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1 VZV Ramsay-Hunt Vol.22, 2015 I NSAIDs J-STAGE esenba@wakayama-med.ac.jp 17 X MRI ,500 mg day 7 1 NSAIDs NSAIDs

2 Vol.22, mg mg day 6 15 mg day BNP varicella-zoster virus VZV

3 4 II 1 zoster sine herpete 2 Neuralgic pain can be very severe and should not be underestimated by the clinician. Sympathetic-nerve blockade can provide rapid temporary relief of severe pain 3, RCT III VZV VZV 90 1, , I 16 6 I 2 I I VZV I 1866 Broadbent 7 Thomas 1, segmental zoster paresis Jeevarethinam Gupta Merchut Gruener limb segmental zoster paresis fibrillation positive sharp waves high frequency discharges 53 40

4 Vol.22, Ramsay-Hunt Bell III C5 brachial plexitis 13 VZV IV 2 86 X C5 C5,6C5,6C6-8 C5,6 C6-8 Na VZV-IgG EIA 1,490 2 VZV-IgG EIA F MRI C3 4 C4 5 C5 6 C6 7 MRI C5 C6 MRI C5 C6

5 3,000 mg 7 30 mg V Mondelli 14 FDA 800 mg 1 5 1,000 mg mg QOL Wood RCT 16 RCT VI 1949 Oike C3-5 DRG Oike 85 C4, X 14 X 17 Lin 48 C gadloinium-t1 MRI C VZV Th9-11

6 Vol.22, Th VZV Th Th12 L Cornell James Ramsay Hunt Brain Hunt petrous ganglion plexiform ganglion Ramsay-Hunt VZV Ramsay-Hunt Bell VZV Sweeney Gilden general somatic afferent GSA 2 3 special visceral afferent SVA VZV II general visceral efferent GVE VZV Th9-11 VZV 1 Ramsay-Hunt Robillard 1,507 Ramsay-Hunt VZV Ramsay-Hunt ,076 6

7 Ramsay-Hunt Ramsay-Hunt Devriese Ramsay-Hunt synkinesis VII VZV chickenpox VZV DRG in situ VZV DNA PCR 28 VZV VZV VZV DNA 6 29 Dayan 2 1 Th8 DRG 30 1 ACTH 2 19 C4,5 Th8, VZV VZV DNA VZV DRG 4 7 VZV 1 VZV VZV VZV VIII 1 2GSA GSE SVEGVE SVA Burkman KA, Gaines RW Jr, Kashani SR, et al. Herpes zoster: a consideration in the differential diagnosis of radiculopathy. Arch Phys Med Rehabil 1988; 69: Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, et al. Neurologic complications of the reactivation of varicella-

8 Vol.22, 2015 zoster virus. N Engl J Med 2000; 342: Wu CL, Marsh A, Dworkin RH. The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia. Pain 2000; 87: Gnann JW Jr, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med 2002; 347: Ragozzino MW, Melton LJ 3rd, Kurland LT, et al. Population-based study of herpes zoster and its sequelae. Medicine Baltimore 1982; 61: Thomas JE, Howard FM. Segmental zoster paresis a disease profile. Neurology 1972; 22: Broadbent WH. Case of herpetic eruption in the course of branches of the brachial plexus, followed by partial paralysis in corresponding motor nerves. Br Med J 1866; 2: Jeevarethinam A, Ihuoma A, Ahmad N. Herpes zoster brachial plexopathy with predominant radial nerve palsy. Clin Med 2009; 9: Gupta SK, Helal BH, Kiely P. The prognosis in zoster paralysis. J Bone Joint Surg Br 1969; 51: Merchut MP, Gruener G. Segmental zoster paresis of limbs. Electromyogr Clin Neurophysiol 1996; 36: Haanpää M, Häkkinen V, Nurmikko T. Motor involvement in acute herpes zoster. Muscle Nerve 1997; 20: Greenberg MK, McVey AL, Hayes T. Segmental motor involvement in herpes zoster: an EMG study. Neurology 1992; 42: Fabian VA, Wood B, Crowley P, et al. Herpes zoster brachial plexus neuritis. Clin Neuropathol 1997; 16: Mondelli M, Romano C, Passero S, et al. Effects of acyclovir on sensory axonal neuropathy, segmental motor paresis and postherpetic neuralgia in herpes zoster patients. Eur Neurol 1996; 36: Whitley RJ, Weiss H, Gnann JW Jr, et al. Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med 1996; 125: Wood MJ, Johnson RW, McKendrick MW, et al. A randomized trial of acyclovir for 7 days and 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med 1994; 330: Oike M, Naito T, Tsukada M, et al. A case of diaphragmatic paralysis complicated by herpes-zoster virus infection. Intern Med 2012; 51: Lin CM, Shieh WB, Chiang PC, et al. An unusual cause of dyspnea in a patient with cervical herpes zoster. J Clin Neurosci 2012; 19: ,,, ; 54: ,,, ; 52: ,,, ; 52: Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry 2001; 71: Hunt JR. On herpetic inflammations of the geniculate ganglion: a new syndrome and its complications. J Nerv Ment Dis 1907; 34: ,,,. 2003; 57: Robillard RB, Hilsinger RL Jr, Adour KK. Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg 1986; 95: Hato N, Kisaki H, Honda N, et al. Ramsay Hunt syndrome in children. Ann Neurol 2000; 48: Devriese PP, Moesker WH. The natural history of facial paralysis in herpes zoster. Clin Otolaryngol 1988; 13: Mahalingam R, Wellish M, Wolf W, et al. Latent varicellazoster virus DNA in human trigeminal and thoracic ganglia. N Engl J Med 1990; 323: Gilden DH, Devlin ME, Wellish M, et al. Persistence of varicella-zoster virus DNA in blood mononuclear cells of patients with varicella or zoster. Virus Genes 1988; 2: Dayan AD, Ogul E, Graveson GS. Polyneuritis and herpes zoster. J Neurol Neurosurg Psychiatry 1972; 35: ,,, ; 69: Schmidbauer M, Budka H, Pilz P, at al. Presence, distribution and spread of productive varicella zoster virus infection in nervous tissues. Brain 1992; 115: