engleski

Ramsay hunt syndrome – a case report

Introduction/Objectives: Ramsay Hunt syndrome (RHS) is a rare neurological disorder caused by reactivation of latent Varicella-zoster virus (VZV) in the geniculate ganglion. A triad of ipsilateral facial paralysis, ear pain and herpes zoster oticus is the typical presentation. Cochleovestibular impairment such as hypoacusis, tinnitus and vertigo may occur. The involvement of other cranial nerves, such as V, IX, X, and XII is rare. Objectives : Review of clinical manifestations and treatment of patient with Ramsay Hunt syndrome caused by VZV reactivation. Case report: A 24-year-old female patient was admitted to the hospital on the third day of illness, presenting with fever, symptoms of upper respiratory tract infection (sore throat, lymphadenitis on left side on neck), loss of salt taste on the front 2/3 of the left side of the tongue, left ear pain without hearing loss, and ipsilaterally a herpetiform vesicular eruption the auricle and external acustic meatus. On the fifth day of the disease, the patient developed an inability to close left eye and a facial asymmetry with the lower left corner of the lips. A complete clinical examination revealed herpes zoster oticus and peripheral facial nerve paralysis a HouseBrackmann grade III on the left side. Diagnosis was performed based on laboratory, physical and neurological examinations. Hematological-biochemical tests were within reference range (erythrocyte sedimentation rate, CRP, blood cell count, liver and kindney enzyme analysis, urine analysis), MRI brain scan was normal, the patient had a bilateral type A tympanogram and stapedial reflex was absent in the left ear. The serological test (EIA) confirmed reactivation of VZV ( IgM antibodies 11-positive, IgG antibodies 38positive , IgA antibodies-borderline). Patient was treated with acyclovir 800 mg PO q4h (5 times daily) for 10 days and oral prednisolone (1 mg /kg q24 h) for 5 days, then the dose was tapered for 10 days. On follow-up four weeks later, complete recovery of neurological deficit was noted. Conclusions: Early diagnosis and prompt treatment of RHS with combination of steroids and acyclovir within 72 hours of rash appearance achieved the higher rate of recovery and prevention of complications such as permanent hearing loss and facial weakness, eye damage and postherpetic neuralgia. Treatment of our patient was started on the third day of the rash, recovering completely within four weeks.

Ramsay hunt syndrome

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