Ramsay Hunt Syndrome with Perineural Involvement: Clinical Case Report

Introduction: The Ramsey Hunt syndrome is characterized by the presence of vesicular rashes and ear pain associated with peripheral facial palsy, whose etiologic agent is the herpes zoster virus. It is more common in elderly and immunocompromised patients. The most commonly affected nerves are the facial (VII) and vestibulocochlear (VIII). In some cases it can affect the trigeminal (V), glossopharyngeal (IX), and vagus (X). Vestibular symptoms (or events), such as dizziness and tinnitus, can be reported.

Objectives: Report a Ramsay Hunt syndrome case with perineural involvement.

Resumed report: This case presents an elderly patient with this syndrome, involving the VII, VIII, IX, and X cranial nerves, complaining of dysphagia, dysphonia, dizziness, and tinnitus on right ear. On clinical examination, score vesicles and crusts on right external auditory canal and on videolaryngoscopic assessment paralysis in left hemilarynx. The subject received treatment with acyclovir, corticosteroids, and physiotherapy, obtaining remarkable improvement of signs and symptoms in about a month. There maintains dysphonia and paresis of the left hemilarynx currently in speech therapy.

Conclusion: This syndrome arises from an acute inflammatory reaction of cranial nerves caused by the herpes zoster virus. Clinical treatment is controversial in the literature. Some authors recommend the use of anti-vertigo medicines, painkillers, and eye lubricants. Others recommend the use of corticosteroids and acyclovir. Furthermore, we highlight the importance of a multidisciplinary approach. It has less favorable prognosis for idiopathic facial paralysis. Furthermore, it is important to emphasize that early diagnosis can detect and best treat possible neurological complications.

Keywords: Ramsay Hunt syndrome, dysphonia, dizziness.