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PubMed1999

Ramsay Hunt syndrome associated with brain stem enhancement.

Postcontrast T1-weighted MR images in a patient with Ramsay Hunt syndrome showed an enhancing lesion in the region of the nucleus of the pontine facial nerve and abnormal enhancement of the intrameatal, labyrinthine, and tympanic facial nerve segments and of the geniculate ganglion, as well as enhancement of the vestibulocochlear nerve and parts of the membranous labyrinth. This enhancement most probably resulted from a primary neuritis of the intrameatal nerve trunks of the seventh and eighth cranial nerves.

Brain Stem↗
PubMed1996

Bringing reality to the job hunt process. Interview by Barbara J. Linney.

A substantial percentage of the positions that open in medical management are filled through the use of recruitment firms. This is especially true of more senior positions, but it applies across the full spectrum of openings. If the working arrangement between the recruitment firm and the potential candidate is to be effective, certain key ingredients are necessary. The author interviewed a selection of principals of recruitment firms that operate extensively or exclusively in the medical management sector of executive recruitment. What she discovered about their "wish lists" for candidates' characteristics and levels of job hunting sophistication are summarized in the following statements.

Career Choice↗
PubMedDate not supplied

Cerebral B-cell lymphoma following treatment for Tolosa-Hunt syndrome.

We herein report a unique case of cerebral lymphoma which occurred after lymphocytic neuritis of cranial nerves causing Tolosa-Hunt syndrome and demonstrate the histological difference between these two diseases. A 70-year-old woman developed a sensory disturbance in the first and third divisions of the left trigeminal nerve and a left ocular movement disturbance five years before death. Although she was clinically diagnosed to have a schwannoma in the left cavernous sinus, a histologic examination verified a diffuse infiltration of T lymphocytes in the left trigeminal ganglion. Corticosteroid therapy was effective. Thereafter she demonstrated a disturbance of consciousness and dysphasia four years after surgery. A T1-weighted magnetic resonance image (MRI) disclosed high intensity lesions in both the basal ganglia and corpus callosum. She also showed progressive spastic paralysis. At autopsy a diagnosis of primary intracranial B-cell lymphoma was made. Although there was no invasion of the lymphoma cells into the left trigeminal nerves, a mild inflammatory infiltration of T cells still remained.

Aged↗
PubMed1999

[A case of Ramsay Hunt syndrome associated with local meningitis, multiple cranial neuropathy, and the second cervical nerve involvement].

A 76-year-old man with herpetic vesicle in the right auricle developed ipsilateral 5th, 6th, 7th, and 8th cranial nerves involvement and pain in the dermatome of the second cervical nerve. The CSF study revealed elevated opening pressure up to 220 mmH2O, and pleocytosis up to 151 cells/mm3. Ninety-nine percent of the CSF cells were mononuclear cells. CSF protein was 47 mg/dl, and CSF glucose was 62 mg/dl. On the 24th hospital day the CSF cells decreased to 13/mm3 with 100% mononuclear cells. Titer of varicella-zoster virus (VZV) antibody was significantly elevated in CSF. Brain MRI and ABR demonstrated no abnormality. Although disorders of 5th and 6th cranial nerves and second cervical nerve improved, mild facial nerve palsy lasted and hearing disturbance showed no recovery. There are only seven cases of Ramsay Hunt syndrome associated with external ophthalmoplegia in the literature. However, un like the present case, none of these cases presented disorders of upper cervical nerves. In this case, we speculate that spreading of reactivated VZV caused local meningitis and multiple cranial nerve involvement as well as the second cervical nerve.

Abducens Nerve↗
PubMed1994

Computerised tomography in Tolosa-Hunt syndrome.

Twelve patients who satisfied the clinical criteria of Tolosa-Hunt syndrome (THS), underwent axial computerised tomography (CT) scan of the head. Two patients had abnormalities detected in the cavernous sinus on the affected side which supported the clinical diagnosis. This coupled with steroid responsiveness and long-term asymptomatic follow-up firmly established the diagnosis of THS. We discuss the computerised tomographic findings seen in THS and the relevance of using accurate imaging techniques as the first line of investigation in these cases.

Adult↗
PubMed1999

[Autoimmune neutropenia accompanied by Tolosa-Hunt syndrome].

