acyclovir and Vertigo

This clinical report is presented to describe how results of vestibular function testing were considered along with other medical history to develop a management plan that was ultimately successful.. The patient underwent audio-vestibular assessment including comprehensive audiogram, videonystagmography, cervical vestibular evoked myogenic potential, and postural stability testing.. Results from initial testing were most consistent with uncompensated peripheral vestibular dysfunction affecting the right superior vestibular nerve. These results, considered along with history and symptoms, supported vestibular neuritis. After a second vertigo event, we became concerned about the potential temporal association between the patient's rheumatoid arthritis treatment and symptom onset. It is established that treatment for rheumatoid arthritis can exacerbate latent viral issues, but this has not specifically been reported for vestibular neuritis. There are reports in the literature in which patients successfully used viral suppressant medication to decrease viral activity while they were able to continue benefiting from immunosuppressive therapy. We hypothesized that, if the current patient's vestibular neuritis events were related to her treatment for rheumatoid arthritis, she may also benefit from use of viral suppressant medication while continuing her otherwise successful immunosuppressive intervention.. Patients treated with biologic disease-modifying antirheumatic drugs are more susceptible to viral issues, and this may include vestibular neuritis. For the current case, identifying this possibility and recommending viral suppressant medication allowed her to continue with successful treatment of rheumatoid arthritis while avoiding additional vertigo events.

Topics: Acyclovir; Antirheumatic Agents; Arthritis, Rheumatoid; Biological Products; Female; Humans; Middle Aged; Prognosis; Recurrence; Risk Assessment; Severity of Illness Index; Treatment Outcome; Valacyclovir; Valine; Vertigo; Vestibular Function Tests; Vestibular Neuronitis

Ramsay Hunt's hypothesis that herpes zoster oticus results from reactivation of the varicella zoster virus (VZV) in the geniculate ganglion is supported by the detection of viral genome in archival temporal bones of normals and Ramsay Hunt patients by the polymerase chain reaction. Ramsay Hunt syndrome is characterized by the presence of cochleovestibular symptoms in association with facial paralysis. VZV has also been demonstrated in the spiral and/or vestibular ganglion. Two cases are reported in which cochleovestibular symptoms outweighed the facial nerve symptoms, presumably representing VZV reactivation in the spiral and/or vestibular ganglion. From these observations and the known dormancy of VZV in non-neuronal satellite cells, it is argued that the cochleovestibular symptoms in Ramsay Hunt syndrome may result from VZV transmission across the nerves inside the internal auditory canal and that prompt treatment with an antiviral-corticosteroid combination might be justified in the management of any acute non-hydropic cochleovestibular syndrome.

Topics: Acyclovir; Antiviral Agents; Facial Paralysis; Female; Glucocorticoids; Hearing Loss, Sensorineural; Herpes Zoster; Herpes Zoster Oticus; Humans; Male; Middle Aged; Nystagmus, Pathologic; Prednisolone; Vertigo; Virus Activation

Acute unilateral vestibular failure is characterized by rotatory vertigo, horizontal-rotatory nystagmus, and postural imbalance, all of which last from days to weeks. These signs and symptoms are caused by a vestibular tone imbalance between the two labyrinths. Recovery results from a combination of peripheral restoration of labyrinthine function (usually incomplete) and central vestibular compensation (CVC) of the vestibular tone imbalance. Acute unilateral failure is most often caused by vestibular neuritis, which is most likely due to the reactivation of a latent HSV-1 infection. Therefore, therapeutic strategies to improve the outcome of VN are theoretically based on two principles: (a) vestibular exercises and drugs to improve CVC and (b) drug treatment of the assumed viral inflammation. The following conclusions can be drawn from studies in animals and/or humans: (1) There is strong evidence that vestibular exercises may improve vestibulo-spinal compensation. These exercises should begin as early as possible after symptom onset. Moreover, slower exercises are likely to be more effective than faster exercises because slower ones seem to depend more on the vestibular system. (2) Despite extensive data from animal experiments indicating that drugs have a favorable effect on CVC, this has not been clinically proven and thus cannot be recommended yet. (3) Preliminary results of an interim analysis from an ongoing randomized, prospective study showed that methylprednisolone (plus an antiviral agent?) may be useful for improving peripheral vestibular function in vestibular neuritis.

