients. Neurosarcoidosis and Myasthenia Gravis are two rare diseases with different pathogenesis. Although their coexistance could be coincidental it may also suggest immunologic mechanisms triggering the occurrence of these diagnoses together.

Neural mechanisms underlying peripheral facial nerve palsy: A protocol for systematic review and meta-analysis of neuroimaging studies

Peripheral facial nerve palsy is a general term used to describe diseases that cause lower motor neuron lesions in the facial nerve. The most common cause of peripheral facial nerve palsy is idiopathic Bell's palsy (BP), accounting for 60% to 70% of all peripheral facial nerve palsy cases. Idiopathic BP is found in various medical conditions, such as ischemia, viral infection, and neuroinflammation; however, the specific pathophysiology remains unclear. Neuroimaging techniques help understand the neural mechanisms underlying various neurological disorders. In recent years, several studies have applied functional neuroimaging to investigate alterations of brain function in BP patients. However, the results have been inconsistent due to differences in methodology and quality. Moreover, systematic reviews of studies on functional neuroimaging for BP are insufficient. Therefore, the present study aims to verify the neural mechanisms of brain alterations and draw conclusions about the functional reorganization in patients with BP. This review includes all suitable studies published on or before October 31, 2022. A thorough search will be conducted using the following databases: MEDLINE, Cochrane Library, Excerpta Medica Database (EMBASE), China Knowledge Resource Integrated Database (CNKI), Korean Medical database (KMBASE), Korean Studies Information Service System (KISS). Clinical studies of BP using functional neuroimaging will be selected. We will apply a coordinate-based meta-analysis because most individual neuroimaging studies provide their results as coordinates in the standard space. The primary outcomes will include the types of functional neuroimaging methods and alterations of brain function in BP patients. The secondary outcomes will include the information about clinical measurement of the disease. Study selection, data extraction, and risk of bias assessment will be conducted. If possible, heterogeneity tests, data synthesis, and subgroup analyses will be conducted. The study will analyze the alterations in brain activity and worsening of clinical symptoms caused by idiopathic BP. The aim of this study is to investigate functional reorganization of brain alterations in patients with BP. This review will improve the understanding of the neural mechanisms of BP based on the most recent publications through extensive data retrieval. If sufficient data are collected, a sensitivity analysis is performed to verify the robustness of the conclusions.

Clinical Study on the Causes and Outcome of Facial Nerve Palsy at Liaquat University Hospital Hyderabad

Background and Aim: A facial paralysis can be enormously distressing for a person. In order to restore and rehab face symmetry, it is essential to understand the source and type of nerve damage. Lower motor neuron facial paralysis was investigated in the current study to assess its various causes. Patients and Method: This prospective study was carried out on 48 facial nerve palsy (FNP) in the Department of Medicine, Liaquat University Hospital, Hyderabad from January 2021 to August 2022. Patients diagnosed with peripheral facial nerve paralysis of any age and both genders were enrolled. Patient’s details such as time of symptom onset, paralysis duration, rapidity of progression, and paralysis completeness were evaluated. Each individual was interviewed about family history, medical illness such as malignancy, tuberculosis, diabetes, autoimmune disorders, previous episodes, any prior surgery, trauma history, and related symptoms such as neurological, auditory, and vestibular. Lesion site and treatment response was administered by Topo diagnostic tests. Data analysis was carried out in SPSS version 26. Results: Out of 48 FNP patients, 34 (70.8%) were male and female 14 (29.2%) respectively. The overall mean age was 35.8±6.2 years with an age range 5 to 70 years. Patients were distributed into different age groups as follows: 6 (12.5%) in 5-20 years, 19 (39.6%) in 21-35 years, 16 (33.3%) in 36-50 years, and 7 (14.6%) in 51-70 years. The prevalence of left and right side affected patients were 20 (41.7%) and 28 (58.3%) respectively. The most prevalent causes of FNP were idiopathic and external trauma found in 12 (25%) cases followed by infections and tumour found in 8 (16.7%) cases. Severity of paralysis calculated based on H. Brackman grading were as follows: Grade IV, V, and VI paralysis were found in 22 (45.8%), 8 (16.7%), and 2 (4.2%) respectively. Physiotherapy and conservative treatment was given to 26 (54.2%) patients followed by facial nerve surgery in 14 (29.2%) patients. Conclusion: The present study found that External trauma and Bell's palsy are the leading causes of LMN facial nerve paralysis. The right side was more affected than the left side, and male patients predominated. Upon presentation, most lesions were suprageniculate and had House Brackmann severity scores of IV. After a one-year follow-up, most of our peripheral facial paralysis cases had recovered fully or partially. Keywords: Facial nerve palsy, Outcomes, Causes, House Brackmann severity.

