Ramsay Hunt Syndrome With Cranial Polyneuropathy and Delayed Facial Nerve Palsy: A Case Report

Al-Ani, Raid M.

doi:10.7759/cureus.27434

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…4,5 The most important prognostic indicator in Ramsay Hunt syndrome is the severity of the facial palsy, although age above 50 is also associated with worse outcomes. 3 The most effective treatment for long-term complications is antivirals associated with corticosteroids if administered early. 1,7…”

Section: Association Of Acute Herpes Zoster Of the Head And Headache ...mentioning

confidence: 99%

“…2 The most affected cranial nerves besides VII are VIII and X, and the involvement of IX and XII is less reported. 3 Neurological symptoms usually appear before cutaneous manifestations, and initially, the syndrome can be confused with other neurological conditions that cause facial paralysis. Severe ear pain is the most common initial symptom, followed by paralysis.…”

Section: Introductionmentioning

confidence: 99%

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Continuous hemicrania as the initial manifestation of Ramsay Hunt syndrome: a case report

Leal¹,

Mendes²,

Bolzani³

et al. 2023

Headache Med

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IntroductionRamsay-Hunt syndrome, also called otic zoster, is a rare complication of herpes zoster. The syndrome is characterized by peripheral facial nerve palsy and an erythematous vesicular eruption in the ear or mouth. Preceding the appearance of the vesicles, unilateral otalgia or neck pain may occur more commonly. However, persistent hemicrania is infrequent in the pre-eruptive phase.ObjectivesTo present an atypical case of Ramsay Hunt syndrome with continuous unilateral headache preceding the onset of other symptoms and signs of the syndrome.Case reportReport of a 69-year-old woman who presented subacute onset of moderate to severe left hemicrania with no autonomic signs. Eight days after the start and continuous headache maintenance, she presented with peripheral facial paralysis. After four days, she noticed the presence of vesicles in the left ear and odynophagia. She developed nausea with several episodes of vomiting and severe imbalance that made it impossible for her to walk unassisted. On physical examination, she presented vesicles in the left ear and oropharynx, left peripheral facial palsy (House Brackmann grade IV), left hypoacusis, nystagmus, and vestibular gait. Diagnostic tests for screening several metabolic diseases and diagnosis of infection (including HIV) were unremarkable. Brain computed tomography and cerebrospinal fluid analysis showed no abnormalities.ConclusionsRamsay-Hunt syndrome mainly involves the facial and vestibulocochlear nerves, causing peripheral facial palsy, otalgia, hypoacusis, and, less frequently, imbalance. Although pain is a frequent manifestation of the pre-eruptive phase of RHS, unilateral headache is not common in this scenario. On the other hand, it is a prevalent complaint in the emergency department and has several different etiologies. Hence, diagnosing RHS when patients present exclusively unilateral headaches is challenging for clinicians. Physicians must consider RHS a vital differential diagnosis of sided-locked headaches, avoiding diagnostic errors and treatment delays.

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Section: Association Of Acute Herpes Zoster Of the Head And Headache ...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Continuous hemicrania as the initial manifestation of Ramsay Hunt syndrome: a case report

Leal¹,

Mendes²,

Bolzani³

et al. 2023

Headache Med

View full text Add to dashboard Cite

show abstract

“…RHS affects 5/100,000 patients annually [18]. It typically manifests in people between the ages of 60 and 80 but can also affect people of any age between 19 and 89 years [18].…”

Section: Available Case Reports Of Ramsay Hunt Syndrome In the Contex...mentioning

confidence: 99%

“…RHS affects 5/100,000 patients annually [18]. It typically manifests in people between the ages of 60 and 80 but can also affect people of any age between 19 and 89 years [18]. RHS encompasses a triad of peripheral facial palsy, vesicular rash over the pinna, and auricular pain.…”

Section: Available Case Reports Of Ramsay Hunt Syndrome In the Contex...mentioning

confidence: 99%

Ramsay Hunt Syndrome in Asymptomatic COVID-19 Infection: A Case Report and a Literature Review

