Discussion in 'Spot Diagnosis' started by Egyptian Doctor, Nov 16, 2012.
What is your medical diagnosis for this case ?
Cold sore - herpes simplex virus
Labia herpes simplex - hpv.
HSV 1, Herpes Labialis
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=&]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.
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.
Don't confuse Bullous myringitis and Malignant otitis externa with Ramsay Hunt Syndrome
[FONT=&]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]
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.
Ramsay hunt has already been discussed
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 ?
Answer : Herpes Simplex
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