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At least 91 records · Page 5Linked to original sources

Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms.

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.

Acyclovir↗

Hunting increases adaptive auditory map plasticity in adult barn owls.

The optic tectum (OT) of barn owls contains topographic maps of auditory and visual space. Barn owls reared with horizontally displacing prismatic spectacles (prisms) acquire a novel auditory space map in the OT that restores alignment with the prismatically displaced visual map. Although juvenile owls readily acquire alternative maps of auditory space as a result of experience, this plasticity is reduced greatly in adults. We tested whether hunting live prey, a natural and critically important behavior for barn owls, increases auditory map plasticity in adult owls. Two groups of naive adult owls were fit with prisms. The first group was fed dead mice during 10 weeks of prism experience, while the second group was required to hunt live prey for an identical period of time. When the owls hunted live prey, auditory maps shifted substantially farther (five times farther, on average) and the consistency of tuning curve shifts within each map increased. Only a short period of time in each day, during which the two groups experienced different conditions, accounts for this effect. In addition, increased map plasticity correlated with behavioral improvements in the owls' ability to strike and capture prey. These results indicate that the experience of hunting dramatically increases adult adaptive plasticity in this pathway.

Acoustic Stimulation↗

[Detection of varicella-zoster virus DNA in tear fluid and saliva of patients with Ramsay Hunt syndrome].

Ramsay Hunt syndrome develops when the varicella-zoster virus (VZV) is reactivated. In the present study, we examined the secretion kinetics of VZV DNA in the tear fluid, submandibular gland saliva and parotid gland saliva of 15 patients with Ramsay Hunt syndrome. The presence of VZV DNA was detected using PCR and a microplate hybridization method. Hybridization signals were measured using the fluorescence density of an enzymatic reaction product using fluoroscan and a system involving streptavidin-conjugated beta-galactosidase. The results were converted into numerical values and used to estimate the number of virus DNA copies. VZV DNA was detected in the tear fluid, submandibular gland saliva and parotid gland saliva of the Ramsay Hunt syndrome patients. The rate of VZV DNA detection in the submandibular gland saliva was 72%, and the detection rate in the parotid gland saliva was 57%. The detection rate in the tear fluid was 27%, which is significantly lower than other two detection rates. Regarding the submandibular gland saliva and the parotid gland saliva, the VZV DNA was detected in samples collected at a comparatively early stage of onset. In the tear fluid, the detection rate increased significantly in samples collected 2 weeks after onset or later. Thus, differences in the detection rate were observed depending on the type of secretory gland and the timing of the sample collection. The VZV DNA in the tear fluid is thought to derive from the ganglion trigeminale. The increase and decrease in the number of VZV DNA copies detected in samples collected at different times is considered to substantiate VZV reactivation in Ramsay Hunt syndrome.

Adult↗

[Fatal hunting injuries in North Rhine-Westphalia].

The investigation covers 14 fatal hunting accidents which occurred in North Rhine-Westphalia in the last 23 years, among them 13 firearm fatalities. All the accidents happened during the statutory hunting season reaching a peak in the main small game season. 86% of the persons causing the accidents and 73% of the victims were over 41 years and experienced hunters. 36% of the accidents were caused by the victims themselves. The fatal gunshot injuries were inflicted by rifle bullets in 7 cases (54%) and shotgun pellets in six cases (46%). No accidents were due to shotgun slugs or handgun ammunition. The main factors responsible for the fatalities were: covering the victim while swinging on the game (31%), failure to discharge the firearm while descending from the raised hide or transporting the weapon in vehicles (31%), mistaking the victim for game (15%), failure to discharge the weapon during a hunting break or while pressing down obstacles or careless handling of the weapon (23%). In no case was the accident caused by a defective weapon or ammunition. In conclusion aspects of preventing fatal hunting accidents are discussed.

Accidents↗

[Otogenic herpes zoster--the Ramsay-Hunt syndrome].

