RESUMEN
We carried out a clinical and epidemiological study of adult patients with varicella-zoster virus central nervous system infection diagnosed by PCR in cerebrospinal fluid. Twenty-six patients were included. Twelve (46.2 %) patients were diagnosed with meningitis and fourteen (53.8 %) with meningoencephalitis. Twelve (46.2 %) had cranial nerves involvement (mainly the facial (VII) and vestibulocochlear (VIII) nerves), six (23.1 %) had cerebellar involvement, fourteen (53.8 %) had rash, and four (15.4 %) developed Ramsay Hunt syndrome. Three (11.5 %) patients had sequelae. Length of stay was significantly lower in patients diagnosed with meningitis and treatment with acyclovir was more frequent in patients diagnosed with meningoencephalitis. We believe routine detection of varicella-zoster virus, regardless of the presence of rash, is important because the patient may benefit from a different clinical management.
Asunto(s)
Encefalitis por Varicela Zóster/diagnóstico , Herpes Zóster Ótico/diagnóstico , Herpesvirus Humano 3/patogenicidad , Meningitis Viral/diagnóstico , Aciclovir/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Sistema Nervioso Central/patología , Sistema Nervioso Central/virología , Cerebelo/patología , Cerebelo/virología , Nervios Craneales/patología , Nervios Craneales/virología , Encefalitis por Varicela Zóster/líquido cefalorraquídeo , Encefalitis por Varicela Zóster/tratamiento farmacológico , Encefalitis por Varicela Zóster/virología , Femenino , Herpes Zóster Ótico/líquido cefalorraquídeo , Herpes Zóster Ótico/tratamiento farmacológico , Herpes Zóster Ótico/virología , Herpesvirus Humano 3/efectos de los fármacos , Herpesvirus Humano 3/fisiología , Humanos , Masculino , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/tratamiento farmacológico , Meningitis Viral/virología , Persona de Mediana Edad , Estudios Retrospectivos , Nervio Vestibulococlear/patología , Nervio Vestibulococlear/virologíaRESUMEN
Acoustic neuromas are a result of damage to the affected nerve function and can potentially press surrounding tissues. Although some sources suggest that observation is the treatment of choice for only those over 65 years of age and those unable to tolerate undergoing surgery or radiosurgery, most affected individuals should strongly consider not doing any aggressive therapies. Herpes has already been shown to mimic acoustic neuroma clinically, but growing evidence suggests that it is likely the cause of most cases of this entity.
Asunto(s)
Infecciones por Herpesviridae/complicaciones , Neuroma Acústico/etiología , Herpesviridae/patogenicidad , Humanos , Modelos Neurológicos , Neuroma Acústico/terapia , Neuroma Acústico/virología , Células de Schwann/virología , Nervio Vestibulococlear/virologíaRESUMEN
Delayed facial palsy after acoustic neuroma resection may occur in up to 15% of cases. Prognosis is generally good if the palsy does not progress to total paralysis. However, a delayed palsy with subsequent total paralysis has a more variable final outcome, which ranges from normal function to permanent total paralysis. This delayed paralysis has been attributed to edema from surgical manipulation of the facial nerve. Steroids and intraoperative decompression of the meatal foramen have been used with some success, but some cases remain refractory to these measures. Herpes simplex virus and varicella-zoster virus are ubiquitous in the population and remain in a latent state in neural ganglia. These viruses are reactivated during times of stress. Trigeminal nerve surgery (partial sensory rhizotomy and microvascular decompression) stimulates reactivation of herpes simplex with manifestations in the sensory distribution of the trigeminal nerve in 38-94% of procedures. Prevention of this reactivation has been demonstrated in placebo-controlled trials by using prophylactic acyclovir. We present a patient who underwent translabyrinthine resection of an intracanalicular acoustic neuroma and in whom developed otalgia, vesicles on the ear canal and the ipsilateral buccal mucosa, and progressive facial palsy the week after surgery. Serologic evaluation confirmed the diagnosis of herpes zoster oticus. Reactivation of latent virus apparently occurred as a result of surgical manipulation of the facial nerve. This parallels viral reactivation seen in trigeminal nerve surgery. We propose a new theory for an additional cause of delayed facial palsy after acoustic neuroma resection-reactivation of latent herpesvirus resulting from surgical trauma. Acyclovir should be evaluated in clinical trials for a prophylactic role in patients undergoing acoustic neuroma resection or a therapeutic role in patients in whom a delayed postoperative facial palsy develops.