Ramsay Hunt Syndrome – A Diagnostic Dilemma

Abstract

Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth. Ramsay Hunt Syndrome (RHS) is a rare, severe complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion. Ramsay Hunt syndrome is rare in children and affects both sexes equally. Incidence and clinical severity increases when host immunity is compromised. It is also accompanied by other frequent symptoms like tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus due to the close proximity of the geniculate ganglion to the vestibulocochlear nerve within the bony facial canal. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction.We describe a 23 year old female who was initially misdiagnosed as Bell's palsy and later developed vesicles on the pinna which led to a diagnosis of RHS and successfully treated with acyclovir and steroids.

Síndrome de Ramsay Hunt: una temida presentación del herpes zóster

“…Esta reactivación ocasiona edema y compresión de dicho nervio, además de e416 un proceso de desmielinización, lo cual aumenta el daño nervioso (1). No obstante, es importante recalcar que, dada la relación anatómica cercana entre los pares craneales, sus anastomosis individuales, su distribución cercana con los ganglios cervicales espinales y por la posibilidad de la afectación inicial de múltiples ganglios, pueden verse involucrados otros pares craneales y los ganglios espinales de C2-C4 (1,8), si bien solo el 27.3% de los pacientes presentará la afección de múltiples pares craneales (1).…”