RAMSAY HUNT SYNDROME: A CASE REPORT

Background: Ramsay Hunt syndrome (RHS) results from reactivation of the varicella-zoster virus (VZV) in the geniculate ganglion of the facial nerve. It typically presents as peripheral facial palsy associated with erythematous vesicular eruptions of the external ear or oral mucosa,and may involve cochleovestibular dysfunction.

Case Presentation: A 56-year-old male with poorly controlled type II diabetes presented with right peripheral facial palsy (House Brackmann grade IV) associated with vesicular lesions on the auricular concha (Ramsay Hunt zone). The patient reported hearing loss and vertigo. Clinical examination showed a horizontal rotatory nystagmus beating to the left. Videonystagmography revealed a 58% right vestibular deficit on caloric testing. The Video Head Impulse Test (vHIT) demonstrated bilateral posterior canal involvement and right lateral canal hypofunction. Vestibular Vibration Stimulation (VVS) was pathologic at 16° on the right side. Early combined therapy with acyclovir and corticosteroids was initiated. The vesicular lesions resolved, and hearing partially improved. However, vertigo persisted with covert saccades on vHIT, and no facial recovery was observed after two months of follow-up.