Skip to main content

Advertisement

SpringerLink
Log in

Cranial polyneuropathy caused by herpes zoster infection: a retrospective single-center analysis

  • Miscellaneous
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Cranial polyneuropathy (CP) is a rare complication of herpes zoster (HZ) infection. This entity often produces situations of a diagnostic dilemma, as can be seen in a wide spectrum of clinical presentations. The aim of this study was to report the clinical characteristics, treatment, and outcomes of 11 patients from a single-institution experience.

Methods

A retrospective analysis of patients treated for HZ CP over a 12-year period was performed.

Results

The present study included 11 patients with CP caused by HZ infection—7 (63.63%) females, and 4 (36.36%) males. The mean age at presentation was 63 years (range, 38–85 years). Cranial nerve VII was affected in nine (81.82%) cases, CN VIII in six (54.55%) cases, CN V in five (45.45%) cases, CN III and IX in two (18.18%) cases, and CN VI and X in one (9.09%) case. The treatment of choice was acyclovir in all patients, while corticosteroids were administered in six (54.55%) patients. Complete CN recovery was observed in seven (63.63%) patients, while four (36.36%) patients suffered from permanent CN damage—two (18.18%) CN VII, one (9.09%) CN VII and VIII, and one (9.09%) CN VI.

Conclusion

Herpes zoster CP presents an interesting diagnostic and therapeutic challenge. Successful management of these patients depends on a thorough knowledge of the anatomy and topodiagnostic of CNs. Early administration of antiviral agents is crucial in terms of responsiveness to treatment and expedite recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and materials

Not applicable.

Code availability

Not applicable.

References

  1. Cohen JI (2013) Clinical practice: herpes zoster. N Engl J Med 369(3):255–263. https://doi.org/10.1056/NEJMcp1302674

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Tsau PW, Liao MF, Hsu JL, Hsu HC, Peng CH, Lin YC, Kuo HC, Ro LS (2020) Clinical presentations and outcome studies of cranial nerve involvement in herpes zoster infection: a retrospective single-center analysis. J Clin Med. https://doi.org/10.3390/jcm9040946

    Article  PubMed  PubMed Central  Google Scholar 

  3. Shin DH, Kim BR, Shin JE, Kim CH (2016) Clinical manifestations in patients with herpes zoster oticus. Eur Arch Otorhinolaryngol 273(7):1739–1743. https://doi.org/10.1007/s00405-015-3756-9

    Article  PubMed  Google Scholar 

  4. Im M, Kim BJ, Seo YJ, Park JK, Lee JH (2007) Complete ophthalmoplegia after herpes zoster. Clin Exp Dermatol 32(2):162–164. https://doi.org/10.1111/j.1365-2230.2006.02296.x

    Article  CAS  PubMed  Google Scholar 

  5. Pitton Rissardo J, Fornari Caprara AL (2019) Herpes zoster oticus, ophthalmicus, and cutaneous disseminated: case report and literature review. Neuroophthalmology 43(6):407–410. https://doi.org/10.1080/01658107.2018.1523932

    Article  PubMed  Google Scholar 

  6. Shin HM, Lew H, Yun YS (2005) A case of complete ophthalmoplegia in herpes zoster ophthalmicus. Korean J Ophthalmol 19(4):302–304. https://doi.org/10.3341/kjo.2005.19.4.302

    Article  PubMed  Google Scholar 

  7. Steele L, Ghedia R, Ahmad H, Mace A (2017) Ramsay Hunt syndrome with cranial polyneuropathy with features of supraglottitis. BMJ Case Rep. https://doi.org/10.1136/bcr-2017-221135

    Article  PubMed  PubMed Central  Google Scholar 

  8. Keane JR (2005) Multiple cranial nerve palsies: analysis of 979 cases. Arch Neurol 62(11):1714–1717. https://doi.org/10.1001/archneur.62.11.1714

    Article  PubMed  Google Scholar 

  9. Chaker N, Bouladi M, Chebil A, Jemmeli M, Mghaieth F, El Matri L (2014) Herpes zoster ophthalmicus associated with abducens palsy. J Neurosci Rural Pract 5(2):180–182. https://doi.org/10.4103/0976-3147.131673

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zainine R, Sellami M, Charfeddine A, Beltaief N, Sahtout S, Besbes G (2012) Ramsay Hunt syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 129(1):22–25. https://doi.org/10.1016/j.anorl.2011.08.003

