Van de Steene V, Kuhweide R, Vlaminck S, Casselman J
Department of ENT, Head and Neck Surgery, AZ St-Jan Hospital, Bruges, Belgium.
Acta Otorhinolaryngol Belg. 2004;58(1):61-6.
J. Ramsay Hunt's hypothesis that herpes zoster oticus results from a reactivation of the herpes zoster virus in the geniculate ganglion, has been supported by the demonstration of varicella zoster viral DNA in the geniculate ganglion of the side with facial paralysis in patients with Ramsay Hunt syndrome, with the use of the polymerase chain reaction. Similarly, DNA of the varicella zoster virus has been identified in the spiral and vestibular ganglion as well. We report on three patients with cochleovestibular symptoms as the first manifestations of Ramsay Hunt syndrome. A 64-year old woman and a 72-year old man presented with vertigo and an auricular herpetiform eruption. Only the woman developed later on a mild facial paralysis. A 58-year old man presented with an acute cochleovestibular syndrome, serologically proven to be a varicella zoster viral reactivation, which was followed three weeks later by the typical cutaneous recrudescence. We believe that these cases result from reactivation of latent varicella zoster virus in the spiral and/or vestibular ganglion. As the varicella zoster virus is dormant in the non-neuronal satellite cells, the facial symptoms in our patients as well as the high incidence of cochleovestibular symptoms in classical Ramsay Hunt syndrome can be explained by viral transmission across the nerves inside the internal auditory canal. Therefore, we think there are grounds to recommend a prompt treatment with an antiviral and a corticosteroid agent, not only in case of an acute facial paralysis but also when confronted with an acute cochleovestibular syndrome.
J. 拉姆齐·亨特提出的耳带状疱疹是由膝状神经节中的带状疱疹病毒再激活引起的假说，已通过聚合酶链反应在拉姆齐·亨特综合征患者面神经麻痹侧的膝状神经节中检测到水痘带状疱疹病毒DNA得到了支持。同样，在螺旋神经节和前庭神经节中也发现了水痘带状疱疹病毒的DNA。我们报告了3例以耳蜗前庭症状为拉姆齐·亨特综合征首发表现的患者。一名64岁女性和一名72岁男性表现为眩晕和耳部疱疹样皮疹。只有该女性后来出现了轻度面神经麻痹。一名58岁男性表现为急性耳蜗前庭综合征，血清学证实为水痘带状疱疹病毒再激活，三周后出现典型的皮肤复发。我们认为这些病例是由螺旋神经节和/或前庭神经节中潜伏的水痘带状疱疹病毒再激活引起的。由于水痘带状疱疹病毒潜伏在非神经元卫星细胞中，我们患者的面部症状以及经典拉姆齐·亨特综合征中耳蜗前庭症状的高发生率可以通过病毒经内耳道内的神经传播来解释。因此，我们认为有理由建议不仅在急性面神经麻痹的情况下，而且在面对急性耳蜗前庭综合征时，应立即使用抗病毒药物和皮质类固醇药物进行治疗。
