RAMSAY HUNT SYNDROME FOLLOWED BY MULTIFOCAL VASCULOPATHY AND POSTERIOR CIRCULATION STROKES
RAMSAY HUNT SYNDROME FOLLOWED BY MULTIFOCAL VASCULOPATHY AND POSTERIOR CIRCULATION STROKES
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拉姆齐亨特综合征继发多灶性血管病变和后循环中风
DOI：
10.1212/01.wnl.0000306634.51885.87
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发表时间：
2008
期刊：
影响因子：
9.9
通讯作者：
J. Romano
中科院分区：
文献类型：
--
作者：
G. Ortiz;S. Koch;A. Forteza;J. Romano
一名24岁女性，无既往病史，左耳道出现疼痛性水泡样皮疹，随后出现左侧周围性面瘫。诊断为耳带状疱疹，并口服阿昔洛韦治疗7天，皮疹消退，面神经麻痹改善。两周后，患者出现中度搏动性前额头痛，与恶心、呕吐或恐惧症无关，对非甾体类抗炎药无反应。头痛发作3天后，她突然出现轻度左侧无力、构音障碍和吞咽困难。由于症状没有改善，她于5天后到我院就诊。
她报告说以前很健康，没有偏头痛史。她的家族史不明显，她否认使用酒精，烟草和药物。她的血压为130/84，脉搏为78/分钟（规律），体温为97.8 °F。一般检查未发现，此时未观察到外耳道囊泡。瞳孔反射、眼球运动、眼底镜检查和对抗视野均正常。有轻度构音障碍，轻度左侧面瘫（包括上面部和下面部），无咽反射，腭部抬高正常。观察到4/5左侧轻偏瘫伴反射亢进和巴宾斯基征，但无感觉障碍。没有共济失调。
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A 24-year-old woman with no previous medical history developed a painful, vesicular rash on the left ear canal, followed by left peripheral facial palsy. Herpes zoster oticus was diagnosed and treated with oral acyclovir for 7 days, with resolution of the rash and improvement of the facial palsy. Two weeks later, she developed a throbbing frontal headache of moderate intensity, not associated with nausea, emesis, or photophobia and not responsive to nonsteroidal anti-inflammatory agents. Three days after the onset of headache she suddenly developed mild left-sided weakness, dysarthria, and dysphagia. As symptoms did not improve, she presented to our institution 5 days later.
She reported being previously healthy, with no history of migraine headaches. Her family history was unremarkable and she denied the use of alcohol, tobacco, and drugs. Her blood pressure was 130/84, pulse was 78/minute (regular), and temperature was 97.8 °F. The general examination was unrevealing and no external canal vesicles were noted at this time. Pupillary reflexes, ocular movements, funduscopic examination, and visual fields by confrontation were normal. There was mild dysarthria, mild left facial palsy (including upper and lower face), absent gag reflex, and normal palate elevation. A 4/5 left hemiparesis with hyperreflexia and Babinski sign were noticed, but no sensory deficits. There was no ataxia.
Brain MRI revealed acute …