Nobuo Kukimoto

Clinical factors that influence the prognosis of facial nerve paralysis and the magnitudes of influence.

Objective: To show the significance of various factors when predicting the outcome of facial nerve paralysis.

Viral infections in acute peripheral facial paralysis. Nationwide analysis centering on CF.

The degree of participation and regional specificity of virus infection in relation to atraumatic acute peripheral facial palsy was studied, placing particular emphasis on change in the CF titre of varicella zoster virus (VZV), herpes simplex virus (HSV) and adenovirus (adeno). The subjects of the study were 91 patients with Hunts syndrome and 396 patients with Bells palsy treated at 17 institutions all over Japan in the period between April 1985 and November 1986. Among the cases of Hunts syndrome, the positive conversion rate of CF antibody titre of VZV was 81%. In Bells palsy cases, virus participation was detectable in 8% with VZV, 4% with HSV and 4% with adeno. With regard to the age distribution, Bells palsy cases with possible virus involvement tended to be observed in younger patients than those without that possibility. As to regional specificity, the incidence of Bells palsy with possible virus involvement tended to be higher in densely populated areas. With regard to the main cause of acute peripheral facial palsy, virus infection has been implicated, as well as insufficient blood circulation (ischemia). Even in cases of acute peripheral facial palsy, in which herpes zoster oticus is not observed, the participation of varicella zoster virus (VZV) as a cause of paralysis has been pointed out in some cases (zoster sine herpete). Furthermore, it is known that the serum antibody titres of various viruses such as herpes simplex virus (HSV) change significantly in some cases of Bells palsy (2, 5-13).(ABSTRACT TRUNCATED AT 250 WORDS)

A case report of facial nerve palsy associated with chickenpox.

We examined a very unusual patient who developed peripheral facial palsy with chickenpox. A survey of the English literature revealed that eight such patients had been reported, but the period between the appearance of the vesicles of varicella and the facial nerve palsy ranged from five days before to 16 days after the eruption development. We presume that the route of infection was neurogenous in patients who had palsy after the appearance of the eruptions, but haematogenous in patients who had palsy before the appearance of vesicles. The two patients whose infection route was presumed to be haematogenous, had a poor prognosis.

An ELISA study on varicella-zoster virus infection in acute peripheral facial palsy.

ELISA was applied to atraumatic acute peripheral facial palsy for the purpose of examining the usefulness of the method with respect to early diagnosis of varicella-zoster virus (VZV) infection. The material for this study consisted of 287 cases of Bells palsy, 64 cases of Hunts syndrome and 12 cases of zoster sine herpete diagnosed by the CF method, obtained from 16 institutions throughout Japan. In view of the results thus obtained, it was provided that cases of specific anti-VZV-IgG antibodies (anti-VZV-IgG) with a titre of 0.6 or more or specific anti-VZV-IgM antibodies (anti-VZV-IgM) with a titre of 0.2 or more were to be regarded as cases of VZV infection. By adopting ELISA, a diagnostic ratio of 94.3% in Hunts syndrome was achieved. Moreover, possible cases of zoster sine herpete increased further by 28. Furthermore, most of the cases became diagnosable in the second week after onset of the facial palsy. It was therefore presumed that ELISA makes possible diagnosis in the comparatively early stages with only one testing, and that it is a more useful method than CF.

Activation of intravascular coagulation in Bell's palsy.

Although the causes of Bell’s palsy are still unknown, it is more or less the unanimous view that ischemic hypothesis and viral hypothesis constitute the main factors. With regard to ischemia, it has been believed that such factors as embolism which occur in vasa nervorum distributing to the facial nerve, or as vasospasm which is induced by dysfunction of the autonomic nervous system, cause ischemia. When considering embolism, it is easily understood that the coagulation functions of individuals are involved in such an abnormality. However, very few studies have so far been made on the functional state of coagulation in patients with facial paralysis. We made a study on the condition of coagulation functions in the acute phase of Bell’s palsy based on the clinical examination centering on the thrombin-antithrombin III complex (TAT), and plasmin-α2 plasmin inhibitor complex (PIC), which have recently attracted much attention as indexes of hypercoagulability. Relationships between the coagulation and the fibrinolytic systems, TAT and PIC, are shown in Fig. 1.