Ramsay Hunt syndrome

Ramsay Hunt syndrome (or herpes zoster oticus) is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion occurs.

Triad: ipsilateral facial nerve paralysis, ear pain, and vesicles on the face, ear, or in the ear.

Usually, there are auricular vesicles and symptoms and signs such otalgia and peripheral facial paralysis. In addition, rarely, a rash around the mouth can be seen. Immunodeficient patients are more susceptible to this condition.

This syndrome is also known as geniculate neuralgia or nervus intermedius neuralgia. Ramsay Hunt syndrome can also occur in the absence of a skin rash, condition known as zoster sine herpete.

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 herpesvirus 3 (ie, varicella-zoster virus [VZV]).

The following may be observed:

VZV auricularis

VZV in any of the zoster zones of the head and neck (herpes auricularis, herpes facialis, and herpes occipito-collairs) with facial palsy

VZV in any of the zoster zones with facial palsy and auditory symptoms (eg, tinnitus, deafness, vertigo, nystagmus, ataxia).

Diagnosis is essentially based on symptoms.

Paiva et al. report the case of a diabetic female patient who sought the emergency department with a complaint of this rare entity 1).

Paiva ALC, Araujo JLV, Ferraz VR, Veiga JCE. Facial paralysis due to Ramsay Hunt syndrome - A rare condition. Rev Assoc Med Bras (1992). 2017 Apr;63(4):301-302. doi: 10.1590/1806-9282.63.04.301. PubMed PMID: 28614529.
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