INTRODUCTION: Herpes zoster is a viral disease caused by a specific neurotropic virus-varicella zoster, similar to varicella virus, but not identical. Herpes zoster oticus was described by Letulle in 1882 and Körner in 1884, but particularly studied by Ramsay Hunt who reported it as a herpetic disease of ganglion geniculi in 1907. Herpes zoster oticus associated with facial nerve paralysis is most commonly called the Ramsay-Hunt syndrome. MATERIAL AND METHODS: In this work, cases of herpes zoster oticus associated with facial nerve paralysis are shown. At the ORL Clinic in Novi Sad, in the period from 1996-1997, 5 cases with Ramsay-Hunt syndrome were treated. The diagnostic procedure involved analysis of anamnestic data, clinical examination, complete cochleovestibular investigation with electronystagmography (ENG), topodiagnostic investigation of facial nerve (Schirmer's test, stapedial reflex, electrogustometry), electromyographic investigation (EMG), laboratory and virusologic investigations. According to many statistical data, paralysis of facial nerve due to herpes zoster is after Bell's paralysis the most common cause of the disease. The efflorescence of auricula, face and neck, which are typical manifestations of the disease, may precede facial nerve paralysis for about a week or more, and therefore may be disregarded and misdiagnosed with Bell's paralysis. The peripheral paralysis of this nerve in herpes zoster has an unfavorable course. More than 75% of patients have consequences of paralysis (paresis, hemispasm, synkinesia etc.). Regarding the unfavorable recovery period in herpes zoster, we managed our patients accordingly. CONCLUSION: Herpes zoster oticus is a common cause of peripheral facial nerve paralysis. The clinical course is not as favorable as in Bell's paralysis. It may be associated with sensorineural hearing disorder, vertigo and paralysis of other cranial nerves. The therapeutic procedures in Ramsay-Hunt syndrome include administration of conservative therapy and surgical intervention. We performed surgery in 2 and conservative therapy in 3 patients. Facial nerve decompression is indicated in persistent paralyses, or in cases without clear clinical signs of recovery after 6 weeks-2 months from the onset of the disease. The site of decompression is determined by topodiagnostic investigations.

Female↗

A comparison of the prevalence of Spirocerca lupi in three groups of dogs with different life and hunting styles.

The prevalence of Spirocerca lupi in 260 privately owned dogs with different life and hunting styles in Greece was based on the examination of randomly taken faecal samples using Teleman's sedimentation technique. The dogs did not demonstrate any clinical signs of spirocerciasis. Although the prevalence was 10%, it was found to be significantly higher in trace hunting dogs (21%), than in scent hunting dogs (5%) and household pets (0%). There was no relationship between prevalence and age/sex of dogs. The impact of life and hunting styles on the prevalence of S. lupi in the dog and that of the faecal examination technique, are discussed.

Animals↗

Animal welfare and the harp seal hunt in Atlantic Canada.

Much attention has been given over the years to animal welfare issues surrounding the seal hunt in Atlantic Canada. However, very little information is available on this subject in the scientific literature. This article reports the results of observations made by representatives of the Canadian Veterinary Medical Association at the hunt in recent years and compares them with observations made by members of the International Fund for Animal Welfare. The conclusion is that the large majority of seals taken during this hunt (at best, 98% in work reported here) are killed in an acceptably humane manner. However, the small proportion of animals that are not killed effectively justifies continued attention to this hunt on the part of the veterinary profession.

Animal Welfare↗

Aneurysmal subarachnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system.

BACKGROUND AND PURPOSE: Patients in poor clinical condition (Hunt and Hess grade 4 or 5) after subarachnoid hemorrhage (SAH) have historically fared poorly and many often were excluded from aggressive treatment. Early aggressive surgical treatment of SAH can produce good-quality survival for a higher percentage of patients than previously reported. We assessed the outcome of patients with Hunt and Hess grade 4 or 5 who were treated with Guglielmi detachable coil (GDC) embolization. METHODS: We retrospectively evaluated the records of 27 consecutive grade 4 and 5 patients with 29 aneurysms treated within 72 hours of SAH by using GDCs. Percentage aneurysm occlusion after embolization, perioperative complications, and symptoms of vasospasm were evaluated. Outcome was assessed with the Glasgow Outcome Scale. RESULTS: Sixteen patients (59%) were grade 4, and 11 (41%) were grade 5. Eighteen (67%) had one aneurysm, six (22%) had two aneurysms, and three (11%) had three aneurysms. Twenty-nine aneurysms were treated. Fourteen (48%) were completely occluded, and four (14%) were nearly completely occluded (>/=95% occlusion) at embolization. Eleven aneurysms (38%) had partial coiling (<95% occlusion). In the 27 patients, one technical (4%) and one clinical (4%) complication occurred at embolization. No rehemorrhage occurred in any patients (follow-up, 6-44 months; mean, 23 months). Twenty-five (92%) had vasospasm, and seven required endovascular treatment because of worsening clinical status. Sixteen patients (59%) died within 30 days of SAH. Eight patients (30%) had a good clinical outcome at a mean follow-up of 23 months. CONCLUSION: Patients with Hunt and Hess grade 4 or 5 after SAH can undergo successful coil embolization of the aneurysms despite their poor medical condition and a high frequency of vasospasm at the time of treatment. Morbidity and mortality rates with this disease are still high. These findings compare favorably with those published in surgical series for aggressively treated patients with Hunt and Hess grade 4 or 5.

