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Atypical clinical manifestations of herpes zoster oticus: diagnostic usefulness of magnetic resonance imaging

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Abstract

Typical symptoms of Ramsay Hunt syndrome (RHS) consist of painful vesicular eruptions in the external ear, unilateral facial palsy, and/or vestibulocochlear deficit. When RHS patients show atypical clinical manifestations, correct diagnosis can be delayed, and ideal treatment timing for antiviral therapy may be missed. The aim of this study is to describe RHS patients with atypical clinical manifestations and evaluate the usefulness of magnetic resonance imaging (MRI) for early differential diagnosis. We retrospectively reviewed the clinical data and investigated the findings of internal auditory canal (IAC) MRI of seven patients diagnosed with RHS presenting “atypical” clinical manifestations between January 2013 and December 2016. “Typical” symptoms of RHS consist of herpetic vesicular eruption and facial palsy with or without vestibulocochlear deficit. Regardless of symptomatic presentations, IAC MRI demonstrated post-contrast enhancement of cranial nerve (CN) VII, CN VIII, and IAC dura in patients with atypical clinical manifestations. In cases with multiple lower CN palsy, enhancement along the involved nerve was observed on IAC MRI. When RHS was complicated by acute parotiditis, diffuse enhancement of the parotid gland was demonstrated. The present study shows that in IAC MRI of RHS patients with atypical clinical manifestations, post-contrast enhancement was not confined to the facial nerve but also observed in CN VIII and IAC dura regardless of the symptoms, which may facilitate early diagnosis of RHS.

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea

    Jin Woo Choi

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05030, Republic of Korea

    Hyunjoo Nahm, Jung Eun Shin & Chang-Hee Kim

Authors
  1. Jin Woo Choi
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  2. Hyunjoo Nahm
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  3. Jung Eun Shin
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  4. Chang-Hee Kim
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Contributions

JWC, HN, KH, and JES: acquisition of data. JWC, HN, KH, JES, and CHK: analysis and interpretation of data. JWC and CHK: drafting of the manuscript. CHK: critical revision of the manuscript, study concept, design, and supervision.

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Correspondence to Chang-Hee Kim.

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The study was approved by the Institutional Review Board (KUH1110084).

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The authors declare that they have no conflict of interest.

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Choi, J.W., Nahm, H., Shin, J.E. et al. Atypical clinical manifestations of herpes zoster oticus: diagnostic usefulness of magnetic resonance imaging. J. Neurovirol. 25, 874–882 (2019). https://doi.org/10.1007/s13365-019-00781-8

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  • DOI: https://doi.org/10.1007/s13365-019-00781-8

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