Manifestaciones clínicas del síndrome de Ramsay-Hunt en una serie de 20 casos
Resumen Introducción y objetivo: la experiencia clínica nos ha mostrado las distintas formas de presentación y la variabilidad sintomatológica que puede revelar el síndrome de Ramsay-Hunt o herpes zóster ótico. Las descripciones que ofrece la literatura nos han servido para corroborar los hallazgos de un conjunto de pacientes, cuyas características y evolución hemos ido reuniendo en el tiempo. Dada la importancia del tratamiento precoz, el objetivo de este trabajo ha consistido en realizar una exposición estructurada de este complejo síndrome con sus diversas manifestaciones. Método: estudio retrospectivo. Resultados: 20 pacientes ejemplifican los diferentes aspectos de este proceso. Discusión: se trata de una patología infrecuente, con una tríada sintomática patognomónica que consiste en otalgia, erupción vesicular y parálisis facial. Sin embargo, este síndrome no siempre se expresa de forma completa ni con la aparición de los síntomas en el orden indicado, añadiéndose con frecuencia otros cocleovestibulares. La posibilidad de que la infección se propague de forma centrífuga y centrípeta facilita el que se afecten otros nervios sensitivos y motores, ocasionando una polineuropatía craneal (herpes zóster cefálico) y raquídea o incluso, con mucha menor frecuencia, la aparición de una meningoencefalitis. No conocemos con precisión los mecanismos por los que progresa este proceso ni los factores desencadenantes, aunque en ocasiones les haya predisponentes. Establecer un diagnóstico es fundamental para iniciar el tratamiento, cuya precocidad facilita la resolución del proceso. Conclusiones: siendo la sospecha clínica la principal herramienta de un diagnóstico precoz, nos ha parecido de interés realizar esta revisión, dada la infrecuencia del herpes zóster ótico.
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2. Robillard RB, Hilsinger RL Jr, Adour KK. Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg. 1986;95:292–7.
3. Sweeney CJ, Gilden DH. Ramsay Hunt Syndrome. J Neurol Neurosurg Psychiatry. 2001;71:149–54.
4. Gunbey HP, Kutlar G, Aslan K, Sayit AT, Incesu L. Magnetic Resonance Imaging Evi-dence of Varicella Zoster Virus Polyneuropathy: Involvement of the Glossopharyngeal and Vagus Nerves Associated With Ramsay Hunt Syndrome J Craniofac Surg. 2016;27(3):721-3. doi: 10.1097/SCS.0000000000002583.
5. Laguna del Estal P. Complicaciones del herpes zoster. Emergencias. 2000;12:S19-S28.
6. Mueller NH, Gilden DH, Cohrs RJ, Mahalingam R, Nagel MA. Varicella zoster virus in-fection: clinical features, molecular pathogenesis of disease, and latency. Neurol Clin. 2008;26:675–97. doi: 10.1016/j.ncl.2008.03.011.
7. Wagner G, Klinge H, Sachse MM. Ramsay Hunt syndrome. J Dtsch Dermatol Ges. 2012;10(4):238-44. doi: 10.1111/j.1610-0387.2012.07894.
8. Sauvaget E, Herman P. Zona auriculaire. EMC. Oto-rhino-laryngologie. 2012;7(4):20-245-A-10.
9. Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Arch In-tern Med. 1995 Aug 7-21;155(15):1605-9.
10. Henche-Martín R, Sánchez-de Paz F. Complicaciones neurológicas del herpes zoster diferentes de la neuralgia postherpética. Piel. 2003;18(10):548-51.
11. De La Blanchardiere A, Rozenberg F, Caumes E, Picard O, Lionnet F, Livartowski J, et al. Neurological complications of varicella-zoster virus infection in adults with human immunodeficiency virus infection. Scand J Infect Dis. 2000;32(3):263-9.
12. Lee HL, Yeo M, Choi GH, Lee JY, Kim JS, Shin DI, et al. Clinical characteristics of headache or facial pain prior to the development of acute herpes zoster of the head. Clin Neurol Neurosurg. 2017;152:90-4. doi: 10.1016/j.clineuro.2016.12.004.
13. Kennedy PG. Varicella-zoster virus latency in human ganglia. Rev Med Virol. 2002 Sep-Oct;12(5):327-34.
14. Letchuman V, Donohoe CD. Brainstem and Cerebellar Involvement in Ramsay Hunt Syndrome. Case Rep Otolaryngol. 2019;2019:7605056. doi: 10.1155/2019/7605056.
15. Chernev I, Dado D. Segmental zoster abdominal paresis (zoster pseudohernia): a re-view of the literature. PM R. 2013;5(9):786-90. doi: 10.1016/j.pmrj.2013.05.013.
16. Nahm FS, Kim SH, Kim HS, Shin JW, Yoo SH, Yoon MH, et al. Survey on the treatment of postherpetic neuralgia in Korea; multicenter study of 1,414 patients. Korean J Pain. 2013 Jan;26(1):21-6. doi: 10.3344/kjp.2013.26.1.21.
