Delayed facial palsy after cochlear implantation caused by reactivation of Herpesvirus: A case report and review of the literature.

Cochlear implantation has many complications; however, delayed facial palsy is relatively rare. In this report, we present the case of a 60-year-old woman with delayed facial palsy after cochlear implantation. Eleven days after the operation, the patient complained of right facial palsy (Yanagihara score 6, House-Brackmann [HB] grade VI). Herpes virus reactivation and local bacterial infection were considered as possible causes of the facial paralysis. A blood test revealed an increase in viral antibody titer, and the patient was diagnosed as having herpes virus reactivation. She was treated with antiviral therapy for the facial palsy until resolution. Slight mouth weakness continued even at 1.5 months (Yanagihara score 34, HB II) but eventually resolved at 3 months (Yanagihara score 40, HB I). Delayed facial palsy is a rare but serious complication that can occur with viral reactivation regardless of the competence of the surgical procedure. Therefore, it is important to inform patients preoperatively regarding the risk of not only immediate but also delayed postoperative facial paralysis.

Peripherally administered orexin improves survival of mice with endotoxin shock.

Sepsis is a systemic inflammatory response to infection, accounting for the most common cause of death in intensive care units. Here, we report that peripheral administration of the hypothalamic neuropeptide orexin improves the survival of mice with lipopolysaccharide (LPS) induced endotoxin shock, a well-studied septic shock model. The effect is accompanied by a suppression of excessive cytokine production and an increase of catecholamines and corticosterone. We found that peripherally administered orexin penetrates the blood-brain barrier under endotoxin shock, and that central administration of orexin also suppresses the cytokine production and improves the survival, indicating orexin's direct action in the central nervous system (CNS). Orexin helps restore body temperature and potentiates cardiovascular function in LPS-injected mice. Pleiotropic modulation of inflammatory response by orexin through the CNS may constitute a novel therapeutic approach for septic shock.