Socio-demographic Characteristics of Tick Bite and Erythema migrans not associated with the Diagnosis of Neuroboreliosis

Introduction Lyme neuroborreliosis (LNB) is a tick-borne infection caused by bacteria Borrelia burgdorferi sensu lato that accounts for 10-15% of all Lyme borreliosis cases in Europe. LNB can present with a variety of neurological manifestations. We aimed to describe the typical anamnestic, clinical and laboratory features of patients diagnosed with LNB and to describe the differences between paediatric and adult cases. Additionally, we assessed the factors associated with definite LNB. Methods We retrospectively evaluated data of patients with suspected LNB had undergone lumbar puncture and were admitted to the Infectious diseases department of University hospital Bratislava, Slovakia, between September 2019 and May 2022. Patients were divided into three categories according to the diagnostic criteria of European Federation of Neurological Societies: A) cases with definite LNB, B) cases with possible LNB, C) non-LNB controls. Results In total, 139 patients were included in the analysis. 32 individuals were classified as definite LNB, 23 as possible LNB and 84 as non-LNB controls. 55.5% were females and 35.3% were children aged<18 years. 56.3% of patients with definite LNB reported a history of tick bite, and 21.9% a history of erythema migrans (EM). Peripheral facial nerve palsy (PFNP) was the most common clinical symptom in patients with definite LNB (65.6%), followed by headache (50.0%), fever (21.9%) and radicular pain (18.8%). In a univariate and multivariable analyses neither history of tick bite nor history of EM were significantly associated with definite LNB. Factors independently associated with definite LNB in multivariable analyses were (i) age < 18 years (aOR 7.89, 95% CI 2.00-31.03, p < 0,003), (ii) female gender (OR 6.34; 95% CI 1.66-24.17, p < 0.007), and (iii) facial nerve palsy (OR 10.54; 95% CI 2.41-55.19, p < 0.002). Conclusion We found that peripheral facial nerve palsy is the strongest predictor of definite LNB, and that the children<18 years and females in our study were more likely to be diagnosed with LNB. Our study also suggests that anamnestic data on history of tick bite and EM contribute little to the diagnosis of LNB and that the examination of CSF is essential for the diagnosis of LNB.

Correlation Between Accompanying Symptoms of Facial Nerve Palsy, Clinical Assessment Scales and Surface Electromyography

Background: This retrospective study aimed to determine whether there were correlations between the number and type of accompanying symptoms of peripheral facial nerve palsy, and surface electromyography (SEMG) and clinical assessment scales to help diagnosis.Methods: There were 30, cases of peripheral facial nerve palsy at Visit 1 to the Korean Medicine Hospital, Dong-eui University, 22 cases at Visit 2 and 10 cases at Visit 3. The study period was from July 19, 2021 to November 31, 2021. Symptoms were evaluated three times (with two-week intervals which began 7 days from onset) using SEMG, clinical assessment scales and accompanying symptoms. In this study, the House-Brackmann grading system (HBGS), and the Yanagihara’s unweighted grading system (Y-score) clinical assessment scales were used. The Pearson or Spearman correlation was used for statistical analysis.Results: On Visit 1, the number of accompanying symptoms of peripheral facial nerve palsy had no significant correlation with other measures. On Visits 1-3, the HBGS score had a significant negative correlation with the Y-score. On Visit 2, most of the mean values measured had significant correlations with each other although not between SEMG-Z and SEMG-O that Z means a zygomaticus muscle and O means a orbicularis oris muscle. On Visit 3, the number of accompanying symptoms significantly correlated with the clinical assessment scales. The HBGS score, Y-score, and SEMG measurements (except SEMG-Z) had significant correlations with each other. A significant positive correlation between SEMG-Z and SEMG-T was noted.Conclusion: We predict accompanying symptoms can be used to diagnose the peripheral facial nerve palsy including both clinical assessment scales and SEMG measurements at 2-5 weeks after onset.

Oral health and oral health-related quality of life in patients with chronic peripheral facial nerve palsy with synkineses-A case-control-study.

