Trident shingles combined with Ramsay Hunt syndrome 1 case.

Trident neuroline herpes caused by chickenpox shingles virus ( ) is characterized by clusterary small blisters distributed along the one-sided trigeminal nerve syllabeice often accompanied by significant nerve painWhen the invasion of the knee-like nerve section can occur the outer ear canal or hermhes knee-shaped nerve section of the knee and simultaneously invade the facial nerve movement and sensory fiberwhen the patient is characterized by facial palsy, earache and outer ear tract herpes triavestriatal syndrome ()This paper reports cases of trigeminal nerve shingles combined syndrome and discusses its etiology, clinical manifestations, diagnosis, treatment and prognosis in combination with relevant literatureThe case reported that the man was admitted to hospital with "pain in his right cheek and right ear"The patient had severe pain in the right face, right lip, right cheek, right outer ear canal and self-serving ibuprofen and six-flavored yellow pills during blistersThere was no improvement in the symptoms of anti-infection treatment at the community hospitalSo before the new year to visit our hospital clinic to "trigeminal nerve shingles" income hospitalIn the past, he was in good healthCheck: No facial palsyThe two-sided eye position is the eye moving free-flowing visual function is goodThe right face, right lip, right cheek, right outer ear canal, and ear screen in front of the cluster of small blisters range no more than the middle lineThe lower right lip is full of blood and swellingThe pus secretion is visible in the right outer ear canalIn-mouth examination shows the right cheek mucosa, tongue back, mouth bottom mucous membrane can also be seen waterhers local irregular erosion surface mucous membrane congestive pain () does not exceed the middle lineThe trigeminal nerve shows the trigeminal nerve form on both sides, walking naturally does not see a clear lesions abnormal signal around the small blood vesselsOn the first day of the disease, low-heat right nasal lip groove became shallow and the gills were leakingPatients complained that hearing in the right ear decreased compared to when admitted to the hospital Pure sound listening threshold: right ear mid-range sensory nerve deafness Progressive facial nerve symptoms aggravated the appearance of the forehead line to shallow right eye can not close the angle of the mouth to the left skew It is graded as class IV according to the facial nerve function (Figure - ) Diagnosis: Right trigeminal nerve shingles combination syndrome type III Treatment: post-hospital antiviral (more cifieve), anti-infection (meloxiconshubatams sodium), nutritional nerves (methylcobalamin), pain relief (Irisib tablets) and other comprehensive treatment Local skin herpes external use of more xielovico cream, intra-mouth mucosa disease damage application chlorine has been fixed mouthwash mouthwash while with laser treatment to promote intra-mouth mucous membrane healing Apply to tubmycin eye drops eye drops, erythromycin eye cream applied to the eyelids to prevent exposure conjunctivitis, corneal damage After treatment weeks, patients with right face, peripheral herpes after the formation of herpes skin shed the right facial herpes after the residual pain intense consultation of the pain department ocassipin; gaba dino capsule; ammonia curdloto tablets; hydroxycodone hydrochloric acid slow release tablets (can gradually increase) Results When discharged from the hospital, the patient's right face, herpes skin has all fallen off the surface of the skin to form a color sink intra-mucosal ulcer has healed When the symptoms of facial palsy are still, the basic symmetry of the face is completely closed after the eye full ysute with maximum force after the mild asymmetry facial nerve function is graded to level II and improved compared to the initial facial palsy symptoms The after-effects of herpes have severe nerve pain Patients are instructed to continue to take oral nutritional neurotropic drugs, analgesicdrugs after discharge from the hospital, and regularly review liver and kidney function at outpatient follow-up, supplemented by physiotherapy, acupuncture and other measures to promote facial nerve function recovery A month after discharge from the hospital, the patient's facial nerve function returned to normal The electrophysiological examination of the surface nerve indicates that the incubation period of the surface nerve motion conduction returns to normal, the amplitude is normal and there is no significant difference between the opposite side The right ear hearing was slightly more sensitive and deaf hearing Follow-up to the present month slater nerve function returned to normal hearing significantly improved without significant shingles after the nerve pain Discuss the etiology and pathogenesis of syndrome () due to the first reports of the year also known as ear band-like herpes The main clinical manifestations of severe ear pain on one side of the ear herpes with the