Ramsay Hunt syndrome with severe dysphagia

Area of Science:

• Neurology
• Infectious Diseases
• Otolaryngology

Background:

• Ramsay Hunt syndrome (RHS) is a rare condition characterized by facial paralysis, otalgia, and vesicular rash.
• It is caused by the varicella-zoster virus (VZV), a reactivation of the herpes zoster virus.
• VZV can affect multiple cranial nerves beyond the facial nerve.

Observation:

• A patient presented with clinical manifestations of RHS.
• Cranial nerve involvement included V, VII, VIII, X, and possibly XII.
• The patient exhibited pharyngeal wall and vocal fold paralysis with reduced laryngeal elevation.

Findings:

• The extensive cranial nerve involvement resulted in severe oropharyngeal dysphagia.
• Significant difficulty swallowing necessitated the placement of a percutaneous endoscopic gastrostomy (PEG) tube.
• This case underscores the potential for severe neurological complications of RHS.

Implications:

• Ramsay Hunt syndrome can present with complex neurological deficits beyond typical facial palsy.
• Dysphagia due to cranial nerve paralysis in RHS requires prompt and aggressive management.
• Early recognition and intervention are crucial for preventing malnutrition and aspiration in affected patients.