Ramsay-Hunt syndrome in the differential diagnosis of stroke

Abstract

An 82-year-old man with a medical history of diabetes, hypertension, and right hemispheric stroke 4 years previously, presented to the emergency department complaining of pain in the right ear, otorrhea, and hypoacusis for 5 days. His spouse also mentioned symptoms of drooling and aggravation of previous defi cits, namely dysarthria, facial asymmetry, and left hemiparesis. Due to the suspicion of a new stroke event, a neurological evaluation was requested, which revealed right peripheral facial palsy (Figure A), ipsilateral hypoacusis, and spastic left hemiparesis with impaired deambulation without support. An ear inspection revealed various blistering lesions and cicatricial tissue on the right external auditory canal (Figure B). Routine blood analysis was normal, and cerebral computed tomography showed no recent lesions, particularly ischemic or hemorrhagic lesions. The cerebrospinal fluid investigation revealed pleocytosis (75 cells, 95% of which were mononuclear), normal glucose and protein values, and negative results for the microbiological investigation, including unsuccessful isolation of varicella zoster virus (VZV). The patient was treated with acyclovir (800mg 5 times daily) and REFERENCES