• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Toxicology
    • Trauma
    • Ultrasound
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us

Ramsay Hunt Syndrome

John Costumbrado, MD, MPH* and Ryan Brenchley, MD*

*University of California, Riverside, Department of Emergency Medicine, Riverside, CA

Correspondence should be addressed to John Costumbrado, MD, MPH at jcostumbrado@gmail.com

DOI: https://doi.org/10.21980/J85S7QIssue 3:2
ENTVisual EM
No ratings yet.

History of present illness:

Patient is a 70-year-old female who presented to the emergency department for left-sided facial numbness and facial paralysis associated with left ear pain for 4 days. She had been unable to close her left eye, and had experienced drooling out of the left side of her mouth. On exam, she had a left-sided cranial nerve VII palsy, swelling of the left pinna and inner ear canal, with mild erythema and swelling of the left auricle. Notably, there were small vesicles found within the left external ear and posterior to left ear. Tympanic membranes were clear bilaterally.

Significant findings:

Left-sided cranial nerve VII palsy with flattened forehead creases, inability to keep the left eye open, and drooping of the corner of mouth. Vesicular lesions were found in and posterior to the left ear in a unilateral, dermatomal distribution.

Discussion:

Ramsay Hunt syndrome (RHS) is a clinical diagnosis characterized by otalgia, vesicular lesions of the auditory canal and auricle (herpes zoster oticus), and ipsilateral facial paralysis.1 It is associated with reactivation of the varicella zoster virus (VZV) in the geniculate ganglion.2 The risk is highest in the elderly, females, Caucasians, and those with a family history of shingles.3 RHS has an incidence of about 5 in 100,000 population in the US, and may be associated with up to 20% of cases of Bell’s palsy due to cranial nerve VII (lower motor neuron) dysfunction.4,5 The mainstay of RHS treatment includes oral antivirals (e.g. acyclovir); however, there is no strong evidence that it improves outcomes.4 RHS due to VZV reactivation has been associated with the development of vasculopathies that increase the risk for aneurysms, intracranial hemorrhage, and stroke.6 This highlights the importance of making the correct diagnosis in seemingly straightforward cases of unilateral cranial nerve VII palsy, as the diagnosis of RHS is an established risk factor for stroke and other serious outcomes associated with VZV vasculopathies.7

Topics:

Herpes zoster, shingles, Bell’s palsy, dermatology, neurology.

References:

  1. Adour KK. Otological complications of herpes zoster. Ann Neurol. 1994;35 Suppl:S62-64.
  2. Furuta Y, Takasu T, Fukuda S, et al. Detection of varicella-zoster virus DNA in human geniculate ganglia by polymerase chain reaction. J Infect Dis. 1992;166(5):1157-1159.
  3. Cohen JI. Clinical practice: Herpes zoster. N Engl J Med. 2013;369(3):255-263. doi: 10.1056/NEJMcp1302674
  4. Uscategui T, Dorée C, Chamberlain IJ, Burton MJ. Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev. 2008(4):CD006851.
  5. Gilchrist JM. Seventh cranial neuropathy. Semin Neurol. 2009;29(1):5-13.
  6. Gilden D, Cohrs RJ, Mahalingam R, Nagel MA. Varicella zoster virus vasculopathies: diverse clinical manifestations, laboratory features, pathogenesis, and treatment. Lancet Neurol. 2009;8(8):731-740.
  7. Marra F, Ruckenstein J, Richardson K. A meta-analysis of stroke risk following herpes zoster infection. BMC Infect Dis. 2017;17(1):198.
Icon

Ramsay Hunt Syndrome - Case Report

1 file(s) 515 KB
Download
Icon

Ramsay Hunt Syndrome - Images

1 file(s) 267 KB
Download
Issue 3:2Photograph

Reviews:

No ratings yet.

Please rate this





Retinal Detachment

13 Apr, 18

An Unusual Case of Pharyngitis: Herpes Zoster of...

13 Apr, 18
JETem is an online, open access, peer-reviewed journal-repository for EM educators

Most Viewed

  • Telemedicine Consult for Shortness of Breath Due to Sympathetic Crashing Acute Pulmonary Edema
  • Anticholinergic Toxicity in the Emergency Department
  • The Suicidal Patient in the Emergency Department Team-Based Learning Activity
  • Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic
  • Acute Chest Syndrome

Visit Our Collaborators

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright © 2016 JETem. All rights reserved.