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Facial paralysis due to Ramsay Hunt syndrome – A rare condition
Rev Assoc Med B ras 2017; 63(4):301-302 301
IMAGE IN MEDICINE
Facial paralysis due to Ramsay Hunt syndrome – A rare condition
Aline Lariessy Campos Paiva1*, João Luiz V itorino Araujo2, Vinicius Ricieri Ferraz1, José Carlos Esteves Veiga3
1Neurosurgery Resident, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
2PhD in Neurology from Universidade de São Paulo. Assistant Neurosurgeon, FCMSCSP. Neurosurgeon, Instituto do Câncer Arnaldo Vieira de Carvalho, São Paulo, SP, Brazil
3Full Professor and Head of the Neurosurgery Division, FCMSCSP, São Paulo, SP, Brazil
Summary
Study conducted at Faculdade
de Ciências Médicas da Santa Casa de
São Paulo, São Paulo, SP, Brazil
Article received: 7/12/2016
Accepted for publication: 10/4/2016
*Correspondence:
Faculdade de Ciências Médicas
da Santa Casa de São Paulo
Address: Rua Cesário Mota Júnior, 112
São Paulo, SP – Brazil
Postal code: 01221-020
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. 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. Diagnosis is essentially based on symptoms. We report the
case of a diabetic female patient who sought the emergency department with a
complaint of this rare entity.
Keywords: facial paralysis, herpes zoster oticus.
A 68 year-old female patient with history of type II diabe-
tes sought our emergency service (ER) with a clinical
complaint of difficulty to blink and left-sided hearing
loss associated with labial deviation to the right. The
symptoms had begun eleven days before her admission.
On neurological examination, we noted left facial pa-
ralysis House-Brackman grade IV associated with vesicles
and crusted lesions on the left auricle (Figure 1). She
complained of hearing loss on the same side. No other
abnormalities were found in the general examination.
This clinical picture is therefore very suggestive of a rare
condition known as Ramsay Hunt syndrome (herpes zoster
oticus). It was first described by James RamsayHunt in 19071,2
and its occurrence is due to varicella zoster virus (VZV) re-
activation in sensory root ganglia. The geniculate ganglion
is located on the facial nerve in the depths of the internal
auditorymeatus at the entrance to the bony fallopian canal.3
The infection involves facial and vestibulocochlear nerves,
causing peripheral facial paralysis, otalgia and sensorineural
hearing loss. Vestibular symptoms are rare.2
FIGURE 1A. Auricular vesicles at the left pinna. B. Left peripheral facial paralysis House-Brackman IV, 149 x 91 mm (96 x 96 DPI).
A B