Res Vestib Sci.  2023 Dec;22(4):120-126. 10.21790/rvs.2023.22.4.120.

A Case of Ramsay Hunt Syndrome Showing Central Findings due to Brainstem Involvement

• Lee MH
• Kim MB

• KMID: 2549106
• DOI: http://doi.org/10.21790/rvs.2023.22.4.120

Abstract

Ramsay Hunt syndrome occurs when the varicella zoster virus reactivates. Classic findings include the triad of facial paralysis, otic pain and herpetic lesions due to the pathogenesis associated with anterograde axonal reactivation of the varicella zoster virus in the geniculate ganglion. In addition to the classic triad, rare features such as a central type of vestibular function test may be observed due to the retrograde spread of the varicella zoster virus from the geniculate ganglion into the brain stem, including involvement of the vestibular nucleus. We present a case of Ramsay Hunt syndrome in a 57-year-old male patients, manifesting not only the typical triad of symptoms but also the unique features associated with brain stem involvement. This presented as direction-changing gaze-evoked nystagmus and a decrease in gain on both sides on video head impulse test. And brain magnetic resonance imaging showed a lesion in the vestibular nucleus of the brain stem.

Keyword

Ramsay Hunt syndrome; Herpes zoster oticus; Brain stem; 람세이-헌트 증후군; 이성대상포진; 뇌간