Topics: Acyclovir; Animals; Ear, Inner; Exercise; Humans; Methylprednisolone; Vertigo; Vestibular Neuronitis

Dizziness and ataxia are known adverse effects of pregabalin, but characteristic oculomotor signs in pregabalin intoxication have not been reported. Here we describe a patient who displayed perverted head-shaking and positional downbeat nystagmus after prescription of a high dosage of pregabalin. Since pregabalin reduces excitatory neurotransmitter secretion in the central nervous system, decreased excitatory inputs from the brainstem may lead to cerebellar dysfunction, causing perverted head-shaking and positional downbeat nystagmus.

Topics: Acyclovir; Aged; Anticonvulsants; Antiviral Agents; Dizziness; Female; gamma-Aminobutyric Acid; Head Movements; Humans; Nystagmus, Pathologic; Pregabalin; Tremor; Vertigo

We herein present a case of 6-year-old female demonstrating atypical Ramsay-Hunt syndrome. She presented with an earache, severe vertigo, and vomiting at onset, and thereafter, herpes zoster oticus appeared. No facial nerve palsy was seen. She was vaccinated for varicella and had no past history of apparent varicella infection. The patient showed positive IgG and negative IgM serum antibodies for varicella-zoster virus (VZV). An analysis of VZV-DNA from the patient's ear lesion using alleric discrimination real-time PCR identified a wild-type strain of VZV. We diagnosed her to have atypical Ramsay-Hunt syndrome caused by reactivation of the VZV. Aciclovir and prednisolone were administered, and she recovered completely. This case indicates that Ramsay-Hunt syndrome could be caused by a VZV infection after vaccination, even though its frequency is low. Ramsay-Hunt syndrome may thus be considered as one of causes of sudden onset vertigo in children.

Topics: Acyclovir; Chickenpox Vaccine; Child; Diagnosis, Differential; Earache; Female; Herpes Zoster Oticus; Herpesvirus 3, Human; Humans; Prednisolone; Severity of Illness Index; Treatment Outcome; Vertigo; Vomiting

Discussion of a rare case of angioleiomyoma of the internal auditory canal.. Thirteen-year-old female patient with a 1-year history of progressive hearing loss.. Middle cranial fossa approach providing complete surgical extirpation.. Surgical pathology.. Radiography and history suggestive of vestibular schwannoma; pathology revealed angioleiomyoma.. Angioleiomyoma is a rare lesion of the internal auditory canal that has many similar clinical and radiographic features of a vestibular schwannoma. There are no previous reports of this tumor occurring within the internal auditory canal in this age group.

Topics: Acyclovir; Adolescent; Angiomyoma; Anti-Inflammatory Agents; Antiviral Agents; Cranial Fossa, Middle; Ear Neoplasms; Ear, Inner; Facial Nerve; Facial Nerve Diseases; Female; Hearing Loss, Sudden; Humans; Magnetic Resonance Imaging; Postoperative Complications; Prednisone; Tomography, X-Ray Computed; Valacyclovir; Valine; Vertigo; Vestibular Nerve

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Bromodeoxyuridine; Diagnosis, Differential; Facial Paralysis; Female; Herpes Zoster Oticus; Humans; Treatment Outcome; Vertigo; Vomiting

We compared bedside tests of vestibulo-ocular function (head thrust and head heave signs) with caloric testing results in 68 patients with acute vestibular neuritis seen at onset and in follow-up for one year. The head thrust and head heave signs each were strong predictors of a decreased probability of recovery, and if both were present, there was a trend for a slower recovery and a further decrease in the probability of recovery. If the head thrust sign was absent, recovery was assured. Our results suggest that careful bedside testing of semicircular canal (head thrust maneuver) and otolith (head heave maneuver) function provides useful information for predicting prognosis in patients with acute vestibular neuritis.

Topics: Acute Disease; Acyclovir; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Calorimetry; Female; Follow-Up Studies; Head Movements; Humans; Male; Middle Aged; Motor Activity; Multivariate Analysis; Point-of-Care Systems; Prognosis; Time Factors; Vertigo

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.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Diagnosis, Differential; Drug Therapy, Combination; Evoked Potentials, Auditory, Brain Stem; Facial Paralysis; Female; Geniculate Ganglion; Hearing Loss, Sensorineural; Herpes Zoster Oticus; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prednisone; Vertigo

Topics: Acyclovir; Adult; Ear; Female; Herpes Zoster; Humans; Pharyngitis; Vertigo