acyclovir and Paralysis

Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. The overall prognosis is good. More than two-thirds of patients with typical Bell palsy have a complete spontaneous recovery. For children and pregnant women, the rate of complete recovery is up to 90%. Bell palsy is idiopathic. Laboratory testing and imaging are not required for diagnosis. When other causes of facial weakness are being considered, laboratory testing may identify a treatable cause. An oral corticosteroid regimen (prednisone, 50 to 60 mg per day for five days followed by a five-day taper) is the first-line treatment for Bell palsy. Combination therapy with an oral corticosteroid and antiviral may reduce rates of synkinesis (misdirected regrowth of facial nerve fibers manifesting as involuntary co-contraction of certain facial muscles). Recommended antivirals include valacyclovir (1 g three times per day for seven days) or acyclovir (400 mg five times per day for 10 days). Treatment with antivirals alone is ineffective and not recommended. Physical therapy may be beneficial in patients with more severe paralysis.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Child; Female; Humans; Paralysis; Pregnancy; Valacyclovir

The authors report a 56-year-old woman with Ramsey Hunt syndrome with multiple cranial nerve paralysis and acute respiratory failure. Five days before admission, she experienced right otalgia and right facial pain and consulted an otolaryngologist of our hospital, who diagnosed the illness as acute parotitis and laryngopharyngitis. One day before admission, she experienced mild dyspnea and general fatigue and came to our hospital emergency room. A chest X-ray film revealed no abnormalities but some blisters were observed around her right ear. The next day, her dyspnea became more severe and she was admitted. A chest X-ray film on admission revealed right lower lobe consolidation, and neurological examination disclosed multiple cranial nerve paralysis, i.e., paralysis of the right fifth, seventh, eighth, ninth, tenth, eleventh, twelfth and left tenth cranial nerve. The serum titer of anti-herpes zoster antibody was elevated to 1,024, and the patient was diagnosed as having Ramsey Hunt syndrome with multiple cranial nerve paralysis. Arterial blood gas analysis revealed hypoxemia with hypercapnea, which was considered to be due to aspiration pneumonia and central airway obstruction caused by vocal cord paralysis. Mechanical ventilation was soon instituted and several antibiotics and acyclovir were administered intravenously, with marked effects. Three months after admission, the patient was discharged with no sequelae except mild hoarseness. Patients with herpes zoster oticus, facial nerve paralysis and auditory symptoms are diagnosed as having Ramsey Hunt syndrome. This case was complicated by lower cranial nerve paralysis and acute respiratory failure, which is very rare.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Cranial Nerve Diseases; Drug Therapy, Combination; Female; Herpes Zoster Oticus; Humans; Middle Aged; Paralysis; Pneumonia, Aspiration; Respiratory Insufficiency

The incidence of paresis due to herpes zoster (HZ) infections are reported very differently in the literature with rates varying from 0.5 to 31%. Many of the paresis are presumed to be undiagnosed on account of topographic dissociation, variable periods from the cutaneous affection to the muscular involvement, masking of the paresis by pain, paresis of the intercostal and abdominal muscles which are not obvious and difficulties in correlating the visceral symptoms with a herpes zoster eruption. Paresis of the cranial nerves are easily diagnosed and 50% of all HZ paresis are diagnosed from this region. Early acyclovir treatment has improved the prognosis. Four cases of hypotonic herpes zoster paresis in immunocompetent persons are described and the diagnostic difficulties are discussed.

Topics: Acyclovir; Aged; Antibodies, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Paralysis

A 72-year-old woman presented with acute-progressive muscle weakness after a rash in the left upper limb. Muscle weakness was restricted to the left C5 innervated muscles. Short inversion time inversion recovery magnetic resonance imaging (MRI) showed a high-intensity signal in the left C5 nerve root, and nerve ultrasound showed its enlargement. She was diagnosed with segmental zoster paralysis (SZP) and treated with acyclovir and methylprednisolone. Her muscle strength gradually recovered, and the abnormal signal and enlargement in the left C5 nerve root improved. This is the first SZP case of confirmed improvement of abnormal findings on MRI and nerve ultrasound in association with muscle power recovery.

