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Brainstem and Cerebellar Involvement in Ramsay Hunt Syndrome
Vijay Letchuman1, Charles D Donohoe1
1Department of Neurology, University of Missouri-Kansas City School of Medicine and Truman Medical Center, Kansas City, MO, USA.
Case Reports in Otolaryngology
|January 10, 2020
Summary
Ramsay Hunt Syndrome (herpes zoster oticus) can spread to the brainstem and cerebellum, causing facial paralysis and ataxia. Early diagnosis and treatment with acyclovir are crucial for better outcomes.
Area of Science:
- Neurology
- Virology
Background:
- Ramsay Hunt Syndrome (herpes zoster oticus) is caused by varicella zoster virus reactivation.
- Typical symptoms include facial paralysis, ear pain, and ear rash.
Observation:
- A 62-year-old male with laryngeal cancer developed Ramsay Hunt Syndrome.
- Unique presentation involved retrograde spread of varicella zoster virus to the brainstem and cerebellum.
Findings:
- Neurological deficits included facial paralysis, sixth nerve palsy, diplopia, truncal ataxia, and dysmetria.
- Involved brainstem structures: abducens nucleus, facial nucleus, middle/inferior cerebellar peduncles.
Implications:
- Highlights the importance of considering brainstem/cerebellar involvement in Ramsay Hunt Syndrome.
- Recommends brain MRI and CSF analysis with PCR for varicella zoster virus.
- Emphasizes prompt high-dose intravenous acyclovir and steroid treatment for encephalitis to prevent deficits.
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