Ramsay hunt facial paralysis: Clinical analyses of 185 patients

Abstract

In a prospective study of 1507 patients, evaluated consecutively for facial palsy in the Cranial Nerve Research Clinic at the Kaiser Permanente Medical Center, Oakland, California, between 1966 and 1976, 185 cases (12%) were diagnosed as Ramsay Hunt syndrome. In 46 cases (25%), the diagnosis of herpes zoster was confirmed by acute and convalescent serum titers for varicella-zoster virus. In 139 cases (75%), viral titers were not performed and the diagnosis was based on the characteristic clinical presentation of the Ramsay Hunt syndrome. The data were subjected to multivariate analysis evaluating age, sex, race, signs, and symptoms at onset, severity of paralysis, associated medical problems with concomitant neurologic deficits, and response to therapy. These were compared with data of 1202 patients with Bell's (herpes simplex) palsy. The facial palsy of Ramsay Hunt syndrome was found to be more severe, to cause late neural denervation, and to have a less favorable recovery profile than Bell's (herpes simplex) facial palsy. Prognostic factors and treatment recommendations are discussed.

Role of Corticosteroids in Oral Lesions

“…RHS is a potentially serious viral infection that accounts for approximately 12% of all facial nerve palsies (Robillard 1986;Uri 2003).…”

Facial Weakness and Rash

“…Acyclovir is indicated, however, in patients with immunosuppression or encephalitis. It is generally well tolerated IV and the dose is' 5-10 mg per kg, 3 Surgery to decompress the facial nerve has been recommended for some patients, but its efficacy also is unproven.…”

Ramsay Hunt syndrome

“…According to Malin et al [9] the diagnosis RHS can be made when in addition to herpes zoster oticus with peripheral facial nerve paresis further cranial nerve lesions and sensory disturbances in cervical dermatomes are present (Table 1). Robillard et al diagnosed RHS on the basis of the symptom triad of ear pain, peripheral facial nerve paresis and herpes zoster lesions on the external auditory tract, the concha of the ear or other cervical dermatomes [10]. In the opinion of Sweeney and Gilden the diagnostic criteria for RHS in a "strict" sense are fulfilled when in the case of peripheral facial nerve paresis zoster lesions are seen on the ear or oral mucosa.…”

“…The studies by Robillard et al led to comparable epidemiological results. Among 185 patients with peripheral facial nerve paresis in herpes zoster oticus, 20 % more women were found as well as an increased incidence in the sixth decade of life when corrected for age [10]. From the above epidemiological data it can be estimated that with 300.000 herpes zoster cases nationwide, a proportion of herpes zoster oticus of 1 % and a frequency of peripheral facial nerve paresis in herpes zoster oticus of about 96 %, about 2 700 patients aged 50 years and older develop RHS annually in Germany.…”