A further contribution to the herpetic inflammations of the geniculate ganglion : a syndrome characterized by herpes zoster oticus, facialis, or occipitocollaris, with facial palsy and auditory symptoms / by J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1908
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Licence: In copyright

Credit: A further contribution to the herpetic inflammations of the geniculate ganglion : a syndrome characterized by herpes zoster oticus, facialis, or occipitocollaris, with facial palsy and auditory symptoms / by J. Ramsay Hunt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Tearing and shooting pains in one or more of the three divisions of the fifth nerve are mentioned (Hasslauer,15 Anstie,16 Hammerschlag17). The points of exit of the trigeminus were found tender on pressure (Berger18 and Hammerschlag). Diminution or absence of the corneal and conjunctival reflexes (Berger, Hammerschlag, Ramsay Hunt19), hypesthesia and hypalgesia of the face on the affected side have been observed. These fifth nerve symptoms are sensory in nature, and unaccompanied by a corresponding eruption of herpes. - I find an explanation for their presence in a mild inflammatory reaction of the Gasserian ganglion, but not of sufficient severity to produce the eruption. It must be admitted, however, that the neural connection between the geniculate ganglion and the second and third divisions of the fifth nerve (great and small superficial petrosal nerves) may give rise to a referred pain. Mild sensory symptoms of a similar nature may, likewise, be present in the distribution of the cervical nerves in cases of herpes oticus. In one of my cases a typical example of herpetic inflam- mation of the geniculate ganglion, with herpes zoster oticus, facial palsy, and deafness, severe lancinations were present in the occipital region and neck for several days. In addition there were distinct hypalgesia and hypesthesia on the left side of the face, head, and neck for two weeks. This sensory disturbance was not present below the level of the neck, and there were no stigmata of hysteria. VII. The Ganglia of the Glossopharyngeal and Vagus Nerves and Their Probable Role in Zoster. These ganglia, composed of unipolar cells, taking their origin from the neural ridge, are the homologues of the posterior spinal ganglia (Fig. 3). Theo- retically there is no reason why they should not be involved in cases of posterior poliomyelitis. From our knowledge gained by the dissection method alone, the ganglia of the vagus presumably have a skin representation on the posterior wall of the auditory canal, the posterior portion of the tympanic membrane, concha, and posteromesial surface of the auricle (<auricular branch of the vagus). The glossopharyngeal ganglia through their communi- cations with the vagus and facial nerves may also be represented in the same area. In an analysis of many cases of zona of the cephalic extremity, I have had constantly in mind the possibility of symptoms which might be ascribed to a disturbance of the vagus function. The following case, reported by Buys20 is the only one coming under my notice, which might bear this interpretation: “ A girl, aged seventeen years. Onset with headache and vomiting. Severe headaches continued with stiffness of the neck, and frequent 15 Deut. Mil.-Aerzt. Zeit., 1905, vol. xxxv. 16 The Practitioner, 1871, p. 198. 17 Arch. f. Ohrenheil., 1901, s. 16; 1898, s. 1. 18 Neur. Centralblatt, 1905, s. 844. 19 Jour, of Nerv. and Ment. Dis., 1907. 80 Bull, de la Soc. Beige d'otol., de laryng. et de rhin., 1898. Eruption herpetique du pavilion precede de phenomenes nerveux considerables.