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.
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Clinical presentation
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 vertigo, sensorineural hearing loss, and tinnitus may be present.
Pathology
The syndrome is due to latent infection of the geniculate ganglion with varicella zoster virus (VZV) and subsequent reactivation.
Radiographic features
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 and prognosis
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).
History and etymology
This eponymous syndrome was named after James Ramsay Hunt (1872-1937), an American neurologist 2.
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