Ramsay-Hunt Syndrome

AKA Herpes zoster oticus

Aetiology agent:
- Herpes zoster virus
Latent (Reactivation) infection at geniculate ganglion of virus from past infection (chicken pox)

Structure affected: 
- Facial nerve (CN VII)
- +/- Vestibulocochlear nerve (CN VIII)

MRI:
- Contrast enhancement of the CN VII canalicular segment. Normally do not enhance in this area.
- Asymmetric contrast enhancement of the geniculate ganglia labyrinthine, tympanic and/or mastoid.
- +/- Vestibular & Cochlear nerve contrast enhancement.
- +/- Pontine colliculus facials contrast enhancement.

Symptoms:
Classic triad
- Vesicles along the facial nerve distribution (ear, EAC, face, palate, tongue) AND/OR
- Ipsilateral hemi-facial weakness / paralysis AND/OR
- Ear (otic) pain
Others:
- Tinnitus, sensorineural hearing loss, vertigo (vestibulocochlear nerve CNVIII involvement)
- Unable to close eye (ipsilateral)
- Altered / Loss of taste perception
- Dry mouth & eyes

Complication:
- Facial paralysis (can be permanent)
- Hearing loss (can be permanent)
- Post-herpetic neuralgia
- Meningo-encephalitis

Rx: EARLY TREATMENT!!
- Antiviral medications
- Short term high dose Steroids
- Benzodiazepine
- Analgesia
- Eye-moisturiser