Ramsay Hunt syndrome with cranial polyneuropathy with features of supraglottitis

Abstract

A 67-year-old woman presented with a 1-week history of left otalgia and a 1-day history of odynophagia, pain extending into the face and neck, and a productive cough. Flexible nasendoscopy showed features of supraglottitis, with swollen arytenoids and pooling of saliva in the piriform fossae. Laboratory investigations revealed a mildly raised C reactive protein. A CT scan of the neck supported the diagnosis of supraglottitis and pharyngitis, with thickening of the mucosa of the left piriform fossae and left oropharynx. Standard supraglottitis treatment was instigated, but on day 4 of the admission, a vesicular rash and features of cranial nerve involvement (V, VII, VIII, X) developed. A revised diagnosis of Ramsay Hunt syndrome with cranial polyneuropathy was made and later confirmed by varicella zoster virus PCR. After 4 weeks, facial nerve function normalised, but features of other cranial nerve palsies were persistent.

Manifestaciones clínicas del síndrome de Ramsay-Hunt en una serie de 20 casos

“…Respecto al corticoide, no parece haber diferencias entre el tratamiento oral y parenteral y aunque se usan diferentes protocolos, el tratamiento más habitual es de 1 mg/kg/día en dosis decreciente durante 14 días [8,23,53]. La capacidad antinflamatoria de los corticoides reduce el edema de los nervios afectados, lo que puede acelerar su recuperación [78] y aunque una reciente revisión de la Cochrane, ante la ausencia de estudios aleatorizados no establece conclusiones al respecto [81], su uso es generalmente recomendado [23,30,82].…”