A 47-year-old woman presented with severe neutropenia accompanied by diplopia and orbital pain. Her bone marrow was normal except for the absence of segmented neutrophils. Because the administration of granulocyte colony-stimulating factor (G-CSF) at a dose of 1 microgram/kg/day was not sufficiently effective and neutropenia developed, the patient was admitted to our hospital. Physical examination revealed painful ophthalmoplegia and hypoalgesia in the first region of trigeminal nerve, suggestive of Tolosa-Hunt syndrome. Severe neutropenia was observed in both peripheral blood and bone marrow, together with mild anemia and thrombocytopenia. The life span of red cells and platelets was shortened. High PAIgG levels, a positive Coombs test, and a positive test for anti-NA1 antibody suggested that blood cells were being destroyed by an autoimmune mechanism. Corticosteroid hormone therapy preceded by the administration of G-CSF at 5 micrograms/kg/day was effective for both neutropenia and in improving the patient's neurological findings.

Autoimmune Diseases↗
PubMed2000

[A case of herpes zoster encephalitis with Ramsay-Hunt syndrome, herpes zoster generalisatus and acute pancreatitis].

We describe here a 71-year-old man who had herpes zoster encephalitis. He developed high fever, headache and disturbance of consciousness on 1st, May, 1998. On admission, neurological examination revealed disturbance of consciousness with restlessness and meningeal signs. Brain MRI (T 1 and T 2 weighted images) demonstrated high signal lesions in the left temporal lobe and cerebellar vermis. VSV encephalitis was diagnosed based on CSF pleocytosis, high serum and CSF titers of VZV antibody and EEG abnormality. During hospitalization, Ramsay-Hunt syndrome, herpes zoster generalisatus and acute pancreatitis developed. To our knowledge, the characteristic combination of the clinical signs in this case is very rare. We discussed the pathogenic mechanisms of these conditions, and this case was considered to have VZV encephalitis, and to be associated with right facial nerve palsy and pancreatitis, in spite of the absence of immunological deficiency.

Acute Disease↗
PubMed2000

[Diagnosis of Ramsey Hunt syndrome is both simple and difficult. The viral attack is more extensive than expected earlier].

In Ramsay Hunt's syndrome (herpes zoster of the head and neck in combination with facial palsy), the vesicles often appear on the external ear (herpes zoster oticus) but they can also be found on the exterior of the neck. Serologically verified cases without vesicles occur (zoster sine herpeticum). Complications from the eighth cranial nerve (hearing loss and vertigo) are common. MR and PCR studies show a more extensive viral attack than was earlier believed to be the case. Due to the risk of remaining cranial nerve dysfunctions, as exemplified in a case report, antiviral treatment is indicated, in severe cases combined with corticosteroids. The potential value of varicella vaccination to reduce zoster complications is discussed.

Adult↗
PubMed1999

[Ramsay Hunt syndrome--differential diagnosis, pathogenesis and therapy].

Ramsay Hunt syndrome is caused by infection of the geniculate ganglion of the seventh cranial nerve by varicella-zoster virus. A case in an 82-year-old woman is described. She presented with oral lesions, right facial palsy and an eruption and pain in her right ear. Oral examination revealed small circumscribed erosions on the right anterior two-thirds of the tongue, with loss of taste. There were also lesions on her right palate. Early diagnosis and treatment are important as immediate treatment is more likely to prevent irreversible complications affecting the facial and other cranial nerves involved.

Acyclovir↗
PubMed1975

Acute pulmonary edema and seizures in hunting dogs.

The clinical and radiographic appearance of acute pulmonary edema in three hunting dogs are reported. The etiology is discussed. The conclusion was drawn that the cause of pulmonary edema was probably neurogenic, probably induced by hypoglycemia. Prevention and treatment are discussed.

Acute Disease↗
PubMed2000

Diplopia from skew deviation in Ramsey-Hunt syndrome. A case report.

