Hiroyuki Maeyama

Gd-DTPA Enhanced MRI in Ramsay Hunt Syndrome

Ten patients with Ramsay Hunt syndrome underwent magnetic resonance (MR) scans. In many examinations, abnormal enhancement of the 7th nerve in the internal acoustic meatal segment through the mastoid segment was observed. Out of seven patients with cochlear and/or vestibular symptoms, only one showed abnormal enhancement of the 8th nerve, in addition to the 7th. The other 6 patients showed the same findings as in Bells palsy, showing no enhancement of the 8th nerve. This suggests that clinical symptoms have no relation to the results of MRI. Enhanced MRI is the most sensitive means of making differential diagnoses between Hunts syndrome and tumors, but it is impossible to detect all lesion sites corresponding to the symptoms in Hunts syndrome.

Electrophysiological Study on the Pathology of Synkinesis after Facial Nerve Paralysis

By conducting electrophysiological tests on patients with facial nerve paralysis, the characteristics of synkinesis and the mechanisms of its manifestations were examined. The subjects were 114 patients of facial nerve paralysis on whom electroneurography (ENoG) and the blink reflex were conducted. As a result, it was indicated that synkinesis could be determined by the blink reflex, and that the frequency of synkinesis manifestation increased with severity of paralysis. From examination during the latent period, early component (SI) recognized in the cases of synkinesis was found to be the waveform which passed the fibers with a slow conducting speed. It was not related to the degree of degeneration of nerves for either the severe or light degeneration of nerves. From the above result it was concluded that synkinesis is generated as a misdirection of reproduced nerves.

Contrast-enhanced MRI of the facial nerve in patients with Bell's palsy.

Magnetic resonance imaging (MRI) enhanced by Gd-DTPA has been one of the recent topics under discussion for imaging diagnosis. However, the clinical evaluation of MRI in facial palsy has not yet been established. In this report, the diagnostic value of enhanced MRI in patients with Bell’s palsy was investigated.

Recent Treatment of Ramsay Hunt Syndrome

The cure rate for Bell’s palsy has improved thanks to recent advances in conservative therapy [1, 2]. For the treatment of Ramsay Hunt syndrome (Hunt’s syndrome), antiviral agents and steroids are generally administered, but the prognosis for Hunt’s syndrome is less satisfactory than for Bell’s palsy. In recent years, high-dose steroid and antiviral agents, such as acyclovir, have been used for the treatment of severe Hunt’s syndrome in our clinic. In the present study, the effects of antiviral agents and of high-dose steroid administration in the treatment of Hunt’s syndrome are discussed.

Distribution of Facial Nerve Conduction Velocities in Patients with Bell’s Palsy

The etiology of Bell’s palsy remains unclear. Generally speaking, the thicker the myelinated nerve fibers, the faster the conduction velocity. Thick fibers with fast conduction velocity are considered susceptible to damage due to compression. Compression of the nerve in the fallopian canal may possible be the cause of Bell’s palsy. To determine the distribution of facial nerve diameter in normal subjects, and to investigate the electrophysiological pathology of Bell’s palsy, we developed a method for determining the distribution of nerve conduction velocities (DNCV) in facial nerve using the collision method of Hopf [1].

Management of Bell’s Palsy Accompanied by Diabetes Mellitus

As is well known, it is not uncommon that Bell’s palsy is accompanied by diabetes mellitus. On the other hand, it is obvious that administration of steroids is effective for treating patients with Bell’s palsy. However, steroids should be given with much caution, because they cause the adverse effect of hyperglycemia. This report has two purposes. One is to clarify the methods for diagnosing diabetes mellitus in patients with Bell’s palsy and for assessing diabetic control. The second is to describe a high-dose steroid therapy for diabetes in cases of Bell’s palsy accompanied by diabetes.

A Clinical Study of Paranasal Sinus Mycosis

A case of aspergillosis with the maxillary sinus cured by peroral antimycotic drug was reported. A 71-year-old woman visited our clinic complaining of right nasal obstruction and purulent nasal discharge. A necrotic mass was found in the middle meatus of the right nasal cavity. A CT-scan revealed a large soft tissue mass occupying the right maxillary sinus extended through the medial wall to the nasal cavity. Biopsy specimens from the mass showed a characteristic picture of aspergillosis. Conservative treatment with oral administration of the antimycotic drug, fluconazole was carried out. The aspergillosis was cured within seven weeks. Treatment with oral administration of fluconazole is recommended as the first choice of the paranasal sinus mycosis as well as follow-up treatment for the prevention of recurrence after surgery. In addition to this case report, 10 cases of primary fungal infections in the paranasal sinuses treated in Yamagata University Hospital during the 14 years from 1976 to 1991, have been reviewed.