side peripheral facial palsy can be accompanied by hearing and balance impairment The cause is infection Viruses are bi-stranded viruses genus herpes virus alpha subtypes with nerve-obsessed and skin characteristics The specific mechanism of entering cells is not clear Most scholars believe that the various glycoprotein protrusions on the surface of the virus include, and so on, play different roles in the adsorption and wear-in process Viruses escape immune defense function sewelled in the nerve section for a long time after the initial infection of children was the disappearance of chickenpox infection symptoms, through interference with antigens, induced control of the expression of interferon, the expression of reduced immune molecules after infection with dendritic cells, interference with the expression of nucleic factors and the expression of intercellular adhesion molecules The reactivation of latent infection when the standby body is immunosuppressed, especially when the cell proportion is unbalanced, causes damage mainly caused by skin blisters, nerve pain and nerve dysfunction In addition to sensory nerve secia, there are motor nerves affected When the facial nerve trunk is affected, the facial neuroedema degeneration causes facial nerves and blood vessels to be pressured by local ischemia, hypoxia and facial palsy The hearing nerve and the facial nerve are covered by the same nerve diaphragm often induce auditory and balance consciousness disorders Clinical characteristics of trigeminal nerve band herpes combined clinical rare literature in the form of case reports Its typical clinical manifestations are: (1) outer ear herpes This is caused by the virus's invasion of the knee-shaped nerve section, which is characterized by herpes in the outer ear or herpes of the ear membrane (2) Earache Since some patients have early symptoms, only ear pain does not appear herpes in the form of severe knife-cutting, burning-like, electric shock-like pain and radiation along the nerve distribution region This characteristic can be used as a basis for early diagnosis and identification with external ear canalitis or tymonitis The degree of pain is not related to the severity of herpes Usually children with shingles pain is very light or no pain in middle-aged and elderly patients with more severe pain and about the patients who leave nerve pain after the disease is eliminated often last sons or longer Considering that older patients are prone to produce high tints of antiantibodies the antibody is directly related to the degree of pain and pain duration (3) Facial palsy As an infection causes a vicious cycle of facial neuroedema hypoxia, the syndrome causes worse facial paralysis than bell surface palsy prognosis Its specific manifestations are typical symptoms of peripheral complete or incomplete facial palsy: vantage disappears, the upper and lower eyelids can not close or not fully closed eyes when the eye turns outwards, the side mouth angle of the sagging healthy side angle upward skew, can not close the mouth water leakage, the gill sill, blowing and other functional barriers can occur before the tongue taste loss Patients without ear herpes are easily misdiagnosed as Bell facial palsy should pay attention to whether there are ear pain and other symptoms Some patients due to the virus invasion of the hearing nerve will be accompanied by tinnitus hearing loss vertigo and balance dysfunction According to the pathological process of the disease, type: type I has only one side of the shingles; type II is type I with the same side nerve paralysis; type III is type II type hearing impairment; type IV is type III with side balance impairment The diagnosis and differential diagnosis is based on herpes, ear pain and different degrees of facial palsy, where herpes is the most important basis Typical clinical diagnosis based on patient's medical history and symptoms is not difficult but often difficult to diagnose early on a large difference in clinical symptoms and progression In particular, the initial site is not typical such as the throat, such as shingles is not easy to be found and easy to be misdiagnosed or even patients without herpes manifestations of herpes-type palsy is easily confused with Bell facial palsy Acute peripheral facial palsy caused by other diseases for those with the initial symptoms of facial palsy and no herpes can be initially considered for infection if there is local pain on the side of the head even if there is no change in skin herpes Liu Zhonglin and others think that can reflect the nerve of the lesions section for single-sided patients can meet when a section of nerve thickening (compared with the opposite side) However, the patient spotting abnormal consideration of facial neuromorphic form may be related to the degree of facial neuritis The analysis of the cause sourcing of misdiagnosis summarizes the common causes of misdiagnosis: (1) the initial symptoms are not common When the virus first attacks the mucosa of the upper respiratory tract, some