A Rare Case of Ramsey Hunt Syndrome With Cranial Polyneuropathy: Findings of the Brain MRI

In this case, we present the case of a 74-year-old female patient who visited the University Hospital of Patras, Greece, because of a 10-day history of earache and discharge in the left ear. Concurrently, the patient exhibited ipsilateral peripheral facial nerve palsy. We also observed vesicular eruption at the auricle and the external auditory canal (EAC) of the left ear. Following a thorough examination, the diagnosis of Ramsey Hunt syndrome (RHS) was established. Initial MRI scan of the head and neck indicated enhancement of both the left facial nerve (VII) and the vestibulocochlear (VIII) nerve, raising suspicion of RHS, which was subsequently confirmed through a positive polymerase chain reaction (PCR) test for varicella-zoster virus (VZV) DNA. The patient experienced a gradual clinical decline, ultimately affecting seven cranial nerves (CNs), with the emergence of meningoencephalitis. A follow-up brain MRI unveiled additional enhancement in CNs (VII, VIII, IX, XII) alongside signs of meningitis and encephalitis. Treatment included acyclovir administration (500 mg three times daily for one month), concurrent administration of prednisolone (125 mg per day for 20 days), permanent tracheostomy, and dedicated six-month physical rehabilitation. Over the course of a six-month follow-up, the patient exhibited significant clinical improvement and regained her ability to ambulate independently.