Adult↗

Hunting-related injuries.

One hundred four patients treated for injuries incurred while hunting were prospectively studied during two consecutive fall seasons. A questionnaire was completed at initial evaluation and hospital records were subsequently reviewed. One hundred (98%) patients were male. Patient ages ranged from 10 to 78 years (median = 32 years). Mechanism of injury included knife or arrow penetrations (25), firearm wounds (12), falls (17), overexertion (5), and misadventures with hazards (40). Soft tissue, maxillofacial and orthopedic injuries predominated. Four patients experienced cardiac events. Hypothermia was noted in three, and animal-related injuries occurred in five. Eighteen (17%) patients were hospitalized. Serious injury was evident in 34 (33%). There were no deaths. Outpatient follow-up was necessary in 90%. Mishaps most frequently occurred because of overexcitement, unfamiliarity with equipment, or carelessness. Alcohol and drug use were only rarely identified. Almost one half of patients were injured during the 9-day gun deer hunting season. A wide variety of injuries occur during hunting activities. While many are minor, serious morbidity with potential long-term disability may result. Costs in time and money may be substantial. Simple measures could prevent many hunting-related mishaps.

Accidental Falls↗

[A case of alternating Tolosa-Hunt syndrome].

A 50-year-old woman developed third, fourth, and fifth cranial nerve palsies in the right associated with frontal pain in the ipsilateral side. Oral administration of prednisolone (30 mg/day) was initiated. The painful ophthalmoplegia improved dramatically following this treatment. Three months later, the patient developed the third, fourth, and fifth cranial palsies in the left which was contralateral to the previous episode. The patient had pain in the left frontal region. The corticosteroid therapy was again effective. Cavernous sinus and orbital venographies demonstrated a constriction of the right superior ophthalmic vein in the first and third parts, with a partial filling of the cavernous sinus. The left superior vein and cavernous sinus were normal. A left carotid arteriogram showed a slight deformity of the carotid siphon in the left. The glucose tolerance test demonstrated a mild diabetic pattern. Diabetic ophthalmoplegia can also be suspected in this case, however, the finding of a partial filling of the right cavernous sinus was indicative of Tolosa-Hunt syndrome. Therefore this case was diagnosed as Tolosa-Hunt syndrome. Alternating relapsing Tolosa-Hunt syndrome involving the third, fourth and fifth cranial nerve as seen in this case is very rare. There are many diseases which may demonstrate similar symptoms; i.e. parasellar tumor, aneurysm, diabetic ophthalmoplegia, multiple cranial neuropathy, etc. The pathologic process involved in Tolosa-Hunt syndrome is poorly understood and it appears that the clinical entity of this syndrome should be questioned. We believe that it is necessary to clarify the precise pathologic process involved in this syndrome and its relation with other similar syndromes exhibiting similar symptoms.

Female↗

[Periarteritis of the carotid siphon (Tolosa-Hunt syndrome, painful ophthalmoplegia)].

A detailed clinical analysis of 5 cases of Tolos-Hunt's syndrome is presented, and the most characteristic diagnostic signs and the peculiarities of the clinical syndrome formation are described. These signs and peculiarities are: regular presence (from the very beginning) of the symptoms of involvement of the carotid artery sympathetic plexus and absence of any other symptoms on the part of the brain stem, the hemispheres, and the meninges. Since this syndrome can be simulated by a number of other organic diseases and primarily, by an infraclinoid aneurysm, the use of carotid angiography is obligatory in all cases. No connection between the disease onset and any local or systemic inflammatory process was discovered. The positive effect from the application of corticosteroids should not be regarded as a diagnostic criterion. Instead of the names "Tolos-Hunt's syndrome" and "pain ophthalmoplegia" the terms "Tolos-Hunt's" periarteritis of the carotid siphon" or "Tolos-Hunt's disease" are suggested.

