Abril - 2017

aiva

ALC

302

ssoc

ras

2017; 63(4):301-302

Diagnosis is performed based on signs and symptoms.

Examination of cerebrospinal fluid and gadolinium-enhanced

MRIs have proved no diagnostic or prognostic value,

al-

though a positive polymerase chain reaction (PCR) test for

VZV is used for confirmation.

Proper physical examination

and history is essential because in many cases, when facial

paralysis is noted at the ER, the first hypothesis is that of

stroke, which leads to misdiagnosis and wrong treatment

and can cause sequelae, such as permanent hearing loss.

After diagnosis, the treatment includes steroids and

antiviral drugs during the acute fase.

4,5

Usually, prednisone

(duration and dose varies a lot but usually is 1 mg/kg/day

for 5-7 day) is combined with intravenous or oral acyclovir

(or similar drugs) concomitantly. It is essential to refer pa-

tients to rehabilitation after the acute phase for motor phys-

iotherapy, biofeedback andmassage therapy.

2,4

Our patient

received seven days of prednisone and acyclovir, and a request

for physioterapy as soon as the pain improved. She progressed

with complete resolution of the facial paralysis 30 days after

onset of treatment and no hearing sequelae was observed.

esumo

Paralisia facial secundária à síndrome de Ramsay Hunt –

Uma condição rara

A síndrome de Ramsay Hunt (ou zóster auricular) é uma

complicação rara do herpes-zóster em que ocorre reati-

vação de uma infecção latente pelo vírus varicela-zóster

no gânglio geniculado. Geralmente, estão presentes

vesículas auriculares e sintomas como otalgia e parali-

sia facial periférica. Além disso, mais raramente pode

haver

rash

ao redor da boca. Pacientes com imunodefi-

ciência apresentam maior susceptibilidade para essa

condição. O diagnóstico é essencialmente pelo quadro

clínico. É apresentado o caso de uma paciente diabética

que compareceu ao setor de emergência com essa mani-

festação rara.

Palavras-chave:

paralisia facial, herpes-zóster da ore-

lha externa.

eferences

Hunt JR. On herpetic inflammations of the geniculate ganglion. A new

syndrome and its complications. J Nerv Ment Dis. 1907; 34(2):73-96.

2. Gondivkar S, Parikh V, Parikh R. Herpes zoster oticus: a rare clinical entity.

Contemp Clin Dent. 2010; 1(2):127-9.

Simpson RR. Section of Otology – Discussion: the Ramsay Hunt syndrome.

Proc Royal Soc Med. 1953; 47:371-84.

Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg

Psychiatry. 2001; 71(2):149-54.

5. Costa A, Veiga A. Ramsay-Hunt syndrome in the differential diagnosis of

stroke. Rev Soc Bras Med Trop. 2013; 46(5):663.