Ramsay Hunt Syndrome with Pharyngolaryngeal Involvement Mimicking Acute Stroke: A Case Report

Area of Science:

• Neurology
• Infectious Diseases
• Otolaryngology

Background:

• Ramsay Hunt syndrome (RHS) arises from varicella zoster virus (VZV) reactivation in the geniculate ganglion.
• Typically presents with facial nerve paralysis, ear rash, and hearing loss.
• Rarely, RHS can involve other cranial nerves, including glossopharyngeal and vagal nerves.

Purpose of the Study:

• To report a rare case of Ramsay Hunt syndrome with extensive cranial nerve involvement.
• To discuss diagnostic challenges, especially in patients with a history of cardiovascular events.
• To highlight the importance of considering RHS in atypical presentations of unilateral cranial nerve palsies.

Main Methods:

• Case presentation of a 56-year-old male with suspected stroke initially.
• Diagnostic workup included magnetic resonance imaging (MRI) to rule out cerebrovascular accident.
• Clinical examination and indirect laryngoscopy confirmed facial paralysis, auricular vesicles, hearing loss, and involvement of glossopharyngeal and vagal nerves.

Main Results:

• The patient was diagnosed with Ramsay Hunt syndrome with cranial polyneuropathy.
• Treatment with oral acyclovir and prednisolone led to partial recovery of facial paralysis and vocal cord function.
• The case underscores the potential for VZV reactivation to cause widespread neurological deficits.

Conclusions:

• Ramsay Hunt syndrome can manifest with polyneuropathy affecting multiple cranial nerves.
• Atypical RHS presentations, particularly in patients with cardiovascular history, necessitate broad differential diagnoses.
• Early recognition and treatment of RHS are crucial for improved patient outcomes.