acyclovir and Vocal-Cord-Paralysis

Miller Fisher syndrome (MFS), an acute demyelinating neuropathy, is characterised by a triad of areflexia, ataxia and ophthalmoplegia. It is the most common variant of Guillain-Barre Syndrome (GBS). In about 5.6%-7.1% of MFS cases, patients also suffer from progressive motor weakness of the limbs. This condition is termed MFS/GBS overlap syndrome. Whether it is in MFS or GBS, bilateral vocal cord paralysis (BVCP) is a rare manifestation with limited cases reported in the literature. We report an extremely rare case where a 65-year-old man developed BVCP in an MFS/GBS overlap syndrome. We have also reviewed previous case reports in the literature for comparison.

Topics: Acyclovir; Aged; Antiviral Agents; Chickenpox; Disease Progression; Electrodiagnosis; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Male; Miller Fisher Syndrome; Neural Conduction; Tracheostomy; Vocal Cord Paralysis

Herpes zoster reactivaction in the head and neck region is often associated with multiple cranial neuropathies, the most common one being facial paralysis. Laryngeal paralysis has also been occasionally reported with zoster infection. We present two such cases, and discuss the relevant literature on the pathophysiology, evaluation and management of this disease. Recent advances in antiviral therapy have allowed for specific medical treatment, thus making it all the more imperative to suspect zoster, even in clinically atypical cases. We suggest aggressive treatment with intravenous acyclovir for cephalic zoster complicated by vocal cord paralysis.

Topics: Acyclovir; Aged; Diagnosis, Differential; Herpes Zoster Oticus; Humans; Male; Middle Aged; Vocal Cord Paralysis

Topics: Acyclovir; Antiviral Agents; Ear Auricle; Female; Glossopharyngeal Nerve; Herpes Zoster; Herpesvirus 3, Human; Humans; Laryngeal Muscles; Methylprednisolone; Middle Aged; Paresis; Pulse Therapy, Drug; Recurrent Laryngeal Nerve; Skin; Treatment Outcome; Vocal Cord Paralysis

Topics: Acyclovir; Adrenal Cortex Hormones; Aged, 80 and over; Antiviral Agents; Herpes Simplex; Humans; Male; Respiratory Sounds; Simplexvirus; Ulcer; Vagus Nerve Diseases; Virus Activation; Vocal Cord Paralysis

Herpes zoster is a neurocutaneous disease resulting from the reactivation of endogenous varicella-zoster virus (VZV) in dorsal sensory or cranial nerve ganglia. Rarely, this infection manifests without the characteristic dermatomal rash, a condition termed zoster sine herpete. Viral spreading of herpes zoster in the head and neck may manifest as various signs and symptoms because of the multiple possible combinations of cranial neuropathies. With only six cases reported in the English literature up to now, isolated neuropathies of the vagus nerve in the absence of cutaneous lesions tend to be misdiagnosed as idiopathic laryngeal paralysis.. We report a case of herpes zoster of the larynx in an 80-year-old man presenting with sore throat, dysphagia, and hoarseness.. Endoscopic examination revealed unilateral vocal fold paralysis, pooling of secretions, and mucosal vesicles of the hemilarynx. After the diagnosis of VZV infection with polymerase chain reaction (PCR) testing, the patient was treated with valacyclovir and corticosteroids, leading to complete recovery after 2 months.. Herpes zoster of the larynx is an uncommon condition that should be included in the differential diagnosis of laryngeal paralysis of idiopathic cause. We recommend performing a thorough examination of the pharyngolaryngeal structures and ordering PCR testing as the diagnostic method of choice.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Deglutition Disorders; Herpes Zoster; Herpesvirus 3, Human; Hoarseness; Humans; Laryngoscopy; Male; Pharyngitis; Polymerase Chain Reaction; Predictive Value of Tests; Remission Induction; Steroids; Time Factors; Treatment Outcome; Valacyclovir; Valine; Virus Activation; Vocal Cord Paralysis

