Fisher's syndrome following trigeminal herpes zoster

A case of Fisher's syndrome associated with trigeminal herpes zoster is reported for the first time. Retrograde propagation of the virus to the brainstem through the trigeminal root was thought to be the most probable pathogenic mechanism. We provide additional evidence suggesting that the focus of Fisher's syndrome is in the brainstem.     

三叉神经带状疱疹临床分析

目的针对三叉神经带状疱疹的临床特征及治疗进行分析。方法选择2012-01—2013-12在我院接受治疗的90例三叉神经带状疱疹患者,依据患者就诊日期随机将患者分为实验组与对照组。实验组患者每天服用规格为0.15g的盐酸伐昔洛韦片0.3g,2次/d,并且每天使用半导体激光治疗仪照射疼痛部位10min;对照组静滴阿昔洛韦针剂0.5g,2次/d,疗程7d。2组用药期间均配合神经营养药物肌内注射及少量糖皮质激素口服,在用药的第7、14天观察疗效。结果实验组总有效率88.37%(38/43),对照组总有效率53.19%(25/47),差异具有统计学意义(P0.05)。治疗组发生后遗神经痛8例(18.60%),对照组21例(44.68%),差异具有统计学意义(P0.05)。结论带状疱疹要及早明确诊断,及时有效治疗;不同抗病毒药物疗效不同;抗病毒药物、营养神经药物、小剂量糖皮质激素、免疫调节剂的联合应用能有效抑制病毒扩散,阻止或减轻病毒对神经的损伤,以提高临床疗效。     

Induction of varicella zoster virus DNA replication in dissociated human trigeminal ganglia

Varicella zoster virus (VZV), a human neurotropic alphaherpesvirus, becomes latent after primary infection and reactivates to produce zoster. To study VZV latency and reactivation, human trigeminal ganglia removed within 24 h after death were mechanically dissociated, randomly distributed into six-well tissue culture plates and incubated with reagents to inactivate nerve growth factor (NGF) or phosphoinositide 3-kinase (PI3-kinase) pathways. At 5 days, VZV DNA increased in control and PI3-kinase inhibitor-treated cultures to the same extent, but was significantly more abundant in anti-NGF-treated cultures (p = 0.001). Overall, VZV DNA replication is regulated in part by an NGF pathway that is PI3-kinase-independent.     

原发性三叉神经痛特征性MRI序列检查的临床应用

目的探讨磁共振断层血管成像(MRTA)不同成像序列在诊断三叉神经痛血管神经压迫的价值。方法回顾分析128例原发性三叉神经痛病人的临床资料,全部行微血管减压术(MVD)。术前均行MRTA检查,运用三维时间飞跃成像序列(3D-TOF)、超快平衡场回波序列(B-TFE)、T1高分辨率各向同性容积激发序列(THRIVE)及最大密度投影法(MIP)重建,观察血管神经走行关系,并与术中所见进行对比。结果 MRTA检查共发现责任血管115例,三叉神经无血管压迫13例;术中观察发现责任血管122例,三叉神经无血管压迫6例。MRTA检查与术中观察情况一致121例(95%)。本组治愈106例,显效15例,有效5例,无效2例。结论 MRTA检查对发现原发性三叉神经痛的责任血管与神经关系具有重要价值,3D-TOF、B-TFE、THRIVE及MIP序列扫描可显示责任血管,并具有较高的准确性,对术前评估和指导手术具有重要意义。     

三叉神经根入脑干区MRI形态学研究

目的研究原发性三叉神经痛(TN)患者三叉神经根入脑干区(REZ)的形态结构及其临床应用价值。方法 36例TN患者和20例非TN患者作为健康对照纳入研究。所有受试对象采用3.0TMRI扫描,采用可变翻转角的三维快速自旋回波序列(3D-SPACE)分别扫描两侧REZ区的形态学结构。采取图像分析软件测量分析三叉神经脑池段长度、三叉神经脑桥角、桥小脑角池面积和三叉神经脑池段面积。结果患侧三叉神经脑池段长度的均值、三叉神经脑桥角的均值、桥小脑角池面积的均值以及三叉神经脑池段面积的均值均小于健侧。对照组的三叉神经脑池段长度、三叉神经脑桥角、桥小脑角池面积及三叉神经脑池段面积的均值均大于疾病组。结论三叉神经脑池段较短,三叉神经脑桥角锐利,易发生神经血管冲突,临床上易导致TN;三叉神经脑池段面积缩小提示三叉神经根的萎缩性改变。MRI形态学信息有利于疾病的诊断及手术决策的选择。     

A case with trigeminal herpes zoster manifesting a long lesion of the spinal trigeminal nucleus and tract on MR T2-weighted image]

We reported a 53-year-old man with the right trigeminal herpes zoster with preceding neuralgia (preherpetic neuralgia) in the right upper cervical nerve area. He developed dysesthesia and scapular pain in the right second cervical nerve area. 5 days later, herpes zoster emerged in the area of the right maxillary division of trigeminal nerve. Furthermore, he developed paralysis on the right facial muscle on the 12th day after the onset of scapular pain. Neurological examination revealed decrease in superficial sensation accompanied by pain and dysesthesia in the areas innervated by the right maxillary division of trigeminal nerve and the right second cervical nerve, and the right peripheral facial nerve palsy. Any rash was not observed in the right second cervical nerve area throughout the course. The cerebrospinal fluid showed a mild mononuclear pleocytosis. The antibody titer for varicella zoster virus (VZV) was elevated in both cerebrospinal fluid and blood serum. T2-weighted magnetic resonance (MR) image revealed a continuously long high-signal lesion corresponding to the right spinal trigeminal nucleus and tract, extending from the lower pons to the second cervical segment of the spinal cord. This lesion could have resulted from a centripetal migration of VZV from the Gasser ganglion to the spinal trigeminal nucleus and tract, which was probably related to the preherpetic neuralgia in the upper cervical nerve area without rash.     

