acyclovir and Polyneuropathies

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adrenal Cortex Hormones; Capsaicin; Carbamazepine; Demyelinating Diseases; Ganciclovir; HIV-1; HTLV-I Infections; Humans; Muscular Diseases; Neuritis; Neuromuscular Diseases; Peripheral Nervous System Diseases; Polyneuropathies; Zidovudine

Cranial polyneuropathy (CP) is a rare complication of herpes zoster (HZ) infection. This entity often produces situations of a diagnostic dilemma, as can be seen in a wide spectrum of clinical presentations. The aim of this study was to report the clinical characteristics, treatment, and outcomes of 11 patients from a single-institution experience.. A retrospective analysis of patients treated for HZ CP over a 12-year period was performed.. The present study included 11 patients with CP caused by HZ infection-7 (63.63%) females, and 4 (36.36%) males. The mean age at presentation was 63 years (range, 38-85 years). Cranial nerve VII was affected in nine (81.82%) cases, CN VIII in six (54.55%) cases, CN V in five (45.45%) cases, CN III and IX in two (18.18%) cases, and CN VI and X in one (9.09%) case. The treatment of choice was acyclovir in all patients, while corticosteroids were administered in six (54.55%) patients. Complete CN recovery was observed in seven (63.63%) patients, while four (36.36%) patients suffered from permanent CN damage-two (18.18%) CN VII, one (9.09%) CN VII and VIII, and one (9.09%) CN VI.. Herpes zoster CP presents an interesting diagnostic and therapeutic challenge. Successful management of these patients depends on a thorough knowledge of the anatomy and topodiagnostic of CNs. Early administration of antiviral agents is crucial in terms of responsiveness to treatment and expedite recovery.

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Herpes Zoster Oticus; Humans; Male; Polyneuropathies; Retrospective Studies

Cranial polyneuropathy is commonly caused by Lyme disease. We discuss the case of a man who presented with cranial nerve deficits causing dysphagia, dysphonia and facial weakness. This diagnostic dilemma stemmed from a workup that ruled out Lyme and vascular causes leading to an expanded search for infectious explanations, which revealed varicella zoster in the cerebrospinal fluid. On review, this phenomenon is rarely reported, but has been observed with a number of herpes family viruses. In emergency department settings, clinical suspicion should be raised for VZV infection even in the absence of rash in patients that present with multiple cranial nerve palsies.

Topics: Acyclovir; Antiviral Agents; Cranial Nerve Diseases; Deglutition Disorders; Dysphonia; Emergency Service, Hospital; Facial Muscles; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Muscle Weakness; Polyneuropathies

Varicella Zoster Virus (VZV) is associated with many disorders of the central and peripheral nervous systems including neuralgia, meningitis, meningoencephalitis, cerebellitis, vasculopathy, myelopathy, Ramsay-Hunt syndrome, and polyneuritis cranialis. Cranial nerves V, VI, VII, VIII, IX, X, XI, and/or XII may be affected. The neurological disorders caused by VZV usually present with rash, but may rarely present without rash.. We herein present a case of polyneuritis cranialis without rash caused by VZV affecting cranial nerves VII, VIII, IX, and X. After excluding other causes of the condition, we diagnosed VZV infection based on VZV DNA in the CSF and an elevated anti-VZV IgG level in serum. The patient responded well to antiviral therapy.. VZV infection should be kept in mind during the differential diagnosis of polyneuritis cranialis; it is important to note that VZV re-activation may occur without rash.

Topics: Acyclovir; Antiviral Agents; Cranial Nerve Diseases; Facial Nerve Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Polyneuropathies; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Middle Aged; Neurologic Examination; Polyneuropathies; Serologic Tests; Treatment Outcome; Valacyclovir; Valine

In March 2003, a 34-year-old man with left facial palsy, dysphagia, and hoarseness treated with acyclovir suffered worsened dermatological and neurological problems. A routine blood test in early April showed the patient to be HIV-antibody positive, so he was transferred to our hospital. Blood analysis showed serum HIV-RNA at 96,000 copies/mL and a CD 4 count of 170/microL. Brain MRI taken on admission showed a T 2 high lesion in their left medulla. Acyclovir was thought to be ineffective due to reduced cell-mediated immunity because of the HIV infection, and HAART therapy was begun. After two months of HAART, skin lesions and the T 2 high lesion in left medulla improred. HIV-RNA became undetectable and the CD 4 count exceeded 500/microL. Intracellular cytokine analysis by flow cytometry showed a shift from Th 2 to Th 1 dominance. The elimination of VZV may thus have been promoted by the combination of acyclovir and HAART.

Topics: Acyclovir; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; Herpes Zoster; HIV Infections; Humans; Male; Polyneuropathies

Medical treatment for facial palsy includes an accurate diagnosis and reliable estimate of prognosis as well as appropriate medication. Cranial polyneuritis (Bell's palsy and Ramsay Hunt syndrome), the most common cause of facial palsy, is an inflammatory, autoimmune, demyelinating disease best treated by parenteral steroids without surgical intervention. The antiviral agent acyclovir is now being tested as an adjunct to or replacement for steroid therapy. Trauma, the second most common cause of facial palsy, is often treated with steroids, but no controlled study has ever been performed. However, animal experiments clearly demonstrate that steroid treatment of a compressed facial nerve accelerates repair of the mechanical injury and decreases time of recovery. Acute otitis media with facial palsy is best treated with myringotomy, appropriate antibiotics, and steroid therapy. The use of steroids with antibiotics improves the resolution of middle ear exudate fourfold, compared with the use of antibiotics alone. Other treatment modes in selected cases are discussed. Physiotherapy in the form of electrical stimulation of the facial muscles is not advised.

Topics: Acyclovir; Animals; Autoimmune Diseases; Cranial Nerve Diseases; Diagnosis, Differential; Facial Paralysis; Guinea Pigs; Herpes Zoster; Humans; Methylprednisolone; Otitis Media; Polyneuropathies; Prednisone; Prognosis