Zoster

Question 1

Tzanck smear

Answer 1

Slide preparation for visualization of intracytoplasmic partiles due to viral infection

Used in the workup of zoster

Question 2

Stapedius muscle

Answer 2

Innervated by CN VII

Attenuates loud sounds

Question 3

Common cause of clinically isolated facial weakness in children

Answer 3

Acute otitis media

Question 4

Features suggestive of peripheral CN VII lesions

Answer 4

• Ipsilateral facial palsy
• Ipsilateral hyperacusis (sounds are louder due to stapedius involvement)
• Ipsilateral loss of taste in the anterior 2/3 of the tongue
• Ipsilateral sensory deficit over the outer ear

Question 5

A thorough exam for facial palsy must ALWAYS involve. . .

Answer 5

. . . an ear exam

Since the middle ear may be involved if it is due to zoster AND may even be causative if there is otitis media or a choleasteatoma

Question 6

Facial neuromas

Answer 6

Schwannomas of the facial nerve

Relatively rare, but benign tumor that grows slowly and produces a slowly progressive (over months) form of facial paralysis

Question 7

Potential causes of bilateral facial paralysis

Answer 7

The list is relatively limited

It includes Lyme disease, sarcoidosis, and Guillian-Barre syndrome

Question 8

Tumors that can cause a LMN-pattern facial palsy

Answer 8

• Parotid tumors
• Tumors of the skull base
• Facial neuromas

Question 9

Ramsay Hunt syndrome

Answer 9

Caused by reactivation of VZV in the geniculate ganglion (the main sensory ganglion of CN VII)

Produces vesicles in the area of sensory innervation of CN VII. This can include the inner ear canal and post-auricular skin

May also involve other CNs. The pain is described as burning and is often intensely painful.

Question 10

Bell’s palsy

Answer 10

By definition idiopathic, but often associated with HSV reactivation

Associated w/ ipsilateral hyperacusis

Corticosteroids are effective in increasing likelihood of recovery if started within 72 hours of onset, but acyclovir has no effect.

Question 11

Regardless of etiology, all patients with facial nerve paralysis need. . .

Answer 11

. . . eyedrops/artificial tears every hour while awake and eye taping at night

To prevent exposure keratoconjunctavitis, which may lead to permanent loss of visiom in the affected eye

Question 12

Vesicles on an erythematous base found on in the postauricular region

Answer 12

Classic presentation of facial nerve VZV (Ramsay Hunt syndrome)

Question 13

Acute cerebellar ataxia

Answer 13

• A rare neurologic complication of acute VZV infection (ie, varicella)
• Only occurs in unvaccinated individuals, paritcularly unvaccinated children
• Typically self-limiting
• Symptoms:
  
  • Presence of varicella (they occur concurrently)
  • Broad-based gait
  • Scanning speech
  • Imbalance