Ramsay Hunt syndrome - a case report

Context: Ramsay Hunt syndrome is uncommon, with an incidence of 5 / 100,000 people (1), characterized by the triad of ipsilateral peripheral facial paralysis, otalgia and vesicles in the ear canal and / or auricular pavilion (1,2,3). It results from the reactivation of the Varicella Zoster virus in the geniculate ganglion and may extend to other cranial pairs, causing inflammation, edema and nerve dysfunction (1,3). As the second leading cause of peripheral facial palsy (1), its importance lies in a lower likelihood of recovery with a worse prognosis compared to Bell’s palsy (4). Case report: M.R.S, female, 54 years old, went to the emergency room due to ophthalmological complaints (blurred vision, diplopia, floaters, photophobia), nausea and vomiting, associated with vertigo, headache and facial hypoesthesia on the left. With the worsening of the condition, she was referred to the neurology service of the municipal hospital São José, presenting dysarthria, vesicular lesions in the left external auditory canal, preserved tactile sensitivity, MRC grade V and facial paralysis on the left (House Brackmann grade IV). Lumbar puncture and cerebrospinal fluid analysis were performed to discard other pathologies of the central nervous system. The diagnosis of Ramsay Hunt syndrome was established and treatment with Acyclovir and prednisone was started. After worsening renal function, drug therapy was suspended and venous hydration increased. She continued with improved renal function and was discharged with valacyclovir and corticosteroids. Conclusions: The importance of early diagnosis and treatment is emphasized in order to avoid permanent sequelae of the disease (1,3).