Ramsay Hunt syndrome presenting in primary care

Ramsay Hunt syndrome is a lower motor neurone weakness of the seventh (facial) cranial nerve caused by reactivation of the herpes zoster virus. The virus infects the geniculate ganglion of the nerve causing facial weakness. The onset of a motor neuropathy makes it inherently different from the more typical presentation of shingles, which predominantly causes a sensory neuropathy. Around 20-30% of individuals will be affected by herpes zoster during their lives. Ramsay Hunt syndrome is a rare disease, affecting fewer than 1 in 1500 people in the United States. The syndrome can present with vague and non-specific symptoms, especially during early onset of the disease. A high index of suspicion and frequent follow up are imperative for early diagnosis. A vesicular erythematous rash on, or around, the pinna (zoster oticus) may be present. Advanced age, diabetes mellitus and hypertension appear to be significant poor prognostic features with patients more likely to suffer complications. There is clear evidence to support the use of early antiviral therapy along with oral corticosteroid use. Early and appropriate intervention has resulted in significant improvement in treatment and complication outcomes.