centered image

centered image

Spot Diagnosis

Discussion in 'Spot Diagnosis' started by Egyptian Doctor, Nov 16, 2012.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

    Joined:
    Mar 21, 2011
    Messages:
    9,751
    Likes Received:
    3,327
    Trophy Points:
    16,075
    Gender:
    Male
    Practicing medicine in:
    Egypt

    What is your medical diagnosis for this case ?

    Mouth.jpg
     

    Add Reply

  2. ioanna

    ioanna Active member

    Joined:
    Sep 9, 2012
    Messages:
    13
    Likes Received:
    1
    Trophy Points:
    25
    Occupation:
    medical student
    Practicing medicine in:
    Greece
    herpes
     

  3. Gospodin Seki

    Gospodin Seki Moderator Staff Member

    Joined:
    Jan 3, 2012
    Messages:
    1,042
    Likes Received:
    303
    Trophy Points:
    3,050
    Gender:
    Male
    Occupation:
    Student of Belgrade Medical School
    Practicing medicine in:
    Serbia
    Herpes labialis
     

  4. kangourou

    kangourou Famous Member

    Joined:
    May 14, 2011
    Messages:
    91
    Likes Received:
    43
    Trophy Points:
    395
    Practicing medicine in:
    France
    Cold sore - herpes simplex virus
     

  5. dupuytren

    dupuytren Bronze Member

    Joined:
    Jan 21, 2012
    Messages:
    650
    Likes Received:
    50
    Trophy Points:
    1,345
    Occupation:
    Medical student at Vita-Salute San Raffaele Univer
    Practicing medicine in:
    Italy
  6. Rocket Queen

    Rocket Queen Super Moderator

    Joined:
    Mar 29, 2011
    Messages:
    1,098
    Likes Received:
    53
    Trophy Points:
    4,345
    Practicing medicine in:
    Serbia
    Herpes labialis.
     

  7. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

    Joined:
    Jul 28, 2012
    Messages:
    839
    Likes Received:
    38
    Trophy Points:
    1,245
    Gender:
    Male
    Practicing medicine in:
    Czech Republic
    Labia herpes simplex - hpv.
     

  8. dr.angela

    dr.angela Bronze Member

    Joined:
    Jan 13, 2012
    Messages:
    361
    Likes Received:
    24
    Trophy Points:
    695
    Occupation:
    Doctor
    Practicing medicine in:
    Macedonia
    HSV 1, Herpes Labialis
     

  9. neo_star

    neo_star Moderator

    Joined:
    Nov 4, 2012
    Messages:
    775
    Likes Received:
    184
    Trophy Points:
    1,545
    Practicing medicine in:
    India
    Ramsay Hunt Syndrome ( type 2 ) vs Herpes Labialis

    Ramsay Hunt Syndrome ( type 2 ) vs Herpes Zoster Opthalmicus vs Herpes Labialis

    There are similarities and differences between the three. Ever thought about it .....

    First the differences - they are caused by 2 different ( but closely related ) viruses.

    1) Ramsay Hunt by varicella zoster / chicken pox / herpes zoster virus.
    Herpes Zoster Opthalmicus
    by varicella zoster / chicken pox / herpes zoster virus. ( similar to Ramsay Hunt )
    Hepes labialis / cold sore / fever blister ( the one in our Spot Diagnosis) by Herpes Simplex type 1 ( nowadays even type 2 )

    2) source of virus in
    Ramsay Hunt - Geniculate ganglion ( of facial nerve )
    source of virus in Herpes Zoster opthalmicus - trigeminal ganglion ( opthalmic part )
    source of virus in Herpes labialis / cold sore - trigemial ganglion ( mainly mandibular part )

    3) Clinical syndrome in Ramsay Hunt - [FONT=&amp]Patients may present with facial paresis, hyperacusia, unilateral loss of taste, reduced tear formation, reduced salivation, pain in the ear, and vesicles in the ear canal and eardrum. [/FONT]( but no vesicles in and around the eye, as in Herpes Zoster opthalmicus )

    Clinical syndrome in Herpes labialis - An outbreak typically causes small blisters or sores on or around the mouth commonly known as cold sores or fever blisters. The sores typically heal within 2–3 weeks, but the herpes virus remains dormant in the facial nerves, following orofacial infection, periodically reactivating (in symptomatic people) to create sores in the same area of the mouth or face at the site of the original infection.

    Clinical Syndrome in Herpes Zoster opthalmicus - Herpes Zoster Ophthalmicus is an ocular disease which usually manifests as a unilateral painful skin rash in a dermatomal distribution of the trigeminal nerve shared by the eye and ocular adnexa.

    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

    Now the similarities

    1) All the 3 are due to reactivation from the respective ganglia, following a primary infection.

    2) All the 3 can be reactivated during extreme periods of stress or following lowered immunity.



    [​IMG]

    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx


    Xtra Edge

    Don't confuse Bullous myringitis and Malignant otitis externa with Ramsay Hunt Syndrome

    [FONT=&amp]Bullous myringitis is an inflammation of the tympanic membrane due to the presence of vesicles; patients complain of earache, hearing loss, and bloody discharge. It occurs in several viral and bacterial infections ex - Mycoplasma pneumoniae). [/FONT]


    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx


    Malignant external otitis (MEO) is an infection that affects the external auditory canal and temporal bone. The causative organism is usually Pseudomonas aeruginosa, and the disease commonly manifests in elderly patients with diabetes. The infection begins as an external otitis that progresses into an osteomyelitis of the temporal bone. Spread of the disease outside the external auditory canal occurs through the fissures of Santorini and the osseocartilaginous junction.

    Cranial nerves can be affected by inflammation along the skull base or by a neurotoxin produced by Pseudomonas species. The facial nerve (VII) is affected most commonly, usually at the stylomastoid foramen. As the disease progresses, cranial nerves IX, X, and XI can be affected at the jugular foramen, followed by XII at the hypoglossal canal. Cranial nerves V and VI can be affected if the disease extends to the petrous apex.

    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx


    Ramsay hunt has already been discussed



    [​IMG]


    Clinical pearls

    1) U can hav bell's palsy in Ramsay hunt ( direct involvement ) or in Malignant otitis Externa ( by extension ). So if u see some ear dischage and Bell's palsy it need not be Ramsay Hunt. One is due to viral and the other is a bacterial cause, so although the patient population can be the sam etreatments are very different.

    2) Ramsay Hunt is not ass with eye inflammation and Herpes Zoster opthalmicus can involve the eye ( look out of iritis...to avoid secondary glaucoma ). In Ramsay hunt however due to facial nerve palsy...eye closing is impaired and then can cause some redness, inflammation and dryness secondary to exposure.


    I hope this review was useful (-:

    If Varicella Zoster Virus attacks the ciliary ganglion, what would you get ?

    Anybody....
     

    Last edited: Nov 18, 2012
  10. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

    Joined:
    Mar 21, 2011
    Messages:
    9,751
    Likes Received:
    3,327
    Trophy Points:
    16,075
    Gender:
    Male
    Practicing medicine in:
    Egypt
    Answer : Herpes Simplex
     

Share This Page

<