Ramsay Hunt syndrome

Last revised by Yoshi Yu on 16 Mar 2023

Ramsay Hunt syndrome, also known as herpes zoster oticus or Ramsay Hunt syndrome type 2, is shingles of the facial nerve. It is due to reactivation of the varicella zoster virus (VZV) in the geniculate ganglion.

Ramsay Hunt syndrome classically presents with a triad of 3,4:

  • otalgia

  • facial nerve palsy

  • a vesicular eruption (often painful) involving the external auditory canal, pinna, tongue (anterior two-thirds) or hard palate

There may be involvement of the vestibulocochlear nerve (CN VIII) in which case vertigosensorineural hearing loss, and tinnitus may be present.

The syndrome is due to latent infection of the geniculate ganglion with varicella zoster virus (VZV) and subsequent reactivation.

Imaging is identical to that seen in Bell palsy, with increased enhancement of the facial nerve. Care should be taken not to mistake normal facial nerve enhancement on MRI for that observed in Ramsay Hunt syndrome.

Treatment is with antiviral medications (e.g. valaciclovir) and corticosteroids (e.g. prednisolone). Additionally, measures should be taken to protect the cornea while there is incomplete eyelid closure (e.g. artificial tears, taping down eyelids shut).

This eponymous syndrome was named after James Ramsay Hunt (1872-1937), an American neurologist 2.

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Cases and figures

  • Case 1: photo
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  • Case 1
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