磁共振成像在三叉神经痛和面肌痉挛诊断中的应用

目的　对应用磁共振成像（ＭＲＩ）特殊序列诊断三叉神经痛（ＴＮ） 和面肌痉挛（ＦＳ）血管神经压迫的价值进行评价。方法　临床诊断ＴＮ１８ 例,ＦＳ１１ 例。先行ＳＥＴ１ＷＩ、Ｔ２ＷＩ扫描,然后行三维时间飞越破坏性稳态梯度回波序列（３ＤＴＯＦＳＰＧＲ） 分析。利用原始图像对两侧三叉神经进行斜矢状位和冠状位重建。结果　ＴＮ中,２ 例为肿瘤所致,１５ 例为血管压迫引起,１ 例未发现病因。１１ 例ＦＳ中发现血管神经接触１０ 例,未发现病因１ 例。８ 例手术证实病例中,７ 例与ＭＲＩ诊断完全符合。结论ＭＲＩ对发现ＴＮ和ＦＳ病因具有重要价值,特别是３ＤＴＯＦＳＰＧＲ原始图像是显示神经血管接触的敏感方法,对选择手术方法具有重要的指导意义。     

MRI evaluation of a case of herpes zoster ophthalmicus with delayed contralateral hemiplegia

We report the case of a patient affected by contralateral hemiplegia during herpes zoster ophthalmicus (HZO) evaluated both with serial CT scans and with MRI. We suggest that MRI examination of patients affected by HZO could be useful for the detection of early signs of cerebral arterial damage which are not yet clinically and radiologically apparent.

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Sommario Viene riportato il caso di un paziente affetto da emisindrome deficitaria associata ad herpes zoster oftalmico studiato sia con TAC dell'encefalo seriate, sia con NMR. Gli autori ipotizzano che l'esecuzione di una NMR a pazienti affetti da herpes zoster oftalmico potrebbe evidenziare piccole lesioni anche nei pazienti clinicamente non complicati da emisindrome deficitaria.

     

三叉神经病的CT/MRI评估与手术

三叉神经(第V颅神经)病并不十分罕见.自1986年1月至1996年1月对150例有三叉神经病可疑者作CT/MRI评估.本研究的目的:①第V颅神经病的临床表现;②建立一种对第V颅神经病有效的检查方法;③通过第V颅神经的节段性解剖建立一种鉴别诊断并采用相应的手术治疗.方法:采用规范式的CT/MRI检查.研究结果表明:97例发现有病变且说明第V颅神经的临床定位诊断是非常不准确的,对有第V颅神经病的人应考虑根据作者所拟定的方法进行MRI评估.     

Magnetic resonance imaging of third cranial nerve palsy and trigeminal sensory loss caused by herpes zoster.

A 44-year-old man with right-sided herpes zoster ophthalmicus (HZO) developed ipsilateral third and sixth cranial nerve palsies and first-division trigeminal (fifth cranial nerve) sensory loss. MRI revealed contrast enhancement of the cisternal and cavernous portions of the third cranial nerve and high signal on a FLAIR sequence within the ipsilateral medulla at the presumed location of the trigeminal nucleus and tract. To our knowledge, this is the first report of the combination of these imaging findings in HZO.     

Trigeminal herpes zoster and Ramsay Hunt Syndrome with a lesion in the spinal trigeminal nucleus and tract

We report the case of a 77-year-old immuno-competent man who developed herpes zoster in the maxillary and mandibular branches of the trigeminal nerve. Within 3 weeks, he developed ipsilateral peripheral facial palsy, hearing loss, vesicles over the external auditory canal, and pain in the face and ear. A T₂-weighted MRI of the brain revealed a hyper-intense lesion at the right medulla corresponding to the spinal trigeminal nucleus and tract. Gadolinium enhancement was seen over the right facial nerve. These lesions suggest a possibility of transaxonal spread of the varicella zoster virus between the trigeminal nerve, the facial nerve, and the spinal trigeminal nucleus and tract.     

Incidence of enhancement of the trigeminal nerve on MRI in patients with multiple sclerosis

The purpose of this study is to review the incidence of contrast enhancement of the trigeminal nerve on magnetic resonance imaging (MRI) in a large cohort of patients with multiple sclerosis (MS). MRI scans of 851 MS patients participating in a phase III clinical trial were reviewed for the presence of gadolinium enhancement on postcontrast T1-weighted images. If enhancement was present, it was documented whether this involved only the proximal or also the distal part of the fifth nerve, and whether the abnormality was unilateral or bilateral. In 24 (2.8%) patients, enhancement of the trigeminal nerve was observed, and was bilateral in 16 (66.7%) of those. In 19 (79.2%) patients with abnormal nerves, enhancement extended to the distal part of the trigeminal nerve (into Meckel's cave). The results of this study indicate a high, probably clinically silent, incidence of trigeminal nerve demyelination in MS and frequent involvement of the peripheral type of myelin in MS.