Ramsay Hunt Syndrome

Ramsay Hunt Syndrome, also known as herpes zoster oticus, is caused by the same virus responsible for chickenpox, the varicella-zoster virus. It is an infection of the facial nerve resulting from a dormant virus present after chickenpox heals. If the immune system fails to destroy the virus it can reactivate resulting in this or other pathologies, such as shingles. Treatment within seven days of onset of symptoms can reduce chance for longterm complications. Since early detection is so important, here are some symptoms to watch for: pain in ear, hearing loss, tinnitus (ringing in ears), vertigo (disorientation), taste perversion, and painful red rash and blisters in the mouth or ear area. Sometimes confused with stroke symptoms, patients may also experience facial weakness on one side (the same side as the affected ear).
Though Ramsay Hunt often occurs in people over the age of 60, anyone who has had chickenpox can be affected. Because this disorder can be spread by touch, until blisters have scabbed over those affected should avoid contact with the following: anyone who has never had chickenpox, anyone with a weak immune system, newborns, and pregnant women. Failure to seek prompt treatment could result in permanent hearing loss and/or facial weakness. If there is severe damage to the facial nerve, it may not repair correctly resulting in abnormal facial movements. Other longterm possibilities include damage to the eye because of inability to close the eyelid; and spread of the virus to other nerves or brain, resulting in headaches, confusion, and overall weakness.
In order to treat Ramsay Hunt Syndrome, doctors may prescribe medication to target the virus and/or the symptoms. Such medications include: antiviral, corticosteroids (to reduce swelling), valium (for vertigo), or pain relievers. Certain exercises and Botox injections may help with facial weakness and the patients inability to close their eye. Treatment could take weeks or even months to take effect. Though there is no way of preventing the virus, the risk may be reduced by the varicella virus vaccine. This vaccine is usually administered between the ages of 12 and 18 months, but may be given to older children who have not had chickenpox.

http://www.mayoclinic.com/health/ramsay-hunt-syndrome/DS00878/DSECTION=prevention

(1st picture and information)

http://www.ramsayhunt.org/

(2nd picture)

http://www.medscape.org/

(3rd picture)

Brainstem Glioma

Brainstem gliomas are cancerous tumors found in the area of the brain between the cerebral aqeduct and the fourth ventricle, known as the brainstem. Occuring more commonly in children, brainstem gliomas are primary brain tumors, meaning they rarely metastasize to other areas of the body. There are several ways to characterize these tumors, a few of which are as follows: origin, location, extent of growth, hemorage, and necrosis. A greater probability of survival has been found in gliomas located in the tectal and cervicomedullary areas. However, intrinsic pontine gliomas, as demonstrated in the image to the left, carry a greater risk.
http://emedicine.medscape.com/article/1156030-media


MRI is typically the modality of choice when diagnosing a brainstem glioma. The patient will usually complain of and/or demostrate lack of facial control, double vision, headaches, nausea, vomiting, weakness, fatigue, and seizures. The onset of symptoms my be abrupt or gradual depending on the growth rate of the tumor; and symptoms may differ depending on location of the tumor. In older children, changes in speech and handwriting abilities may occur; whereas behavioral changes will likely be seen in all ages affected by this pathology.

Because of the location of these gliomas, neurosurgery is not often the treatment chosen. However, not all tumors are created equally and some are operable, as seen in the images below. Chemotherapy and radiation therapy are the more common treatments in such cases. Clinical trials are being conducted to explore other methods of treatment, however due to the aggressiveness of these tumors the prognosis is grim. Even with treatment only 37% survive more than a year beyond diagnosis, while 20% survive two years, and a mere 13% survive three or more years. Though there is no known cause, brainstem gliomas account for roughly 10-20% of childhood brain tumors.

http://upload.wikimedia.org/wikipedia/commons/e/eb/Tumor_BrainstemGlioma2.JPG

http://www.neuroendoscopy.info/img/paediatric_3.jpg

http://www.scielo.br/img/revistas/anp/v63n1/23596f3.jpg

Information from: www.wikipedia.com;

http://emedicine.medscape.com/article/1156030-overview;

http://www.neuroendoscopy.info/