Investig Magn Reson Imaging.  2019 Mar;23(1):65-69. 10.13104/imri.2019.23.1.65.

Ramsay Hunt Syndrome Complicated by Meningoencephalitis and Radiologic findings: a Rare Case Report

• Lee Y
• Lee D

• KMID: 2442235
• DOI: http://doi.org/10.13104/imri.2019.23.1.65

Abstract

Ramsay Hunt syndrome with the complication of encephalitis or meningoencephalitis is rarely reported and uncommon in immunocompetent patients. The radiological manifestations of such cases usually involve the cerebellum and brainstem or exhibit the absence of any abnormality. We report a case of a 78-year-old immunocompetent man hospitalized with Ramsay Hunt syndrome, who later developed meningoencephalitis. The cerebrospinal fluid-study excluded other causes of meningoencephalitis, and the clinical diagnosis indicated varicella zoster virus meningoencephalitis. Magnetic resonance imaging revealed increased signal intensities in the bilateral temporal lobe, midbrain, and pons on T2-weighted imaging, and T2 fluid attenuated inversion recovery and contralateral asymmetric pachymeningeal enhancement. Contrast-enhanced T1-weighted imaging revealed ipsilateral facial nerve enhancement.

Keyword

Varicella-zoster virus; Ramsay Hunt syndrome; Meningoencephalitis; Magnetic resonance imaging

MeSH Terms

Aged
Brain Stem
Cerebellum
Diagnosis
Encephalitis
Facial Nerve
Herpes Zoster Oticus*
Herpesvirus 3, Human
Humans
Magnetic Resonance Imaging
Meningoencephalitis*
Mesencephalon
Pons
Temporal Lobe

Figure

• 

  Fig. 1 (a, b) DW-MR (b1000) showing no diffusion restriction. ADC image showing increased signal intensities in the left external ear and mastoid area. (c, d) DW-MR (b0) showing a mild increase in the signal intensities in the midbrain and right medulla.

• 

  Fig. 2 T2-FLAIR image showing increased signal intensities in the bilateral temporal lobes, midbrain, and superior cerebellum. (a) T2-FLAIR image showing increased signal intensities in the bilateral temporal lobes, midbrain, and superior cerebellum. (b) T2-FLAIR image showing increased intensities in the right medulla and inferior portion of the left middle cerebellar peduncle. (c) CE T1-WI showing contralateral asymmetric pachymeningeal enhancement along the right cerebral convexity. (d, e) CE T1-WI showing the left facial nerve enhancement, involving the canalicular segment, labyrinthine segment, geniculate ganglion, tympanic segment (not shown), and mastoid segment.

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