以拉姆齐·亨特综合征为首发表现的持续性偏头痛1例

Ney Adson Leal II, Nágila Pereira Mendes, Caroline Moraes Tapajós Bolzani, J. Borri, Hilton Mariano da Silva Júnior
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摘要

拉姆齐-亨特综合征,也称为带状疱疹,是带状疱疹的一种罕见并发症。该综合征的特点是周围面神经麻痹和耳朵或嘴巴的红斑性水疱疹。在囊泡出现之前,单侧耳痛或颈部疼痛可能更常见。然而,持续的偏头痛是罕见的在爆发前阶段。目的介绍一例不典型的拉姆齐亨特综合征,在出现其他症状和体征之前伴有持续的单侧头痛。病例报告报告一名69岁妇女,表现为亚急性发作的中度至重度左偏头痛,无自主神经体征。开始治疗8天后,头痛持续维持,患者出现周围性面瘫。四天后,她注意到左耳出现囊泡和咽痛。她出现恶心和几次呕吐,严重的身体失衡,使她无法在没有帮助的情况下行走。体检时,患者表现为左耳和口咽部有囊泡,左侧周围性面瘫(House Brackmann分级IV),左侧听觉低下,眼球震颤,前庭步态。筛查几种代谢性疾病和诊断感染(包括艾滋病毒)的诊断试验不显著。脑部电脑断层及脑脊液分析未见异常。结论ramsay - hunt综合征主要累及面神经和前庭耳蜗神经,可引起周围性面神经麻痹、耳痛、听觉减退,并偶有失衡。虽然疼痛是RHS爆发前阶段的常见表现,但单侧头痛在这种情况下并不常见。另一方面,它是一个普遍的投诉,在急诊科和有几种不同的病因。因此,当患者仅表现为单侧头痛时,诊断RHS对临床医生来说是具有挑战性的。医生必须考虑RHS是侧锁性头痛的重要鉴别诊断,避免诊断错误和治疗延误。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Continuous hemicrania as the initial manifestation of Ramsay Hunt syndrome: a case report
IntroductionRamsay-Hunt syndrome, also called otic zoster, is a rare complication of herpes zoster. The syndrome is characterized by peripheral facial nerve palsy and an erythematous vesicular eruption in the ear or mouth. Preceding the appearance of the vesicles, unilateral otalgia or neck pain may occur more commonly. However, persistent hemicrania is infrequent in the pre-eruptive phase.ObjectivesTo present an atypical case of Ramsay Hunt syndrome with continuous unilateral headache preceding the onset of other symptoms and signs of the syndrome.Case reportReport of a 69-year-old woman who presented subacute onset of moderate to severe left hemicrania with no autonomic signs. Eight days after the start and continuous headache maintenance, she presented with peripheral facial paralysis. After four days, she noticed the presence of vesicles in the left ear and odynophagia. She developed nausea with several episodes of vomiting and severe imbalance that made it impossible for her to walk unassisted. On physical examination, she presented vesicles in the left ear and oropharynx, left peripheral facial palsy (House Brackmann grade IV), left hypoacusis, nystagmus, and vestibular gait. Diagnostic tests for screening several metabolic diseases and diagnosis of infection (including HIV) were unremarkable. Brain computed tomography and cerebrospinal fluid analysis showed no abnormalities.ConclusionsRamsay-Hunt syndrome mainly involves the facial and vestibulocochlear nerves, causing peripheral facial palsy, otalgia, hypoacusis, and, less frequently, imbalance. Although pain is a frequent manifestation of the pre-eruptive phase of RHS, unilateral headache is not common in this scenario. On the other hand, it is a prevalent complaint in the emergency department and has several different etiologies. Hence, diagnosing RHS when patients present exclusively unilateral headaches is challenging for clinicians. Physicians must consider RHS a vital differential diagnosis of sided-locked headaches, avoiding diagnostic errors and treatment delays.
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