Síndrome de Ramsay Hunt. Informe de un caso y revisión de la literatura / Ramsay Hunt syndrome. Case report and literature review

RESUMEN Se presentó paciente masculino de 68 años de edad, con antecedentes de síndrome de Parkinson posinfarto cerebral isquémico antiguo e hipertensión arterial sistémica, con la intensión de describir la experiencia del diagnóstico y tratamiento del síndrome de Ramsay Hunt. El paciente acudió a consulta de Medicina Interna del Policlínico Universitario "Omar Ranedo Pubillones", Guantánamo, por presentar dolor en hemicara izquierda y otalgia homolateral, cefalea y febrícula. Luego, presentó lesiones vesiculosas de aspecto herpético. Se concluyó el diagnóstico definitivo de síndrome de Ramsay Hunt tipo II y se remitió a consulta de Otorrinolaringología, donde se confirmó el diagnóstico. Luego del tratamiento evolucionó satisfactoriamente. Aunque el síndrome de Ramsay Hunt no es un problema de salud, se revela la necesidad de que el médico del nivel primario de atención a la salud se familiarice con las bases teóricas para su diagnóstico y se connota la importancia de la evaluación interdisciplinaria para esta finalidad.

ABSTRACT It was reported a 68 year old male patient with a personal pathological history of post- ischemic stroke Parkinson's syndrome and systemic arterial hypertension and with the intention of describing the experience of diagnosis and treatment of Ramsay Hunt syndrome. Patient presented to his primary health physician at the Univirsity Clinic "Omar Ranedo Pubillones" in Guantanamo, presenting pain in right side of the face and earache, headache and fever. Then, he presented vesicular lesions with a herpetic appearance. It was concluded the definitive diagnosis of Ramsay Hunt syndrome type II and it was referred to Otolaryngology consultation, where the diagnosis was confirmed. After treatment patient's improvement was good. Although Ramsay Hunt syndrome is not a health problem, shows the need for primary care physicians to become familiar with the theoretical basis for its diagnosis and the importance of interdisciplinary evaluation for this purpose.

Relationship between time of treatment of acute herpes zoster with sympathetic blockade and prevention of post-herpetic neuralgia: clinical support for a new theory of the mechanism by which sympathetic blockade provides therapeutic benefit.

BACKGROUND AND OBJECTIVES: Since Rosenak's original report more than 50 years ago as to the efficacy of sympathetic blocks in terminating acute herpes zoster, many investigators have reported that a more important benefit of this form of therapy is the prevention of post-herpetic neuralgia. However, most of these reports have indicated that sympathetic blocks are effective in preventing post-herpetic neuralgia only if applied soon after the onset of the acute phase of the disease; in fact, if applied too late, this form of therapy failed to prevent the development of post-herpetic neuralgia. The present study was carried out to determine more precisely the relationship between the time of treatment of acute herpes zoster and the prevention of post-herpetic neuralgia and to attempt to correlate this time with the authors' previously published theory on the mechanism by which sympathetic blocks provide the therapeutic benefit. METHODS: The present study was a retrospective review of 122 patients treated at variable intervals after the onset of acute herpes zoster. Data tabulated included the duration of symptoms at the time of treatment, the number of sympathetic blocks required to provide relief, and the efficacy of the sympathetic blockade in terminating the acute phase of herpes zoster and then preventing the development of post-herpetic neuralgia. RESULT: According to the data obtained in this retrospective study, sympathetic blocks terminated the pain of acute herpes zoster and prevented or relieved post-herpetic neuralgia in more than 80% of patients treated within 2 months of the onset of the acute phase of the disease, after which time the success rate decreased drastically. CONCLUSION: Sympathetic blockade applied within the first 2 months after the onset of acute herpes zoster terminated the acute phase of the disease, probably by restoring intraneural blood flow, thus preventing the death of the large fibers and avoiding the development of post-herpetic neuralgia. If sympathetic blocks were to be carried out after 2 months, the damage to the large fibers would be irreversible, and this therapeutic modality would not be able to prevent the development of post-herpetic neuralgia.

Zoster-associated chronic pain: an overview of clinical trials with acyclovir.

An overview of all the available placebo-controlled trial data for oral acyclovir in acute herpes zoster infection has confirmed that a dose of 800 mg five times daily for seven to ten days is effective in reducing the incidence of post-herpetic neuralgia and the duration of pain. Although one study failed to demonstrate such an effect, three other studies and a combined analysis, using the log rank test, did so. The duration of pain was shortened from an average of 86 to 49 days (p less than 0.001). Future studies will need to take account of these findings since oral acyclovir is most likely to be used as the standard reference therapy.