Ramsay Hunt Syndrome: Introduction

Ramsay Hunt syndrome is defined as a peripheral facial nerve weakness accompanied by a vesicular rash.

Cause

It is caused by herpes zoster infection of the facial nerve and geniculate ganglion, although the exact pathophysiological processes involved are still unclear [21].

Presentation

Fig 1: Vesicular rash in Ramsey Hunt syndrome (reproduced with permission from Wellcome Images)

Presentation is with a classic peripheral facial nerve weakness, but close examination will reveal an ipsilateral rash that may be evident in one of a number of areas dependant on the sensory ganglion(s) involved:

• In the ear canal or behind the ear
• Over the lateral neck
• On the tongue or buccal mucosa
• On the palate, uvula and/or pharynx

It is important to note that the rash may be initially erythematous only, with vesicles developing later.

Associated symptoms

Ramsay Hunt syndrome is commonly accompanied by associated symptoms, such as hearing loss and vestibular disturbance due to involvement of structures adjacent to the facial nerve [4]. It is associated with a poorer prognosis than Bell’s palsy and sequelae, such as persistent synkinesis and hearing loss, are more common in Ramsay Hunt syndrome [22].