    Article  CAS  PubMed  Google Scholar 

  11. Gilden DH, Dueland AN, Devlin ME, Mahalingam R, Cohrs R (1992) Varicella-zoster virus reactivation without rash. J Infect Dis 166(Suppl 1):S30–34. https://doi.org/10.1093/infdis/166.supplement_1.s30

    Article  PubMed  Google Scholar 

  12. Murakami S, Honda N, Mizobuchi M, Nakashiro Y, Hato N, Gyo K (1998) Rapid diagnosis of varicella zoster virus infection in acute facial palsy. Neurology 51(4):1202–1205. https://doi.org/10.1212/wnl.51.4.1202

    Article  CAS  PubMed  Google Scholar 

  13. Chitose SI, Umeno H, Hamakawa S, Nakashima T, Shoji H (2008) Unilateral associated laryngeal paralysis due to varicella-zoster virus: virus antibody testing and videofluoroscopic findings. J Laryngol Otol 122(2):170–176. https://doi.org/10.1017/S0022215107000898

    Article  PubMed  Google Scholar 

  14. Murakami S, Hato N, Horiuchi J, Honda N, Gyo K, Yanagihara N (1997) Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: significance of early diagnosis and treatment. Ann Neurol 41(3):353–357. https://doi.org/10.1002/ana.410410310

    Article  CAS  PubMed  Google Scholar 

  15. Kim YH, Chang MY, Jung HH, Park YS, Lee SH, Lee JH, Oh SH, Chang SO, Koo JW (2010) Prognosis of Ramsay Hunt syndrome presenting as cranial polyneuropathy. Laryngoscope 120(11):2270–2276. https://doi.org/10.1002/lary.21108

    Article  PubMed  Google Scholar 

  16. Park JM, Kim SE, Yang HC (2020) Clinical characteristics of herpes zoster laryngitis. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-020-06074-9

    Article  PubMed  Google Scholar 

  17. Becerra JC, Sieber R, Martinetti G, Costa ST, Meylan P, Bernasconi E (2013) Infection of the central nervous system caused by varicella zoster virus reactivation: a retrospective case series study. Int J Infect Dis 17(7):e529–534. https://doi.org/10.1016/j.ijid.2013.01.031

    Article  PubMed  Google Scholar 

  18. Nisa L, Landis BN, Giger R, Leuchter I (2013) Pharyngolaryngeal involvement by varicella-zoster virus. J Voice 27(5):636–641. https://doi.org/10.1016/j.jvoice.2013.02.011

    Article  PubMed  Google Scholar 

  19. Pinto JA, Pinto HC, Ramalho Jda R (2002) Laryngeal herpes: a case report. J Voice 16(4):560–563. https://doi.org/10.1016/s0892-1997(02)00131-5

    Article  PubMed  Google Scholar 

  20. Uscategui T, Doree C, Chamberlain IJ, Burton MJ (2008) Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev 4:CD006851. https://doi.org/10.1002/14651858.cd006851.pub2

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Bože Peričića 5, 23 000, Zadar, Croatia

    Jure Pupić-Bakrač & Ivan Baraka

  2. Department of Ophthalmology, General Hospital Zadar, Bože Peričića 5, 23 000, Zadar, Croatia

    Ana Pupić-Bakrač

  3. Department of Infectology, General Hospital Zadar, Bože Peričića 5, 23 000, Zadar, Croatia

    Vedrana Terkeš

Authors
  1. Jure Pupić-Bakrač
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Pupić-Bakrač
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vedrana Terkeš
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ivan Baraka
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JPB: conceptualization, methodology, writing. APB: conceptualization, investigation, writing. VT: resources, validation. IB: resources, supervision.

Corresponding author

Correspondence to Jure Pupić-Bakrač.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The authors assert that all procedures contributing to this work were approved and complied with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1964, as revised in 2013.

Consent to participate

A retrospective analysis was conducted. Only archived patient data and samples processed for diagnostic purposes were used.

Consent for publication

Prior to the processing, informed consent was obtained from all individual participants for whom identifying information was included in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pupić-Bakrač, J., Pupić-Bakrač, A., Terkeš, V. et al. Cranial polyneuropathy caused by herpes zoster infection: a retrospective single-center analysis. Eur Arch Otorhinolaryngol 278, 517–523 (2021). https://doi.org/10.1007/s00405-020-06279-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-06279-y

Keywords

Search

Navigation