Ramsay Hunt syndrome

Ramsay Hunt syndrome

Ramsay Hunt syndrome is a lower motor neurone facial palsy, with vesicles on the same side in the pharynx, external auditory canal, and on the face. It is thought to be due to herpes zoster of the geniculate ganglion.

Ramsay Hunt syndrome is defined as an acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal, auricle (also termed herpes zoster oticus), and/or mucous membrane of the oropharynx.

Ramsay Hunt syndrome was first described in 1907 by James Ramsay Hunt in a patient who had otalgia associated with cutaneous and mucosal rashes, which he ascribed to infection of the geniculate ganglion by human.

Cause for Ramsay Hunt syndrome

The varicella zoster virus that causes Ramsay Hunt syndrome is the same virus that causes chickenpox (varicella) and shingles.

In people with Ramsay Hunt syndrome, the virus is believed to infect the facial nerve near the inner ear. This leads to irritation and swelling of the nerve

Symptoms

 Painful rash on the eardrum, ear canal, earlobe, tongue, roof of the mouth (palate) on the same side as weakness of the face

 Hearing loss on one side

 Sensation of things spinning (vertigo)

 Weakness on one side of the face

· Difficulty closing one eye

· Difficulty eating (food falls out of the weak corner of the mouth)

· Difficulty making expressions, grimacing

· Difficulty with fine movements of the face

· Facial droop

· Paralysis of one side of the face

Investigations

· Blood tests for varicella zoster virus

· Electromyography (EMG)

· Lumbar puncture

· MRI of the head

· Nerve conduction (to determine the extent of damage to the facial nerve)

· Skin tests for varicella zoster virus

Treatment

· Strong anti-inflammatory drugs such as prednisone) are usually prescribed for 5 - 7 days. Antiviral medications, such as acyclovir or valacyclovir, can be given for 7 - 10 days, although the benefit of antiviral medications is uncertain.

· Sometimes strong painkillers are also needed if the pain continues even with steroids. While you have weakness of the face, wear an eye patch to prevent injury to the cornea (corneal abrasion) and damage to the eye if it does not close completely.

· If you have dizziness (vertigo), your health care provider can recommend other medications.