Case report: Recurrent peripheral facial paralysis following two influenza vaccinations in 2009 and 2016

Ramsay Hunt syndrome involving the vagus nerve is very rare. We herein describe a 53-year-old man who developed severe pharyngeal pain after alcohol intoxication. Antibiotic treatment was ineffective. Laryngoscopy showed an ulcer on the right side of the epiglottis. As the condition progressed, the patient developed hoarseness. He then gradually developed multiple herpes lesions on the right side of the head, face, and neck along with right peripheral facial paralysis. Corticosteroid, analgesic, antiviral, and nutritional nerve therapy resulted in disappearance of the herpes lesions, epiglottis ulcer, pharyngeal pain, and right head and face pain. The facial paralysis slightly improved, but the hoarseness did not improve. The patient was discharged with an unsatisfactory outcome, and he attempted treatment with acupuncture. After 6 months, the right facial paralysis and hoarseness disappeared. Our case emphasizes the importance of early diagnosis and treatment of atypical Ramsay Hunt syndrome as well as timely communication, enhancement of trust, and reduction of disputes between doctors and patients.

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Neonatal peripheral facial paralysis’ evaluation with photogrammetry: A case report

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2015.10.051 ◽

2015 ◽

Vol 79 (12) ◽

pp. 2473-2475

Author(s):

Gentil Gomes da Fonseca Filho ◽

Gabriele Natane de Medeiros Cirne ◽

Roberta Oliveira Cacho ◽

Jane Carla de Souza ◽

Danilo Nagem ◽

...

Keyword(s):

Case Report ◽

Facial Paralysis ◽

Peripheral Facial Paralysis

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Persistent hemicrania as onset manifestation of Ramsay Hunt Syndrome

10.5327/1516-3180.584 ◽

2021 ◽

Author(s):

Ney Adson Leal II ◽

Nágila Pereira Mendes ◽

Caroline Moraes Tapajós Bolzani ◽

Hilton Mariano da Silva Junior

Keyword(s):

Case Report ◽

Facial Paralysis ◽

Peripheral Facial Paralysis ◽

Cerebrospinal Fluid Analysis ◽

Varicella Zoster ◽

Ramsay Hunt Syndrome ◽

Fluid Analysis ◽

Peripheral Facial Palsy ◽

Hunt Syndrome ◽

The Brain

Context: Ramsay Hunt Syndrome (RHS), also named Optic Herpes Zoster is caused by the reactivation of Varicella-Zoster Virus that occurs in the geniculate ganglion. The classic syndrome is composed of vesicular lesions in the ear, ipsilateral otalgia and peripheral facial palsy. The onset of the syndrome with persistent hemicrania is absolutely atypical as a manifestation of RHS. Case report: A 69 year old woman with subacute onset of left exclusive hemicrania in moderate strong intensity without autonomic signs. Eight days after the onset of headache, she presented left peripheral facial paralysis and after 4 days, she noticed the appearance of vesicles in the left ear and pain in swallowing. She has developed nausea with several episodes of vomiting, important imbalance that made impossible gait. On physical examination she presented vesicles in the left ear and oropharynx, left peripheral facial paralysis House Brackmann grade IV, left hypoacusis, nystagmus and vestibular gait. The brain CT and cerebrospinal fluid analysis were normal. The patient has progressive improvement with Acyclovir. Conclusions: Otalgia or even intermediate neuralgia are more frequent painful manifestations of RHS. This case report highlights the need to consider the diagnosis of SRH in patients with persistent hemicrania, even if without initial classic signs of the syndrome.

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A case report of atypical Ramsay-Hunt Syndrome presented with severe vertigo and vomiting

Journal of Experimental and Clinical Medicine ◽

10.52142/omujecm.38.4.52 ◽

2021 ◽

Vol 38 (4) ◽

pp. 693-695

Author(s):

Kemal KEF

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Herpes Zoster ◽

Physical Examination ◽

Facial Paralysis ◽

External Auditory Canal ◽

Peripheral Facial Paralysis ◽

Skin Changes ◽

Ramsay Hunt Syndrome ◽

Hunt Syndrome

Ramsay-Hunt Syndrome (Herpes zoster oticus) is often characterized by severe ear pain, vesicles on external auditory canal or auricula and peripheral facial paralysis. However, the patient in this case presented to the clinic with dizziness, pain in the ear and vomiting. During the physical examination there was no vesicles and no evidence of skin changes found around the auricula that were typical for Ramsay Hunt syndrome. The patient did not have facial paralysis. If there is an unexpected severe ear pain accompanying vertigo, Ramsay Hunt syndrome should be considered in the differential diagnosis even if there is no rash or facial paralysis.

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