cases in the initial onset of throat pain, throat herpes, vocal cord paralysis and other upper respiratory symptoms of the ear asymptomatic or symptoms are not obviously easily misdiagnosed as upper respiratory tract diseases (2) Herpes before the appearance of facial palsy first diagnosis easy to be diagnosed with simple shingles The initial symptoms are obvious and herpes-free, easily mistaken for Bell facial palsy (3) The name of ear band-like herpes brings the concept to be misleading In some cases, the symptoms are not in the facial nerve distribution region but in the cranial nerve distribution other than the facial nerve, i.e herpes ectopic (4) The first doctor has insufficient knowledge of the disease When encountering atypical cases, the symptoms of ear and skin nerve pain before herpes, skin feeling dull, etc are ignored The irregular sequence of the occurrence of no sequence of disease-aggressive nerves due to the diversity of disease courses and the absence of sequential symptoms in the position and time of the virus-invading nerves has made early diagnosis in clinical times difficult In this case, trigeminal nerve shingles was diagnosed with trigeminal nerve shingles for the initial symptoms of the adjacent right ear herpes, the outer ear canal overflow was neglected and the patient was admitted to hospital without any symptoms of facial palsy With the progressofofofthe of the disease infected with knee-like nerve section patients appear facial palsy symptoms and hearing loss correction diagnosis is diagnosed as trigeminal nerve band herpes combined syndrome type III The combination of trigeminal nerve shingles was mainly used in the comprehensive treatment of drugs such as early and active application of antiviral, immunomodulation, pain relief, nutritional nerves and glucocorticoids; Early facial supplements with acupuncture, physiotherapy, muscle massage, microwave irradiation and functional exercise in patients with slower palsy recovery can promote functional recovery to prevent facial muscle atrophy The use of glucocorticoids is controversial, but most scholars think that the combined application of glucocorticoids works well Early giving large doses of glucocorticoids can reduce the inflammatory response to prevent the virus from toxicizing nerve knots and nerve fibers and destroy ingest neuroedema to reduce tissue damage and reduce the incidence of shingles complications For patients with low immunity, attention should be paid to the spread of the disease or the possibility of exacerbation of primary disease if necessary, immunomodulatory drugs and antimicrobial drugs may be used to prevent secondary infection Feasible neuroelectrogram examination for patients with complete facial palsy whose course of course exceeded the ineffectiveness of the drug conservative treatment The number of neurodegeneration is greater than the number of patients with feasible facial neurodecompression surgery The prognosis is associated with diagnosis and treatment time and time-to-time normative treatment is recovered quickly once facial neurodegeneration or fibrosis is less effective The factors that affect the prognosis include: (1) the recovery degree of facial palsy is related to the number of facial nerve fibers with denatured, (2) the first herpes appears in the first symptoms of facial palsy, and (3) the patient's elderly patients herpes after-effect sepsis nerve pain is significantly higher than in children The poor prognosis of facial palsy patients caused by Bell's facial palsy was particularly associated with poor facial nerve function recovery in patients with multiple groups of cranial neuropathy The cause may be that Bell's facial palsy is caused by microcirculation disorder but is due to an infection that lurks in the knee-like nerve section and has a neuroticism In this case, the patient's right facial pain after the healing of the right face severe oral drug effect seriously affected the quality of life of the patient Considering persistent nerve pain left after infection, i.e after shingles, is the most common complication of shingles The pathogenesis is not yet known and there is little research on micromolecular biology associated with it At present, there is no satisfactory treatment but the risk factors are clear so that the prevention of high-risk groups in advance can receive good results Early application of antiviral and immune active cell function in addition to the use of anti-viral and immune active cell function in the absence of a moderate amount of steroid hormone therapy by inhibiting the production of antibodies and weakening the inflammatory response caused by the antibody to reduce the patient's pain and shorten the occurrence of pain time prevention In summary, the early diagnosis system and standardized treatment are the key to improve efficacy, shorten the course of the disease, reduce post-residual nerve pain and dysfunction, and also pay attention to the related clinical manifestations of atypical to improve the rate of early diagnosis