The herpes simplex virus DNA was negative

The herpes simplex virus DNA was negative. This allowed the doctor to judge the necessity of a lumbar puncture. Keywords:brainstem encephalitis, diffusion-weighted imaging, magnetic, Ramsay Hunt syndrome, resonance imaging, varicella-zoster virus == 1. Introduction == Varicella-zoster virus (VZV) is a member of the family Herpesviridae. It has the ability to establish latency in the dorsal root, autonomic, and cranial ganglia, and the infection can lead to Ramsay Hunt syndrome (RHS), which is characterized by peripheral facial nerve involvement, or encephalitis with central nervous system (CNS)-related signs and symptoms.[1,2]The coexistence of RHS and VZV encephalitis is rare. The study conducted by T. Kin et al only revealed 8 cases, including 1 case in their study, and other cases from English and Japanese literature.[3]VZV ORY-1001(trans) reaches the CNS by either retrograde axonal transport, or through the blood stream. Scattered inflammatory infiltrates along the intrapontine facial nerve from its core origin within the caudal and lateral pons to its nerve root exit zone at the lateral pons have been histologically ORY-1001(trans) described.[4]However, to date, the involvement of a pontine nucleus and intrapontine nerve course has only been demonstrated on post-contrast T1-weighted images and T2-weighted images in patients with RHS.[5,6]A patient who developed RHS after being infected by VZV, along with a pontine lesion, is reported in the present study. Magnetic resonance imaging (MRI) clearly revealed the invasion paths and demonstrated the complicated anatomical structure of this area. == 2. Case report == A 41-year-old male patient presented with his mouth askew for 7 days and dizziness, accompanied by hearing loss for 3 days. This patient visited our hospital. At 7 days before the hospital visit, the patient had left facial nerve palsy, along with pain in the left external ear canal after upper respiratory infection. However, the patient did not take any medications. At 3 days before the hospital visit, herpes manifested in his left ear, along with dizziness, nausea and vomiting, and tinnitus and hearing loss in the left ear. In addition, the patient denied symptoms, such as headache, limbs twitch, and disturbance of consciousness. This patient visited our hospital. The patient had no history of hypertension and diabetes and was otherwise healthy except for the infection. However, the personal history was not particular. The results of the physical examination revealed that there were a lot of patchy blisters in the left auricle and back of the ear of the patient, along with some secretion. The patient was conscious and had fluent speech. Furthermore, the patient had horizontal nystagmus when his binoculus gazed left or right. In addition, left facial nerve palsy and a positive sign of Bell’s palsy was observed when the patient closed his eyes, and the exposure occurred was 4 mm. Moreover, there was hearing loss in the left ear, negative meningeal irritation signs, and no ORY-1001(trans) abnormalities were found in other neurological examinations. The results of the routine blood test, blood coagulation index, and blood biochemical index were normal. The patient’s anti-HIV antibody was negative. This patient fulfilled the criteria for RHS due to the herpes zoster of the head with facial nerve palsy. MRI of brain after admission revealed long T1 and T2 signals, high FLAIR, and diffusion-weighted imaging (DWI) signals in the left pedunculus cerebellaris medius. The DWI revealed a high signal. The facial nerve and vestibulocochlear nerve swelled. The DWI revealed a high ORY-1001(trans) signal along the nerve course. The gadolinium-enhanced MRI revealed that the facial nerve and vestibulocochlear nerve at the bottom of the internal auditory canal was enhanced, but the brainstem was not abnormally enhanced (Figs.1and2). == Figure 1. == A. Facial colliculus level, DWI showed high signal in the left pedunculus cerebellaris medius NUPR1 and outside of facial colliculus, vestibulocochlear nucleus were injured mainly (a thick red arrow); high signal in the section of pons and cisterns of the facial nerve (long red arrow); high signal in the section of pons of the vestibulocochlear nerve (long black arrow). B. Corresponding brainstem pattern diagrams of Figure 1A in facial colliculus level. DWI = diffusion-weighted imaging. == Figure 2. == A (T1), B (T2), C (FLAIR),.