Acyclovir responsive brain stem disease after the Ramsay Hunt syndrome.

Area of Science:

• Neurology
• Virology
• Infectious Diseases

Background:

• Ramsay Hunt syndrome (RHS), a neurological condition caused by varicella zoster virus (VZV) reactivation, typically affects the facial nerve.
• While VZV is a known neurotropic virus, its potential to cause severe central nervous system disease in immunocompetent individuals requires further investigation.

Observation:

• An immunocompetent patient presented with Ramsay Hunt syndrome (RHS).
• Days following the initial presentation, the patient developed brainstem disease, indicating a potential progression of VZV infection.
• Virological studies confirmed varicella zoster virus (VZV) as the causative agent for both RHS and the subsequent brainstem involvement.

Findings:

• Intravenous acyclovir treatment led to rapid improvement in the patient's neurological deficits.
• Peripheral facial palsy was the only neurological deficit that did not fully resolve with antiviral therapy.
• This case underscores that VZV can cause brainstem disease even in immunocompetent hosts.

Implications:

• The findings suggest that brainstem disease is a potential complication of geniculate zoster (RHS) in immunocompetent individuals.
• Early initiation of antiviral therapy, such as intravenous acyclovir, can be curative for VZV-induced neurological complications.
• This case highlights the importance of considering VZV as a cause of neurological disease beyond peripheral facial nerve palsy.