Facial nerve palsy (FP) is the most common cranial nerve lesion, leading to partial or complete immobility of the affected half of face. If food residues on tooth surfaces cannot be removed by natural self-cleaning mechanisms that this is likely to lead to an increase dental plaque formation and the risk of dental, periodontal and general diseases. It was the aim of this study to assess oral health, oral hygiene with the influence of handedness and oral health related quality of life in patients with chronic peripheral FP. This study included 86 people. Patients with FP (n = 43) in an FP-group (FPG) were matched with 43 participants without ever diagnosed FP in a control group (CG). Oral health and oral hygiene were assessed in a clinical examination performed in hospital. Decayed-missing-filled-teeth-index, periodontal-screening-index, approximal plaque index and sulcus bleeding index were used to evaluate dental caries and periodontal health status. Oral health-related quality of life data (OHQoL) was collected with the Oral health impact profile (Germany-14) by interview. Oral health parameters in the FPG were significantly worse than in the CG. The median revealed 14.3% more proximal plaque (p = 0.014), 20.8% more sulcus bleeding (p = 0.002) and more than twice as much caries (p = 0.024). The paretic side compared to the non-paretic side of patients was significantly more affected by inflammatory periodontal diseases (p = 0.032) and had a higher prevalence of caries (p = 0.163). Right-handed patients with right-sided FP performed worse than right-handed patients with left-sided FP (p = 0.004). Patients with FP described a greater limitation of OHQoL than patients without this disease (p < 0.001). In conclusion, facial nerve palsy affects oral health, oral hygiene and OHQoL of patients while handedness influences oral hygiene and oral health.

Association of Overweight and Obesity With Bell Palsy in Children

BackgroundIn the Division of Pediatric Neurology at the University Medical Center Göttingen we observed that many patients with Bell palsy are overweight or obese. To evaluate whether overweight and obesity are associated with increased risk of Bell palsy in children we conducted this single-centered retrospective study by performing a database search for International Classification of Diseases (ICD)-10 primary and secondary diagnosis of G51.0 (facial nerve palsy) between January 1, 2010, and December 31, 2020. MethodsFor risk assessment, patients' body mass indices (BMIs) were compared with BMI data of controls from a nationwide child health survey. ResultsIn total, 202 patients with peripheral facial nerve palsies (pFPs) were included, of which nearly half were classified as Bell palsies; 38% and 24% of the patients with Bell palsy and pFP had a BMI above the 90th percentile, respectively. High BMI was associated with statistically increased odds of Bell palsy in the group of overweight and obese patients (BMI >90th percentile; odds ratio [OR], 2.42; 95% confidence interval [CI], 1.6 to 3.8; P < 0.001) and solely obese patients (BMI >97th percentile; OR, 2.43; 95% CI, 1.4 to 4.3; P = 0.003). ConclusionsWe could confirm our observation that overweight and obesity are associated with increased risk of Bell palsy in children.

A Case Report of Peripheral Facial Nerve Palsy in a Patient with Spinal Stenosis Hospitalized at a Korean Medicine Hospital and Treated with Korean Medicine

Objectives: The purpose of this study is to investigate the effectiveness of using Korean medical treatment for peripheral facial nerve palsy.Methods: We primarily treated the patient’s peripheral facial nerve palsy during hospitalization (06/28/21~07/13/21) without any other steroids or antiviral drug treatments and additionally treated their spinal stenosis, using Korean medical treatments in both cases (herbal medicine, acupuncture, and herbal acupuncture therapy). The House-Brackmann grading system and Yanagihara’s unweighted grading system were used to assess facial symptom changes, and the Numerical Rating Scale was used to evaluate the back pain caused by the spinal stenosis.Results: Following treatment, the patient’s House-Brackmann and Numerical Rating Scale scores decreased, while their Yanagihara unweighted score improved.Conclusions: This study suggests that Korean medicine may be effective in the treatment of facial nerve palsy.

Ramsay-Hunt syndrome in HIV patient

Introduction Ramsay-Hunt syndrome type (SRH) type II is defined by the combination of herpes zoster oticus to acute peripheral facial nerve paralysis, described in 1907 by James Ramsay Hunt. Reactivation of latent varicella-zoster virus in the geniculate ganglion of the facial nerve will cause SRH, resulting in inflammation, edema, and compression of the VII cranial pair. However, nerve involvement, and in turn the development of SRH, manifests in less than 1% of infected patients. It is the second most common cause of atraumatic peripheral facial palsy (PFP) and has an incidence of 5 cases/100,000 people, with no sex predilection. Currently, SRH is classically described as a triad of otalgia, ipsilateral facial paralysis, and vesicles near the ear and ear canal; however, motor, sensory, and autonomic impairment when combined result in diverse neurological damage and may cause different symptoms, its diagnosis is mainly clinical. Goal To report the case of an HIV patient associated with SHR, seen by IIER between May and June/2022. Case Report Male, 49 years old, sought care on 05/20/22 in a hospital with complaints of vertigo and intense headache, associated with nausea and vomiting with onset of symptoms one day ago. His personal history was HIV+, diagnosed in 2013 and under regular treatment. On 5/25/22 resurfaced with the same symptoms of vertigo in conjunction with the appearance of an erythematous and painful vesicle in the right auricular region with edema and flushing of the region in association with PFP symptoms. On 05/30/22 he returned to the clinic with the same symptoms as before, and a magnetic resonance imaging of the temporal bones was done, showing an inflammatory process through the contrast at the bottom of the internal auditory canal suggestive of Bell's Palsy. (To see the complet abstract, please, check out the PDF.)

