非典型的経過を示したRamsay Hunt症候群の1症例

Atypical Case of Ramsay Hunt Syndrome

　はじめに

　Ramsay Hunt症候群（RHS）は水痘帯状疱疹ウイルスの再活性化により生じ，耳介の帯状疱疹，末梢性顔面神経麻痺，第8脳神経症状（めまい，難聴耳鳴）を主症状とする症候群である。しかし，これらの3徴候のうち第8脳神経症状を欠く不全型や，帯状疱疹も欠き血清抗体価を調べなければベル麻痺と鑑別できない，いわゆるzoster sine herpeteといった非典型例など，その症状，経過には様々なバリエーションが存在する。

　今回われわれは，高度の第8脳神経症状（めまい，難聴，耳鳴）が先行し，遅れて比較的軽度の顔面神経麻痺を呈し，また，帯状疱疹を呈しないなど非典型的な経過をとった1症例を経験したので報告する。

A 57-year-old woman developed right ear pain, right total sensorineural hearing loss, vertigo, and headache. Her right peripheral vestibular functions were absent.The analyses of cerebrospinal fluid suggested meningi-tis. At the later stage she had right mild facial palsy. Throughout this episode she did not show any herpetic vesicles. Reactivation of VZV was revealed by saliva analyses using PCR methods. Finally she was diagnosed as having Ramsay Hunt syndrome and she received acy-clovir treatment. While her facial palsy was completely recovered, the functions of the eighth cranial nerve were not recovered.