Ayoub,

Lizzeik,

Berro

et al. 2023

JCM

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(1) Background: COVID-19 infection has affected almost 6 million people worldwide. Geniculate Ganglion Zoster resulting in Ramsay Hunt Syndrome (RHS) has been rarely described in this context. (2) Methods: Here, a case of RHS in the context of asymptomatic COVID-19 infection is reported followed by a literature review of the previously published cases (PubMed research combining “COVID-19” and “Ramsay Hunt Syndrome” or their abbreviations/synonyms, searching for data published at any time till October 2023). (3) Results: Five cases have been previously published (age range: 25–67 years; n = 3 males). Three patients were known to be immunocompetent prior to infection, one was receiving corticotherapy for lung disease, and one had an unspecified immune status. RHS predominantly involved both facial and vestibulocochlear nerves, with one case exclusively involving the facial nerve as the presented case. Regarding facial nerve palsy, three were right-sided (like the current report) and two were left-sided. Two cases were asymptomatic to COVID-19 (like the present patient), one had mild fatigue, and two had classical COVID-19 symptoms preceding RHS symptoms. Workup included serological testing against Varicella Zoster Virus and PCR assays that can detect the viral DNA in saliva, blood, tears, exudates, and cerebrospinal fluid. The treatment combined antiviral and corticosteroid therapies which yielded heterogeneous outcomes that might be related to some demographic and clinical data. (4) Conclusions: RHS rarely occurs in the context of COVID-19. Early recognition is important. Management seems to be similar to the classical condition. Some data may help predict facial nerve recovery.

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“…In RHS, symptoms of audio-vestibular deficits, such as hearing loss and vertigo, are commonly accompanied by FNP [2][3][4][5][6][7][8][9]. In addition, paralysis of other cranial nerves can be associated with RHS [10][11][12][13][14][15]. Regarding pathological causes of audio-vestibular deficit, it is controversial whether or not the lesioned sites are inner ear endorgans or vestibulo-cochlear nerves [16,17].…”

Section: Introductionmentioning

confidence: 99%

Features of Audio-Vestibular Deficit and 3D-FLAIR Temporal Bone MRI in Patients with Herpes Zoster Oticus

Lee

Choi

Kim

2022

Viruses

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Herpes zoster oticus (HZO) is characterized by otalgia and erythematous vesicles in the auricle or external auditory canal. Ramsay Hunt syndrome (RHS) can be diagnosed when facial nerve palsy is accompanied by these symptoms of HZO, and in this case, audio-vestibular symptoms such as hearing loss or dizziness often develop. Recently, 3D-fluid-attenuated inversion recovery sequence (3D-FLAIR) magnetic resonance imaging (MRI) has been introduced in order to evaluate the inner ear structure pathology. The purpose of this study was to investigate the audio-vestibular characteristics in correlation with temporal bone MRI findings in HZO patients. From September 2018 to June 2022, 18 patients with HZO participated in the study. Thirteen patients (77%) showed high-signal intensity in the inner ear structures in 4 h post-contrast 3D-FLAIR images. In a bithermal caloric test, the lateral semicircular canal showed high signal intensity in 4 h post-contrast 3D-FLAIR images in 75% of patients with abnormal canal paresis. While the cochlea showed high signal intensity in 4 h post-contrast 3D-FLAIR images in 75% of patients with hearing loss, the vestibulo-cochlear nerve showed enhancement in post-contrast T1-weighted images in only 33% of patients with hearing loss. The present study demonstrates that audio-vestibular deficits are well-correlated with increased signal intensity of the inner ear endorgans in 4 h post contrast 3D-FLAIR MRI.

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Ramsay Hunt Syndrome With Cranial Polyneuropathy and Delayed Facial Nerve Palsy: A Case Report

Cited by 3 publications

References 14 publications

Continuous hemicrania as the initial manifestation of Ramsay Hunt syndrome: a case report

Continuous hemicrania as the initial manifestation of Ramsay Hunt syndrome: a case report

Ramsay Hunt Syndrome in Asymptomatic COVID-19 Infection: A Case Report and a Literature Review

Features of Audio-Vestibular Deficit and 3D-FLAIR Temporal Bone MRI in Patients with Herpes Zoster Oticus

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