Ramsay Hunt Syndrome

An interesting case of Ramsay Hunt Syndrome

45 years old male patient came with C/O:

1. Pain right ear - 4 days

2. Deviation of mouth to the left - 2 days

3. Inability to close right eye - 2 days

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Photo showing an eruption in the external auditory canal on the right side

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Photo showing right facial nerve palsy lower motor neuron type

O/E:

patient had an eruption in the right external auditory canal

Patient was unable to close his right eye. Bell's phenomenon was positive (Upward roll of the eyeball when an attempt is made to close the eye). Lower motor neuron type of facial palsy can be differentiated from upper motor type by the loss of wrinkling of forehead in the former ipsilaterally.

Clinical diagnosis: Ramsay Hunt syndrome

Discussion:
This condition is caused by infection by Varizella Zoster virus. The virus affects the geniculate ganglion of facial nerve. This accounts for the eruption in the external auditory canal on the right side. This area corresponds to the nerve supply to the external ear canal i.e. facial nerve.

Syndrome complex:

1. Ear pain

2. Blisters in the external auditory canal

3. Facial nerve palsy (LMN type) due to involvement of geniculate ganglion by the virus

Management:

Purely supportive.

Eye care.

Antibiotics to prevent super added infection (oral cefixime)

Anti inflammatory drugs to reduce pain

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