Department of Neurological, Neurosurgical and Behavioural sciences, University of Siena, Italy.
J Neurol Sci. 2012 Jul 15;318(1-2):160-2. doi: 10.1016/j.jns.2012.04.011. Epub 2012 May 4.
Ramsay Hunt syndrome (RHS) is a frequent cause of facial palsy. It is a consequence of the infection of geniculate ganglion by herpes zoster or herpes simplex virus. In the lack of randomized controlled trials, RHS is empirically treated by a combination therapy of antiviral agents and steroids given orally. However, RHS has, per se, a poorer prognosis than idiopathic facial palsy (Bell's palsy). We describe a case series of two patients with RHS unsuccessfully treated with antiviral drugs and oral corticosteroids, showing an almost complete recovery after late administration of intravenous (i.v.) high dose methylprednisolone. Both patients had all recognized negative prognostic factors including age of onset, a high grade facial weakness, absence of R1 and R2 response at blink reflex test, and in the first case, the involvement of greater superficial petrosal nerve. We propose that i.v. high dose methylprednisolone should be considered, even as a late treatment option, in patients with RHS non recovering after standard antiviral and oral steroid therapy as well as presenting clinical features suggestive of a poor prognosis.
拉姆齐亨特综合征（RHS）是面瘫的常见原因。它是由于膝状神经节感染单纯疱疹病毒或带状疱疹病毒引起的。在缺乏随机对照试验的情况下，RHS 经验性地采用抗病毒药物和口服类固醇联合治疗。然而，RHS 的预后本身比特发性面瘫（贝尔麻痹）差。我们描述了两例 RHS 患者的病例系列，他们使用抗病毒药物和口服皮质类固醇治疗均未成功，在晚期给予静脉内（i.v.）大剂量甲基强的松龙后几乎完全恢复。两名患者均具有所有公认的不良预后因素，包括发病年龄、面部无力程度高、眨眼反射试验中无 R1 和 R2 反应，以及在第一个病例中，涉及更表浅的岩浅大神经。我们建议，对于标准抗病毒和口服类固醇治疗后未恢复的 RHS 患者，以及具有不良预后提示性临床特征的患者，即使作为晚期治疗选择，也应考虑静脉内大剂量甲基强的松龙治疗。
