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Ramsay Hunt syndrome with multicranial nerve involvement.

Hyun Joon Shim1, Hoon Jung, Dong Choon Park

  • 1Department of Otolaryngology, College of Medicine, EulJi University, Seoul, Korea.

Acta Oto-Laryngologica
|November 13, 2010
PubMed
Summary

Ramsay Hunt syndrome (RHS) involving multiple cranial nerves is rare and leads to more severe, intractable cases. Patients with multicranial nerve involvement show lower recovery rates from facial paralysis compared to those with isolated RHS.

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Area of Science:

  • Neurology
  • Otolaryngology
  • Infectious Diseases

Background:

  • Ramsay Hunt syndrome (RHS) typically affects the VII (facial) and VIII (vestibulocochlear) nerves unilaterally.
  • RHS with multiple cranial nerve involvement is an uncommon and potentially more severe presentation.
  • Understanding the clinical characteristics and outcomes of this rare variant is crucial for effective management.

Purpose of the Study:

  • To describe the clinical characteristics of 11 patients with RHS and multiple cranial nerve involvement.
  • To compare the clinical features and outcomes of RHS with and without multiple cranial neuropathy.
  • To evaluate the severity and intractability of RHS based on the extent of cranial nerve involvement.

Main Methods:

  • Retrospective analysis of 339 RHS patients treated between 1995 and 2009.
  • Identification and detailed assessment of 11 patients with concurrent multiple cranial neuropathy.
  • Comparison of clinical characteristics and recovery rates between patients with and without multiple cranial neuropathy.

Main Results:

  • The 11 patients with multiple cranial neuropathy had a mean age of 49.2 years, with 70% being 50 or older.
  • Severe facial paralysis (House-Brackmann grade IV-V) was observed in all 11 patients.
  • Recovery rates for facial paralysis were significantly lower in patients with multiple cranial neuropathy (54.5% vs. 82.9%) and complete recovery rates were also reduced (27.3% vs. 67.7%).

Conclusions:

  • Ramsay Hunt syndrome with multiple cranial nerve involvement represents a more severe and intractable form of the disease.
  • Patients with multicranial nerve involvement experience poorer outcomes regarding facial nerve recovery.
  • This highlights the importance of recognizing and assessing the extent of cranial nerve involvement in RHS for prognostic evaluation.