Adrenal Cortex Hormones↗

Hunting-associated injuries and wearing "hunter" orange clothing--New York, 1989-1995.

"Hunter" orange (i.e., fluorescent or international orange) is worn by hunters to increase their visibility and to reduce their potential for being mistaken for game. Although education courses for hunters promote the use of hunter orange, hunters in New York are not required to wear high-visibility clothing. To examine factors associated with two-party hunting injuries involving firearms (i.e., the injury resulted from the intentional or unintentional discharge of the firearm of another hunter), including the use of hunter orange, the New York State Department of Environmental Conservation (DEC) and the New York State Department of Health analyzed hunting-associated injury reports during 1989-1995. This report describes three of the 62 reported hunting-associated injuries during 1995 and summarizes information about two-party hunting-associated injuries involving firearms during 1989-1995. The findings indicate that most injured hunters in two-party incidents were not wearing hunter orange.

Accident Prevention↗

Detection of varicella-zoster virus DNA in peripheral mononuclear cells from patients with Ramsay Hunt syndrome or zoster sine herpete.

On the basis of alterations in varicella-zoster virus (VZV) antibody titers, it appears that Bell's palsy in some patients could be associated with VZV reactivation, that is, zoster sine herpete. To obtain stronger evidence of this association, polymerase chain reaction (PCR) was used to detect VZV DNA in auricular lesions or peripheral blood mononuclear cells (PBMCs) from Bell's palsy or Ramsay Hunt syndrome patients. VZV DNA was detected in the auricular lesions of Ramsay Hunt syndrome, in PBMCs from 2 Ramsay Hunt syndrome patients, and in 4 of 17 samples from 16 Bell's palsy patients. Three of these four positive patients were thought to have zoster sine herpete because of hearing difficulty, vertigo, and pain. VZV IgM antibodies were positive in 1 of the 2 patients with Ramsay Hunt syndrome, and in 2 of the 17 samples from the Bell's palsy patients. VZV IgG antibody titers during the acute phase were significantly higher in the patients positive for the PCR or VZV IgM antibody than in those negative for them. These findings provide evidence that Bell's palsy in some patients could be associated with VZV reactivation.

Adolescent↗

[Visual cortex in the Tolosa-Hunt syndrome. Functional imaging for the detection of a psychogenic disorder--a case report].

Besides painful ophthalmoplegia, patients suffering from Tolosa-Hunt syndrome often present increasing loss of visual perception. The impairment of the optic nerve leads to a delay of the VEP (visual evoked potentials) responses. Using the method of magnetic resonance imaging (MRI), some patients present unspecific alterations in the vicinity of the optic nerve. However, both methods (VEP and MRI) are unsuitable to assess the effect of an impaired optic nerve function on neuronal processing in the visual cortex. We report one patient suffering from Tolosa-Hunt syndrome affecting the optic nerve. We used fMRI (functional magnetic resonance imaging) to show how this impairment of the optic nerve alters cortical processing of visual information. The activity of the unaffected visual cortex was bilaterally reduced when compared to healthy volunteers but greater that obtained from patients suffering from bilateral occipital infarction. Our results offer new opportunities to assess the efficiency of therapy in patients with increasing loss of visual perception due to the Tolosa-Hunt syndrome. Further studies are necessary to investigate, whether fMRI also provides the possibility to assess the efficiency of drug therapy on optic nerve function.

Humans↗

MRA demonstration of "periarteritis" in Tolosa-Hunt syndrome.

BACKGROUND: Modern magnetic resonance imaging (MRI) diagnosis of Tolosa-Hunt syndrome rests upon demonstration of cavernous sinus abnormalities. We present a case of Tolosa-Hunt syndrome who has no abnormal mass lesion in the cavernous sinuses on MRI but with a diagnostic lesion on magnetic resonance angiography (MRA). CLINICAL PRESENTATION: A 48-year-old woman developed acute periorbital pain and abducens palsy of the right side at the first episode, and subacute peri-orbital pain and rapidly deteriorating visual acuity on the left side at the second episode with a four months interval. MRI showed no soft-tissue abnormality in the cavernous sinuses. FINDINGS: MRA demonstrated a narrowing of the right cavernous carotid artery at the first episode, and narrowings of the left clinoid carotid and ophthalmic arteries at the second episode. Based on these findings, the patient underwent urgent steroid therapy and the symptoms resolved dramatically in each episode. Follow-up MRA confirmed resolution of arterial narrowings. INTERPRETATION: MRA may help prompt the noninvasive diagnosis in certain cases of Tolosa-Hunt syndrome with little inflammatory reaction in the cavernous sinus but with predominant intra- and juxta-cavernous periarteritis.