Topics: Acyclovir; Aged; Female; Herpes Zoster; Humans; Magnetic Resonance Imaging; Muscle Weakness; Paralysis; Paresis

Topics: Acyclovir; Adult; Encephalitis, Herpes Simplex; Female; Herpes Simplex; Humans; Magnetic Resonance Imaging; Migraine Disorders; Paralysis; Stroke; Young Adult

Varicella zoster virus is a Deoxyribonucleic acid (DNA) virus exclusively affecting humans. Reactivation of varicella zoster virus causes herpes zoster with vesicular eruptions in a restricted dermatomal distribution. Peripheral motor neuropathy is a very rare complication of varicella zoster virus.. A 57-year-old previously well Sri Lankan female presented with acute onset painful weakness of the left upper limb with a preceding history of a febrile illness. Subsequently she developed vesicular eruptions in the dermatomal distribution of cervical 5, 6, and 7. Electromyography was suggestive of acute denervation of cervical 5, 6, and 7 myotomes. Diagnosis of zoster-associated brachial plexopathy was made, and the patient was treated with acyclovir, steroids, and analgesics. She made a good recovery.. Brachial plexus neuritis due to varicella zoster infection should be considered in an acute monoparesis of a limb as it is a treatable and reversible condition.

Topics: Acyclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged; Paralysis; Stroke

Topics: Abdominal Muscles; Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Immunoglobulin G; Male; Middle Aged; Pain; Paralysis; Valacyclovir; Valine

Herpes zoster is a common clinical problem but its complications, apart from post-herpetic neuralgia, are comparatively rare. We describe a case of Horner's syndrome and ipsilateral vagal paresis following likely herpes zoster of the third and fourth cervical roots. This unusual combination has not, to our knowledge, been previously described.

Topics: Acyclovir; Antiviral Agents; Dexamethasone; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster; Horner Syndrome; Humans; Male; Middle Aged; Paralysis

Segmental zoster paresis is a relatively rare complication characterized by focal motor weakness, which may occur in limbs affected by herpes zoster. We demonstrate the clinical characteristics of segmental zoster paresis by reviewing the cases of 138 patients, including 3 of our patients.. We report 3 patients with zoster paresis of the limbs. Patients 1 and 3 showed motor weakness in the left shoulder and arm after developing a herpetic rash in the left C5-C6 dermatomes. Patient 2 showed weakness in the right thigh and groin after a right L2-L3 herpetic eruption. The electromyograms of all 3 patients showed abnormal spontaneous activity in the affected muscles. Intravenous acyclovir and corticosteroid pulse therapy were added to oral antiviral drugs for patients 1 and 2. All 3 patients recovered favorably. Our review of the literature revealed that antiviral treatment may prevent the occurrence of zoster paresis; however, there is insufficient evidence to show what treatment hastens recovery from zoster paresis.. Segmental zoster paresis is still underrecognized by neurologists. Awareness of this disorder is important because it may eliminate unnecessary invasive investigations and lead to appropriate treatment. Further studies on the treatment are necessary.

Topics: Acyclovir; Aged; Antiviral Agents; Diabetes Complications; Electromyography; Exanthema; Female; Herpes Zoster; Humans; Lower Extremity; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness; Neural Conduction; Paralysis; Risk Factors; Skin; Upper Extremity

Topics: Acyclovir; Antiviral Agents; Drug Administration Schedule; Female; Fiber Optic Technology; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Laryngoscopy; Middle Aged; Paralysis; Vagus Nerve; Virus Activation

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Cranial Nerve Diseases; Facial Nerve; Herpes Labialis; Humans; Male; Methylprednisolone; Paralysis; Peripheral Nervous System Diseases; Trigeminal Nerve

Hamsters are very susceptible to infections with herpes simplex virus. Inoculation of the skin of the lower back region leads to an ascending involvement of the central nervous system with fatal outcome. This model was used for testing the activity of antiviral substances in herpes infections of the nervous system. Acyclovir given in optimal dosages prevented infection of the central nervous system completely even when therapy was started 48 hours after inoculation. Therapy with acyclovir proved to be successful in animals showing paresis after infection even when the drug was given in lower than optimal dosages.

Topics: Acyclovir; Animals; Antiviral Agents; Brain; Central Nervous System Diseases; Cricetinae; Guanine; Herpes Simplex; Mesocricetus; Paralysis; Simplexvirus; Spinal Cord; Time Factors