(Note: Classification Keywords should be separated with comma)
Ramsay-Hunt syndrome is a disease caused by reactivation of latent Varicella zoster virus. The diagnosis is based on clinical findings that include the triad of ipsilateral facial paralysis, ear pain and vesicles in the auditory canal/auricle. Herein, we report a case of a 46-year-old previously healthy woman that was admitted to the emergency department with right peripheral facial palsy, vertigo, headache and pain on the right ear. Lab work Blood tests and contrast-enhanced head CT scan were normal. She underwent a lumbar puncture with drainage of clear CSF (Cerebro-Spinal Fluid). CSF analysis showed normal glycorrhachia, no pleocytosis and slight proteinorrhachia (84 mg/dL, normal range 15 mg/dL -60 mg/dL). Screening for Varicella zoster DNA on CSF by polymerase chain reaction was positive. A clinical diagnosis of Ramsay-Hunt syndrome was established and the patient was started on acyclovir and prednisolone, humidifying eye drops, right eye protection and physiotherapy. Ramsay-Hunt syndrome is perhaps an underdiagnosed form of peripheral facial palsy, since some patients only develop the vesicular rash after the onset of facial weakness and a minority of patients, like ours, do not develop it at all. This can make the diagnosis indistinguishable from Bell's palsy. It is important to differentiate between these two entities, because patients with Ramsay-Hunt syndrome often have more severe paralysis at the onset and are less likely to recover. Moreover, treatment of this condition involves both glucocorticoids and antiviral therapy, while for Bell’s palsy it remains uncertain whether antiviral therapy adds benefit. A high index of suspicion is necessary to diagnose this syndrome, especially in the absence of a typical vesicular rash. However, early and adequate treatment is crucial to improve damaged nerves and maximize the chances of full recovery.