A case of peripheral‐type facial palsy with dysgeusia due to pontine infarction: A case report

AbstractWe describe an 83‐year‐old woman who presented with an acute onset of hemifacial droop. The patient's neurological examination showed peripheral‐type facial palsy with dysgeusia of the right anterior two‐thirds of her tongue. However, MRI revealed an anterior inferior cerebellar artery lesion, diagnosed as brain stem infarction. Peripheral‐type facial palsy has been reported in some stroke cases, with these cases not presenting with dysgeusia. Thus, this finding usually helps differentiate facial nerve palsy from peripheral‐type facial palsy caused by brain stem lesions. Despite the cerebral infarction, our patient presented with peripheral facial nerve palsy with taste disorder. This is because the lesion not only involved the pons but also the middle cerebellar peduncle. Therefore, patients with multiple vascular risk factors need to be carefully diagnosed.

A case of Miller Fisher syndrome with delayed onset peripheral facial nerve palsy after COVID-19 vaccination: a case report

BackgroundTo prevent the spread of the novel coronavirus disease 2019 (COVID-19) infection, various vaccines have been developed and used in a large number of people worldwide. One of the most commonly used vaccines is the mRNA vaccine developed by Moderna. Although several studies have shown this vaccine to be safe, the full extent of its side effects has not yet been known. Miller-Fisher syndrome (MFS) is a rare condition that manifests ophthalmoplegia, ataxia, and loss of tendon reflexes. It is a subtype of Guillain–Barré syndrome and an immune-mediated disease related to serum IgG anti-GQ1b antibodies. Several vaccines including those for COVID-19 have been reported to induce MFS. However, there have been no reports of MFS following Moderna COVID-19 vaccine administration.Case presentationA 70-year-old man was referred to our hospital due to diplopia that manifested 1 week after receiving the second Moderna vaccine dose. The patient presented with restricted abduction of both eyes, mild ataxia, and loss of tendon reflexes. He was diagnosed with MFS based on his neurological findings and detection of serum anti-GQ1b antibodies. The patient was administered intravenous immunoglobulin, and his symptoms gradually improved. Five days after admission, the patient showed peripheral facial paralysis on the right side. This symptom was suggested to be a delayed onset of peripheral facial nerve palsy following MFS that gradually improved by administration of steroids and antiviral drugs.ConclusionThere have been no previous reports of MFS after Moderna COVID-19 vaccination. This case may provide new information about the possible neurological side effects of COVID-19 vaccines.

Management of the facial nerve following temporal bone ballistic injury.

ObjectiveTo understand the patterns of temporal bone fracture and facial nerve injury from ballistic trauma.Study DesignRetrospective case series.MethodsRetrospective review of 42 patients evaluated following temporal bone ballistic injury at a single institution, university‐based level‐one trauma center between 2012 and 2021. Demographics, facial nerve status, CT images, interventions, complications, and outcomes were reviewed.ResultsMean age 30.3 years (range 5–58 years); 79% male. Racial demographics reflected the surrounding community. Seven mortalities occurred. Nineteen patients (54%) demonstrated facial nerve injury. Of those, 13/19 displayed immediate paralysis, 1 delayed, 5 unknown (due to altered mental status). On consultation, House‐Brackmann grade 6 paralysis was common (13/19). Fracture was otic capsule‐sparing in 17/19 (90%), universally comminuted, with significant disruption along the mastoid tip (16/19), external auditory canal (EAC) (15/19), and periauricular soft tissues (13/19). Nine patients underwent surgical intervention: Transmastoid facial nerve decompression to remove compressive bony spicules (n = 5); eye protection surgery (n = 3); and peripheral facial nerve exploration (n = 1), noting transection at the pes. One required middle cranial fossa and transmastoid repair of cerebrospinal fistulae in setting of severe meningitis. House‐Brackmann scores improved in 80% following transmastoid nerve decompression despite CT evidence of likely additional injury in its extratemporal course.ConclusionsCommon patterns of temporal bone fracture seen in blunt trauma (longitudinal/transverse, otic capsule‐sparing/disrupting) were not found in patients with ballistic facial nerve injury. Rather, injury was commonly apparent in the EAC, mastoid tip, and periauricular soft tissues. Clinicians should have high suspicion for extratemporal facial nerve injury following ballistic trauma.