Facial paralysis due to Ramsay Hunt syndrome - A rare condition

Abstract

Ramsay Hunt syndrome (or herpes zoster oticus) is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion occurs. Usually, there are auricular vesicles and symptoms and signs such otalgia and peripheral facial paralysis. In addition, rarely, a rash around the mouth can be seen. Immunodeficient patients are more susceptible to this condition. Diagnosis is essentially based on symptoms. We report the case of a diabetic female patient who sought the emergency department with a complaint of this rare entity. Keywords: facial paralysis, herpes zoster oticus.A 68 year-old female patient with history of type II diabetes sought our emergency service (ER) with a clinical complaint of difficulty to blink and left-sided hearing loss associated with labial deviation to the right. The symptoms had begun eleven days before her admission. On neurological examination, we noted left facial paralysis House-Brackman grade IV associated with vesicles and crusted lesions on the left auricle (Figure 1). She complained of hearing loss on the same side. No other abnormalities were found in the general examination.This clinical picture is therefore very suggestive of a rare condition known as Ramsay Hunt syndrome (herpes zoster oticus). It was first described by James Ramsay Hunt in 1907 1,2 and its occurrence is due to varicella zoster virus (VZV) reactivation in sensory root ganglia. The geniculate ganglion is located on the facial nerve in the depths of the internal auditory meatus at the entrance to the bony fallopian canal. 3 The infection involves facial and vestibulocochlear nerves, causing peripheral facial paralysis, otalgia and sensorineural hearing loss. Vestibular symptoms are rare. 2 A B

Relato de caso: Síndrome de Ramsay Hunt

“…O quadro clínico apresentado pela paciente como queixa de dor no ouvido direito e o aparecimento de lesões polimórficas do tipo vesículas, pústulas e crostas no pavilhão auditivo externo direito, dor na articulação temporomandibular corroboram com diversos trabalhos na literatura sobre os principais sinais e sintomas desta síndrome (Mclean et al, 2013;Magalhães et al, 2014;Paiva et al, 2017).…”

“…Pode-se utilizar para o diagnóstico mais preciso a reação em cadeia da polimerase (PCR) pois permite a identificação do genoma do VVZ, porém não pode fazer um diagnóstico com rapidez no início dos sintomas. Por isso o citodiagnóstico de Tzanck é mais útil e rápido em casos de emergência (Magalhães et al, 2014;Paiva et al, 2017;Song et al, 2018;Kim et al, 2021;Pupic-Barack et al, 2021). Além disso, a paciente realizou uma ressonância magnética de crânio que apresentou um discreto favorecimento a possibilidade de um processo inflamatório/infeccioso do nervo facial direito (neurite).…”

Ramsey hunt syndrome after antimonial treatment for American Cutaneous Leishmaniasis

“…RHS should be diagnosed as early as possible to enable the fast implementation of appropriate treatment and to avoid sequelae 5 . These complications include encephalitis, myelitis, and cranial and peripheral nerve palsies 2 .…”

“…The incidence of RHS is approximately 5 cases/100,000 individuals and it primarily affects patients in the 20-30 year age group 4 . RHS is also often observed in elderly immunosuppressed patients 5 .…”

Ramsay Hunt Syndrome. A Case Report

“…Ramsay Hunt syndrome, also named as herpes zoster oticus, is a rare condition that occurs due to (VZV) reactivation in the geniculate ganglion of the facial nerve.and in the vestibulocochlear nerve, causing sensorineural hearing loss and facial paralysis. [1][2][3][4][5] In the present case report an unusual presentation of varicella zoster in an immunocompetent patient is reported.…”