P-PN034. Facial paralysis in Ramsay hunt syndrome: A case report, literature review on therapy and prognosis

Abstract

Introduction . Ramsay hunt syndrome is a rare disease caused by infection by varicella zoster virus. The disease causes facial paralysis and painful ear rash. Proper therapy is required for a good prognosis. Results . A 28-year-old female came to hospital with complaints of right-sided facial weakness and right ear pain, hearingloss, tinnitus and vertigo. On physical examination we found 7th cranial nerve palsy, vesicle on right periauricular, and horizontal unidirectional nystagmus. Laboratory examination results show IgM anti-HSV1 1.9 U/ml, IgG anti-HSV-1 10.4 U/ml, IgM anti-HSV-2 1.7 U/ml, IgG anti-HSV-2 6.7 U/ml were all within normal limits. Brain MRI with contrast showed right internal otitis that has affected the right facial nerve. Patient was diagnosed with Ramsay Hunt Syndrome and was given steroid, betahistine and acyclovir therapy. Patient was hospitalized for nine days. Dizziness, tinnitus and ear pain improved fully. Facial weakness slightly improved. Discussion: Several therapeutic formulas are proposed to be the most appropriate therapy in the treatment of Ramsay Hunt syndrome. This paper discusses a comparison of several of these therapeutic formulas in order to get the best outcome. Conclusion . The combination of steroids and acyclovir reach better recovery rates than steroids in monotherapy despite many variations in formula dosage.