17. Adour KK. Otological complications of herpes zoster. Ann Neurol. 1994;35(suppl):S62-S64.
18. Kansu L, Yilmaz I. Herpes zoster oticus (Ramsay Hunt syndrome) in children: case re-port and literature review. Int J Pediatr Otorhinolaryngol. 2012;76:772–6.
19. Hato N, Kisaki H, Honda N, Gyo K, Murakami S, Yanagihara N. Ramsay Hunt syndrome in children. Ann Neurol. 2000;48(2):254–6.
20. Furuta Y, Ohtani F, Aizawa H, Fukuda S, Kawabata H, Bergström T. Varicella-zoster vi-rus reactivation is an important cause of acute peripheral facial paralysis in children. Pediatr Infect Dis J. 2005;24(2):97-101.
21. López-Aguado D, Quesada-Martín P. Parálisis facial periférica. Ponencia oficial. 1ª ed. Madrid: Garsi;1984.376p.
22. Nanda A, Khan IS. Nervus intermedius and geniculate neuralgia. World Neurosurg. 2013;79(5-6):651-2. doi: 10.1016/j.wneu.2012.05.002.
23. Murakami S, Hato N, Horiuchi J, Honda N, Gyo K, Yanagihara N. Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: Significance of early diagnosis and treat-ment. Ann Neurol. 1997;41(3):353-7.
24. Mañós-Pujol M, Nogués-Orpí J, Tornero-Salto J, Jiménez-Montoya R. Patología del nervio facial y de sus vías centrales. Parálisis facial. En: Suárez C, Gil-Carcedo LM, Marco J, Medina JE, Ortega P, Trinidad J. Tratado de Otorrinolaringología y Cirugía de Cabeza y Cuello. Otología. 2ª ed. Tomo II. Madrid: Médica Panamericana;2007. p.1511-1526.
25. Martínez-Oviedo A, Lahoz-Zamarro MT, Uroz-del Hoyo JJ. síndrome de Ramsay-Hunt. An Med Interna (Madrid). 2007;24(1):31-4.
26. Furuta Y, Ohtani F, Mesuda Y, Fukuda S, Inuyama Y. Early diagnosis of zoster sine herpete and antiviral therapy for the treatment of facial palsy. Neurology. 2000;12;55(5):708-10.
27. Lee HY, Kim MG, Park DC, Park MS, Byun JY, Yeo SG. Zoster sine herpete causing facial palsy. Am J Otolaryngol. 2012;33(5):565-71. doi: 10.1016/j.amjoto.2012.02.001.
28. Devriese PP, Moesker WH. The natural history of facial paralysis in herpes zoster. Clin Otolaryngol Allied Sci. 1988;13(4):289-98.
29. Eksi G, Akbay E, Bayarogullari H, Cevik C, Yengil E, Ozler GS. The effect of width of facial canal in patients with idiopathic peripheral facial paralysis on the development of paralysis. Eur Arch Otorhinolaryngol. 2015;272(9):2283-9.
30. Coulson S, Croxson GR, Adams R, Oey V. Prognostic factors in herpes zoster oticus (Ramsay Hunt syndrome). Otol Neurotol 2011;32(6):1025–30. doi: 10.1097/MAO.0b013e3182255727.
31. Aizawa H, Ohtani F, Furuta A, Sawa H, Fukuda S. Variable patterns of Varicella-Zoster reactivation in Ramsay-Hunt Syndrome. J Med Virol. 2004;74(2):355–60.
32. Yeo SW, Lee DH, Jun BC, Chang KH, Park YS. Analysis of prognostic factors in Bell’s palsy and Ramsay Hunt syndrome. Auris Nasus Larynx 2007;34(2):159–64.
33. Byun H, Cho YS, Jang JY, Chung KW, Hwang S, Chung WH, et al. Value of electroneu-rography as a prognostic indicator for recovery in acute severe inflammatory facial pa-ralysis: a prospective study of Bell's palsy and Ramsay Hunt syndrome. Laryngo-scope. 2013;123(10):2526-32. doi: 10.1002/lary.23988.
34. Hohman MH, Hadlock TA. Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center. Laryngoscope. 2014;124(7):E283-93. doi: 10.1002/lary.24542.
35. Monsanto RD, Bittencourt AG, Bobato Neto NJ, Beilke SC, Lorenzetti FT, Salomone R. Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature. Int Arch Otorhinolaryngol. 2016;20(4):394-400.
36. Kim CH, Choi H, Shin JE. Characteristics of hearing loss in patients with herpes zoster oticus. Medicine (Baltimore). 2016;95(46):e5438.
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Ramirez-Salas, J. E., Benito-Orejas, J. I., Bauer, M., Viveros-Díez, P., Cifuentes-Navas, V. A., & Duque-Holguera, V. (2020). Manifestaciones clínicas del síndrome de Ramsay-Hunt en una serie de 20 casos. Revista ORL, 12(1), 3–17. https://doi.org/10.14201/orl.22750
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