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Abstract: The patient presented to our hospital with sudden onset of ear pain, tinnitus, vertigo, and vomiting, accompanied by crookedness of the corners of the mouth, which did not improve significantly after consultation with a local hospital. The patient was examined and a cranial magnetic resonance examination was performed, and the comprehensive findings led to the diagnosis of Hunter syndrome, which is a common acute vestibular syndrome. After communicating with the patient, through a combination of medication + vestibular rehabilitation training + acupuncture + massage, the patient’s symptoms such as vertigo, unstable walking and tinnitus improved, and facial paralysis gradually recovered.
[Basic information] Male, 51 years old
Disease Type】Hunter’s syndrome
Hospital】Qilu Hospital of Shandong University
Date of Consultation】March 2021
Treatment plan】Medication (acyclovir tablets, injectable sodium methylprednisolone succinate, ginkgo biloba extract injection, betahistine mesylate tablets, methylcobalamin tablets, cytarabine sodium injection, erythromycin eye ointment)
[Treatment period] 14 days of inpatient treatment, 6 months of outpatient follow-up
Treatment effect】The patient’s symptoms such as vertigo, unstable walking and tinnitus improved, and facial paralysis gradually recovered.
I. Initial interview
The patient suddenly developed vertigo, spinning sensation, nausea, vomiting, and right ear pain 10 days ago, and found multiple blister-like bumps in the right auricle at the same time. The right frontal stripe disappeared, the right eyelid was incompletely closed, the corner of the mouth was deviated to the left, the left cheek was leaking, and the cranial MRI examination suggested a little ischemic degeneration foci in the brain. The above examination was considered to be Hunter syndrome.
II. Treatment history
I explained to the patient and his family that the patient had Hunter syndrome, probably due to varicella zoster, and that the virus had invaded the face as well as the vestibular nerve, and instructed the patient to relax and ensure sleep. The patient was given infusion therapy (acyclovir tablets, sodium methylprednisolone succinate for injection, ginkgo biloba extract injection, methylcobalamin injection, sodium cytarabine injection), plus oral medication (betahistine mesylate tablets), and erythromycin eye ointment to protect the right eye. During the treatment period, the patient was instructed to massage the right facial muscles by himself and given acupuncture treatment, and encouraged to get out of bed as soon as possible and perform vestibular function training. The patient was discharged after 14 days of hospitalization and continued oral medication (betahistine mesylate tablets, Ginkgo biloba extract tablets and methylcobalamin tablets) after discharge, regular life, continued facial muscle massage exercise and acupuncture treatment, continued vestibular rehabilitation training, and encouraged the patient to participate in badminton, table tennis and other ball games.
III. Treatment effect
After the comprehensive treatment of inpatient medication, acupuncture and vestibular rehabilitation training, the patient’s vertigo was significantly relieved, unsteadiness in walking was improved compared with before, but there was still a sense of instability during rapid head turning and other movements, self-conscious tinnitus was relieved, facial palsy symptoms were improved compared with before, but there was still obvious facial asymmetry at rest. Through continued treatment for six months after discharge, the patient’s vertigo basically disappeared, walking instability further improved, tinnitus was relieved, facial expressions were statically symmetrical, and normal rhythm of life and work was restored. After the treatment, the vestibular function examination, the passive head tossing result improved significantly, the right three semicircular canal gain improved, and the sweeping vision improved.
(Vestibular function examination)
IV. Notes
We are glad that the patient’s symptoms have improved through treatment. After discharge, the patient should relax, ensure sleep, lead a regular life, eat a balanced diet, enhance the immunity of the body, perform daily vestibular rehabilitation training, perform appropriate ball games such as badminton and table tennis to promote vestibular rehabilitation, and massage and exercise the facial muscles several times a day. Avoid high-risk behaviors such as driving, biking and working at height, noise and ototoxic drugs for six months after discharge. If vertigo, ear pain, facial palsy, tinnitus, deafness aggravation or other neurological symptoms such as hoarseness, choking and coughing of drinking water occur, you should seek medical follow-up promptly.
V. Personal insight
Hunter syndrome is a common acute vestibular syndrome caused by varicella zoster virus infection, which is latent in the facial nerve cells and can be activated to develop once the body is exposed to cold, trauma, fatigue, and low immunity. The common manifestations are ear pain, ear herpes, facial paralysis, vertigo, tinnitus and deafness, and in severe cases, the brain and nerves can be involved, causing symptoms such as encephalitis, hoarseness and choking on water. Therefore, after patients find the above symptoms, it is recommended to seek medical consultation in time and actively treat the disease under the clear diagnosis of the doctor to minimize the harm of the disease.