PCR Detection of Herpes Viruses in Patients with Acute „Idiopathic“ Facial Paresis

Czech version

Authors: E. Vlčková ¹; E. Švecová ¹; P. Štourač ¹; H. Štroblová ²; J. Bednařík ¹
Authors‘ workplace: Neurologická klinika LF MU a FN Brno, 2Oddělení klinické mikrobiologie FN Brno ¹
Published in: Cesk Slov Neurol N 2008; 71/104(2): 201-205
Category: Short Communication

Overview

Introduction:
Bell's palsy represents about 70 % of all acute facial palsies. Recently, there has been growing evidence of herpes simplex virus (HSV) type I or II or varicella-zoster virus (VZV) reactivation as the main cause of idiopathic facial palsy. With respect to a high proportion of seropositive individuals in general population, the reactivation of herpes viruses cannot be easily verified by serological methods while PCR (polymerase chain reaction) seems to be more promising for this purpose. The objective of the study was to evaluate the possibility to verify the reactivation of herpes viruses in patients with Bell's palsy using PCR serum and CSF (cerebrospinal fluid) examination.

Patient group and methodology:
PCR detection of herpes viruses was performed in CSF and serum samples of 25 patients with acute facial palsy. In all these patients, common causes of facial palsy including Lyme borreliosis were excluded (i.e., by normal CSF examination results) and the paresis was classified as idiopathic in all the cases (14 women, 11 men, mean age 44.72 ± 17.64, range 18–77). Also present was one patient with Ramsay Hunt syndrome (a 72 years old male). HSV type I and II were examined in all patients including the Ramsay Hunt patient, and PCR detection of VZV was performed in 11 of the idiopathic cases.

Results:
VZV DNA was only found in the CSF (not in the serum) of the Ramsay-Hunt patient. In all the idiopathic cases, PCR detection of both HSV and VZV was negative in the serum and CSF.

Conclusion:
Our findings show poor diagnostic validity of PCR detection of herpes viruses in serum and CSF in patients with acute idiopathic facial palsy and normal CSF cytological findings. Rather than casting doubt on the assumption of reactivation of virus infection as the cause of Bell's paresis, the above results suggest that the reactivation is only local, limited to the facial nerve and thus not detectable in CSF.

Key words:
facial nerve – Bell's palsy – herpes simplex virus – varicella-zoster virus – Ramsay-Hunt syndrome – polymerase chain reaction

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