Ramsay Hunt syndrome is defined by herpes zoster oticus and peripheral facial nerve palsy which is often associated with otalgia. The syndrome is, in rare cases, associated with other cranial nerve paralyses including the vagal nerve causing unilateral vocal cord paralysis. Vocal cord paralysis is more often seen as a symptom of various other diseases, that is, malignant tumours, neurodegenerative illness, cerebrovascular assaults, inflammatory processes or as a result of intubation or surgical procedures. The symptoms of unilateral vocal cord paralysis are mainly hoarseness, dyspnoea and dysphagia. We present a case of Ramsay Hunt syndrome combined with unilateral hearing loss and left vocal cord paralysis. The patient underwent MRI, CT and a lumbar puncture causing anxiety in the patient and delaying the initiation of antiviral and anti-inflammatory treatment, which is only efficient when initiated within 72 h. We hope to raise the awareness of this disease.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Hearing Loss, Unilateral; Herpes Zoster Oticus; Humans; Hydrocortisone; Male; Vocal Cord Paralysis

To report a case of bilateral vocal cord abductor paralysis in the context of primary herpes simplex infection.. A 63-year-old man was urgently admitted to hospital with laryngeal dyspnoea associated with dysphagia but without dysphonia. Physical examination demonstrated the vocal cords in a paramedian position with paralysis of abduction. The patient reported primary herpes simplex infection two weeks prior to this episode. HSV serology indicated recent infection and lumbar puncture demonstrated the presence of herpes simplex virus type 1 in the cerebrospinal fluid. Complete resolution of respiratory symptoms was observed after 21 days of treatment with intravenous aciclovir.. Gerhardt syndrome comprises inspiratory dyspnoea without dysphonia. It used to be mainly due to syphilis, but is now mostly observed in the setting of neurodegenerative disease. The authors report a case of Gerhardt syndrome occurring after an episode of primary herpes simplex infection with the presence of herpes simplex virus in the CSF. Treatment by intravenous antiviral drugs allowed rapid resolution of the symptoms. The pathophysiology of Gerhardt syndrome remains unexplained, but the possible role of herpes simplex infection should be considered in cases of laryngeal palsy.

Topics: Acyclovir; Antiviral Agents; Follow-Up Studies; Herpes Simplex; Herpesvirus 1, Human; Humans; Injections, Intravenous; Male; Middle Aged; Time Factors; Treatment Outcome; Vocal Cord Paralysis

We report a patient with the varicella zoster viral (VZV) infection of multiple cranial nerves mimicking Garcin syndrome, who initially presented with Ramsay Hunt syndrome (herpes zoster oticus). A 78-year-old man showed left facial palsy with zosteric eruptions in his left auricle and dysphagia, followed by left total ophthalmoplegia. His serum anti-VZV antibody titer was elevated. Cerebrospinal fluid examination revealed pleocytosis with a slightly elevated protein level. He was treated with intravenous acyclovir and corticosteroids. His tongue weakness resolved, and then ocular movement improved. The improvement of facial palsy and swallowing difficulty was delayed. VZV infection should be considered even in patients who show unilateral multiple cranial neuropathy mimicking Garcin syndrome because it is treatable.

Topics: Acyclovir; Aged; Cranial Nerve Diseases; Deglutition Disorders; Drug Therapy, Combination; Facial Paralysis; Follow-Up Studies; Herpes Zoster; Herpes Zoster Oticus; Humans; Hydrocortisone; Male; Methylprednisolone; Neurologic Examination; Ophthalmoplegia; Prednisolone; Vocal Cord Paralysis

The cephalic zoster is a cranial neuritis, with great tendency to diffusion along the nerves. The objective of this article is both to report a case of cranial polineuritis due to herpes zoster infection with laryngeal involvement and review of the relevant literature.. The case of 57-years-old man with unilateral laryngeal mucosal eruptions and complete left vocal paralysis is reported. Laryngeal symptoms, diagnostic criteria and therapeutic result are described.. 1. In cases of head and neck herpes zoster, the investigations of all cranial nerves should be carried out, and the larynx must always be examinated; 2. Co-occurrence of the neuralgic pain (radiating especially to the ear or the occipital region) with unilateral laryngeal palsy should raise a suspicion that herpes zoster infection may by the causative factor; 3. The explanation of the etiologic cause of a vocal fold paralysis in idiopathic cases, may yield not only diagnostic, but also therapeutic value.

Topics: Accessory Nerve; Acyclovir; Ceftriaxone; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Paresis; Treatment Outcome; Vagus Nerve; Vocal Cord Paralysis

Topics: Acyclovir; Female; Herpes Zoster Oticus; Humans; Middle Aged; Vocal Cord Paralysis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Colitis; Cranial Nerve Diseases; Cytomegalovirus Infections; Ganciclovir; Hoarseness; Humans; Laryngeal Nerves; Male; Opportunistic Infections; Recurrent Laryngeal Nerve; Vocal Cord Paralysis