Ramsay Hunt Syndrome With Cranial Polyneuropathy and Delayed Facial Nerve Palsy: A Case Report

Herpes zoster oticus is a viral disease caused by the reactivation of the varicella-zoster virus at the geniculate ganglion. The hallmark of the condition is multiple unilateral erythematous vesicles, which are distributed over the auricle and preceded by severe otalgia. If these symptoms are associated with facial nerve palsy, the condition is called Ramsay Hunt syndrome (RHS) which is usually accompanied by vestibulocochlear abnormalities. A 42-year-old woman came to our clinic with sudden onset of right-sided severe otalgia and several erythematous vesicles on the auricle two days ago. She provided a history of dysphagia and hoarseness for 10 days. After two days, ipsilateral facial nerve paralysis was noted. The patient was immunocompetent with an unremarkable medical history. Physical examination revealed the following: the vesicles distributed over the right auricle, external auditory canal, and eardrum; right sensorineural deafness; deviated uvula to the left side; absent gag reflex on the right side; right vocal cord palsy; and lower motor facial nerve paralysis of House-Brackmann grade III. The pure tone audiogram confirmed the diagnosis of right-sided sensorineural deafness. Acyclovir therapy and prednisolone tablets at a loading dose were initiated. At the four-month follow-up, the presenting manifestations were improved. Here, we report a case of RHS with early glossopharyngeal and vagus nerve palsy, followed by pain, vesicular eruptions, sensorineural hearing loss, and delayed onset of facial nerve paralysis. The condition resolved completely on medical treatment with acyclovir and prednisolone.