Atypical clinical manifestations of herpes zoster oticus: diagnostic usefulness of magnetic resonance imaging
Atypical clinical manifestations of herpes zoster oticus: diagnostic usefulness of magnetic resonance imaging
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DOI：
10.1007/s13365-019-00781-8
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发表时间：
2019-12-01
影响因子：
3.2
通讯作者：
Kim, Chang-Hee
中科院分区：
文献类型：
--
作者：
Choi, Jin Woo;Nahm, Hyunjoo;Kim, Chang-Hee
拉姆齐亨特综合征 (RHS) 的典型症状包括外耳疼痛性水疱疹、单侧面部麻痹和/或前庭耳蜗缺陷。当RHS患者出现不典型的临床表现时，可能会延误正确诊断，并可能错过抗病毒治疗的理想治疗时机。本研究的目的是描述具有非典型临床表现的 RHS 患者，并评估磁共振成像 (MRI) 对早期鉴别诊断的有用性。我们回顾性分析了 2013 年 1 月至 2016 年 12 月期间 7 例临床表现“非典型”的 RHS 患者的临床资料和内耳道 (IAC) MRI 结果。RHS 的“典型”症状包括疱疹性水疱疹和面神经麻痹，伴有或不伴有前庭耳蜗缺陷。无论症状如何，IAC MRI 均显示临床表现不典型的患者的颅神经 (CN) VII、CN VIII 和 IAC 硬脑膜对比后增强。在多发性下 CN 麻痹的病例中，IAC MRI 观察到沿受累神经的增强。当RHS并发急性腮腺炎时，腮腺弥漫性强化。本研究表明，在临床表现不典型的RHS患者的IAC MRI中，无论症状如何，造影后增强不仅限于面神经，在CN VIII和IAC硬脑膜中也可观察到，这可能有助于RHS的早期诊断。
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.