Ramsay Hunt Syndrome

Ramsay Hunt syndrome is a peripheral facial neuropathy associated with vesicular rash of the skin of the ear canal, auricle and/or mucous membranes of the mouth.

The syndrome was first described in 1907 by James Ramsay Hunt in a patient with Varicella Zoster virus (VZV) infection.

VZV infection causes primary and secondary infections. Primary infection, chickenpox, is a childhood rash. It has become uncommon since the widespread use of Varicella vaccination. After resolution of the primary infection, the virus resides in ganglia of the various nerves. Any kind of stress (old age, pregnancy) or immune suppression (HIV, chemotherapy) can reactivate the virus. Secondary reactivation causes a localized vesicular rash, known as herpes zoster. Zoster is characteristically shows a dermatomal distribution. When cranial nerve VII is involved, Ramsay Hunt syndrome results.

Corticosteroids and oral acyclovir are commonly used in the treatment of Ramsay Hunt syndrome. A chochrane review (Uscategui T, Doree C, Chamberlain IJ, Burton MJ. Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev. Oct 8 2008.) did not show benefit of using acyclovir in addition to steroids. Less than 50% show full recovery.