LETTER
Bell Palsy and Herpes Simplex Virus
P.P. Devriese, MD, PhD
15 October 1996 | Volume 125 Issue 8 | Page 698
TO THE EDITOR:
Murakami and colleagues [1] used polymerase chain reaction to detect herpes simplex virus type 1 (HSV-1) DNA in patients with Bell palsy and to detect varicella-zoster DNA in patients with the Ramsay Hunt syndrome. Their report is an important contribution to the etiology of these diseases [2].
Contrary to the authors' statement in the introduction of their article, I suggested ischemia not as a cause of Bell palsy but as a factor in the pathogenesis of the paralysis. Inflammation of the facial nerve caused by reactivation of the virus may provoke edema and, as a result, compress the nerve inside the nerve sheath. I demonstrated that in cats, the facial nerve in the facial canal can be paralyzed from within by increasing pressure inside the nerve to supradiastolic and suprasystolic levels [3].
More questions must still be answered. For example, why is the facial nerve infrequently involved? Manifestations of HSV-1 occur much more frequently. The special anatomical situation of the nerve in the endotemporal part of the temporal bone may play a role.
Finally, the term "cephalic herpes zoster" is more appropriate than "Ramsay Hunt syndrome" because the herpetic eruptions are not always visible and restricted to the auricle or area immediately surrounding the auricle. Hunt [4] observed that although neurologic complications (facial palsy and auditory and vestibular symptoms) occur in auricular herpes, they also accompany herpes zoster in zones of the cephalic extremity [4]. The name of the disease has been much debated in the literature [5]. In my opinion, "cephalic herpes zoster" is the preferable term.
|
Author and Article Information
|
|---|
Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
1. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med. 1996; 124:27-30.
2. Baringer JR. Herpes simplex virus and Bell palsy [Editorial]. Ann Intern Med. 1996; 124:63-5.
3. Devriese PP. Compression and ischaemia of the facial nerve. Acta Otolaryngol (Stockholm). 1974; 77:108-18.
4. Hunt JR. On herpetic inflammations of the geniculate ganglion. A new syndrome and its complications. J Nerv Ment Dis. 1907; 34:73-96.
5. Devriese PP. Facial paralysis in cephalic herpes zoster. Ann Otol Rhinol Laryngol. 1968; 77:1101-9.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
Author & Article Info
References
Article