Cavernous Sinus↗

Idiopathic hypertrophic cranial pachymeningitis masquerading as Tolosa-Hunt syndrome.

Idiopathic hypertrophic cranial pachymeningitis is a rare condition. A case of idiopathic hypertrophic cranial pachymeningitis presenting as Tolosa-Hunt syndrome is being reported. The importance of neuroimaging in patients with suspected Tolosa-Hunt syndrome is discussed. Tolosa-Hunt syndrome might represent a focal manifestation of Idiopathic hypertrophic cranial pachymeningitis. Future studies are necessary to further clarify the relationship between these two conditions.

Anti-Inflammatory Agents↗

[Cavernous sinus lymphoma mimicking Tolosa-Hunt syndrome].

INTRODUCTION: Tolosa-Hunt syndrome is characterized by painful ophthalmoplegia due to idiopathic granulomatous inflammation of the cavernous sinus. Steroid therapy dramatically reverses the symptoms and clinical signs. Because they also may respond to steroids, tumors such as lymphoma and meningioma and orbital tumors can make differential diagnosis difficult. EXEGESIS: We report the case of a 78-year-old male patient in whom systemic lymphoma associated with inflammation of the cavernous sinus was uncovered by painful, gradually progressing, ophthalmoplegia mimicking Tolosa-Hunt syndrome. CONCLUSION: When faced with a clinical picture suggestive of the existence of Tolosa-Hunt syndrome clinical workup is mandatory and should lead to diagnosis of exclusion.

Aged↗

Tolosa-Hunt syndrome due to actinomycosis of the cavernous sinus: the infectious hypothesis revisited.

BACKGROUND: The Tolosa-Hunt syndrome is characterized by ophthalmoplegia with unilateral severe retro-orbital pain associated to a granulomatous inflammatory process occupying the cavernous sinus or the superior orbital fissure. The etiology is unknown and diagnosis is based upon a clinical response to steroid treatment and exclusion of neoplasm, trauma, aneurysms, infectious, and inflammatory diseases. CASE DESCRIPTION: A 43-year-old man was admitted because of a 1-week history of acute onset left-sided retro-orbital pain, followed by left sixth cranial nerve palsy. Magnetic resonance imaging was normal and Tolosa-Hunt syndrome was suspected. Steroid treatment controlled pain with recovery of ophthalmoplegia. Four months later, when a good response to treatment was still present, brain magnetic resonance imaging revealed a lesion enlarging the left cavernous sinus, isointense with the gray matter on T1-weighted sequences, hypointense on T2-weighted images, and with homogeneous enhancement after gadolinium injection. Two months later, ocular pain and sixth cranial nerve palsy recurred and new brain magnetic resonance imaging showed an extension of the tissue occupying the left cavernous sinus, over the sella, to the right cavernous sinus, making possible an endoscopic transphenoidal biopsy. RESULTS: Histopathological study revealed a granulomatous aspecific inflammation containing actinomycetes colonies. The patient was treated with intravenous penicillin G followed by amoxicillin per os, with improvement of pain and ophthalmoplegia. A control magnetic resonance imaging 1 month after therapy showed a consistent reduction of the enlarged cavernous sinus, and 3 months later neurological examination and brain magnetic resonance imaging were completely normal. CONCLUSIONS: The present case suggests that the International Classification of Headache Disorders (2nd edition) definition of Tolosa-Hunt syndrome does not reflect the complexity of the syndrome and that some cases of secondary painful ophthalmoplegias can fit the criteria for the primary form. Since the biopsy can only rarely be performed, we agree with other authors that clinical and radiological follow-up should be performed for at least 2 years. Moreover, we propose that in patients with painful ophthalmoplegia having transient response to steroid therapy, a trial with antibiotic therapy should be taken into account.

Actinomycosis↗