OBJECT: Presentation of a 34-year-old pregnant woman with skew deviation due to peripheral vestibular dysfunction caused by herpes zoster oticus. METHODS: A multidisciplinary approach (neuroophthalmology, otorhinolaryngology, neuroradiology) revealed the diagnosis of Ramsey-Hunt syndrome. CASE REPORT: The patient presented with painful herpes zoster vesicles of the left ear, associated with a rotatory vertigo and hearing loss. Otorhinolaryngological examination showed a unilateral peripheral vestibular loss, a nystagmus towards the unaffected right side, no facial nerve dysfunction and a left perception hearing loss, mainly in the frequencies between 2-6 KHz. The patient was treated with Zovirax IV. Neuroradiological examination (MRI without contrast) revealed no abnormalities. Vertical diplopia from skew deviation was noted +/- 10 days after onset of herpes zoster oticus. Neuroophthalmological and orthoptic examination showed a comitant right hypertropia of 6 diopters and a spontaneous nystagmus to the right. CONCLUSION: Skew deviation can be caused by a sudden unilateral cochleo-vestibular loss as described by A.B. Safran. (4,6,7,8).

Acyclovir↗
PubMed1975

Tolosa-Hunt syndrome.

A 58-year-old woman with painful ophthalmoplegia of the left eye associated with thrombosis of the left superior ophthalmic vein and normal angiography is presented. Symptoms cleared on systemic prednisone therapy within 72 hours. The clinical picture associated with the venographic findings and response to steroids are characteristic of the Tolosa-Hunt syndrome.

Constriction, Pathologic↗
PubMed1975

[Painful, alternating and recurrent ophthalmoplegia. Contribution to the study of Tolosa-Hunt syndrome].

A case of the syndrome of Tolosa-Hunt is presented in which the points of interest were the high number of attacks (four in two years and half) and the varying side of the symptoms with an involvement of the left sixth cranial nerve during the first, third and fourth attacks, and of the right third cranial nerve during the second attack. The trigeminal pain was always on the same side as the ophthalmoplegia. Bilateral carotid and vertebral angiography, orbital phlebography and air encephalography did not reveal anomalies. The sedimentation rate was moderately high during each attack. Corticotherapy begun during the last attack was very effective against the pain, but less so against the paralysis. The authors review the literature concerning this rare syndrome, the cause of which is thought to be an inflammatory process involving the cavernous sinuses.

Adult↗
PubMed2002

Ramsay Hunt syndrome presenting as a cranial polyneuropathy.

Ramsay Hunt syndrome (RHS) is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions other cranial nerves are affected as well. We present the case of a 63-year-old woman with RHS with involvement of V, VII, VIII, IX, and XII cranial nerves. The patient showed significant improvement after treatment with acyclovir and prednisolone. RHS should be recognized as a polycranial neuritis characterized by damage to sensory and motor nerves, including the facial nerve and the auditory-vestibular apparatus. Early institution of treatment with antiviral agents may help hasten healing. Involvement of the XIIth cranial nerve has not been reported previously.

Cranial Nerve Diseases↗
PubMed2003

Hunt-Lawrence pouch after total gastrectomy: 4 years follow up.

A 12-year-old boy had undergone total gastrectomy for gastric volvulus with subsequent severe weight loss and malnutrition. A Hunt-Lawrence pouch was constructed to provide gastric reservoir capacity and the child at 4-years follow-up has regained near normal weight for his age and is attending to school and other activities.

Child↗
PubMedDate not supplied

Assessment of health risks from fallout radiocesium in a hunting and food-gathering society.

Hunting and food-gathering societies are particularly vulnerable to the effects of fallout, since these people are often at the head of natural food chains which can bioaccumulate toxic substances. This paper describes a study on the effects of fallout radiocesium in caribou consumers of northern Canada. Portable whole body counting equipment was transported into five Arctic communities in 1989-90 and used to measure radiocesium body burdens in over 1100 people. The results were compared with a similar survey carried out in 1967-68. The mean body burden for adults in each community had decreased by a factor of 20 to 30 since the earlier survey. It was possible to derive an effective half time of about 4.5 years for the decrease of Cs-137 body burdens in the Arctic. The mean lifetime dose from the ingestion of radiocesium since 1967 amounted to not more than 12 mSv, with possibly an equal contribution from the period before 1967. The current radiation doses are much less than natural background and it is possible to reassure northern residents that caribou meat remains a safe and nutritious food source.

Adolescent↗
PubMedDate not supplied

[The nature of the deposit of substances in gunshot injuries from a smooth-bore hunting rifle].

Direct microscopic examinations of plain-barrel hunting gun-shot wounds may reveal on the victim's skin or clothes starch or paraffin particles or impressions thereof (a secondary shell trace). These data may evidence a specific charge of the cartridge and be used to specify the distance from which the shot was made, with an obligatory experimental shot made in each case.

Autopsy↗