Ramsay Hunt syndrome with deep hearing loss and meningitis

Abstract

Introduction. Ramsay Hunt syndrome is a clinical manifestation of varicella zoster virus reactivation. It is characterized by an erythematous vesicular rash in the external auditory canal and pinna with otalgia, vertigo and ipsilesional facial palsy. Symptoms develop over a few days with prodromal signs of facial weakness, tingling, facial numbness. Usually, cranial nerves VII and VIII are involved in the inflammatory process. Possible consequences of Ramsay Hunt syndrome are hearing loss, encephalitis and meningitis. Description of the case report. The authors present the case of a 63-year-old woman with a vesicular rash, earache, vertigo and left-sided facial paralysis who was treated with antiviral drugs and analgesics. These symptoms were complicated by conductive hearing loss in the left ear and meningitis. After treatment facial paralysis decreased. Unfortunately, hearing loss was permanent. Discussion. Rapid administration of antivirals and corticosteroids limited facial paralysis and improved facial expression. The prognosis for facial palsy is poorer in Ramsay Hunt syndrome than in idiopathic forms. Conclusions. A past history of vertigo and hypertension could been a predisposing factor for the severe manifestation of Ramsay Hunt syndrome and subsequent complications.