Ramsay Hunt syndrome

A 63-year-old man presented to our hospital with 2 days history of right-sided earache and numbness followed by development of vesicular rash involving the right side of the face. No history of headache, tinnitus, giddiness or hearing impairment. Neurological examination revealed right-sided mild lower motor neuron type facial palsy (A) and vesicular rash in the distribution of maxillary and mandibular branch of trigeminal nerve without any sensorineural deafness (B, C). Routine all laboratory examinations including retroviral screening were normal. A clinical diagnosis of the Ramsay Hunt syndrome (RHS) was considered based on earache, facial paralysis and typical dermatomal distribution of rash. He was started with oral valaciclovir 1 g three times daily (TDS) for 7 days and Tab prednisolone 60 mg daily for 5 days. Two days after initiation of the treatment vesicular lesions disappeared but neurological examination revealed right-sided grade IV facial nerve palsy. Ramsay Hunt syndrome or Herpes Zoster Oticus is characterized by reactivation of latent varicella zoster virus in the geniculate ganglion and subsequent spread to cranial nerve. The diagnosis is mainly clinical. The facial paralysis seen in Ramsay Hunt syndrome is often more severe with increased rate of late neural denervation and decrease chance of complete recovery.