Case Report
Volume 12 Issue 3 - 2020
Ramsay Hunt Syndrome with Multiple Cranial Nerves Involvement: A Case Report and Literature Review from Africa
Neema W Minja1*, Said Kanenda2, Merium Braaksma3, Mubashir Jusabani4, Denis R Katundu5, Kajiru G Kilonzo1, Marieke C J Dekker6 and William P Howlett1
11Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Tanzania
2Department of Internal Medicine, Bugando Medical Centre, Tanzania
3Neurology, Elisabeth-TweeSteden Ziekehuis, Netherlands
4Department of Orthopedic Surgery, Kilimanjaro Christian Medical Centre, Tanzania
5Department of Otolaryngology, Kilimanjaro Christian Medical Centre, Tanzania
6Department of Paediatrics, Kilimanjaro Christian Medical Centre, Tanzania
*Corresponding Author: Neema W Minja, Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Received: January 13, 2020; Published:February 13, 2020




Abstract

Background: Ramsay Hunt Syndrome (RHS) is a rare viral infection involving reactivation of varicella zoster virus (VZV) infection in the geniculate ganglion of the facial nerve. The classical clinical presentation includes otalgia, herpetic vesicles on the ear, auditory canal and sometimes in the mouth together with ipsilateral facial nerve paralysis. Other adjacent nerve involvement is very rare. We report an unusual presentation of RHS in an immunocompetent male with multiple cranial nerve involvement.

Case Presentation: A 71-year-old African man presented with a one-week history of right-sided headache, otalgia, otorrhoea and right sided facial weakness. He later complained of hoarseness, dysphagia and coughing. Examination revealed a large black necrotic eschar involving almost the whole of the right ear lobe extending from the ear canal and concha to the pinna, together with herpetic like vesicles on the ipsilateral soft palate with ipsilateral facial and palatal palsy, and deafness indicating involvement of adjacent cranial nerves VII, VIII, IX and X. He was treated initially with broad-spectrum antibiotics and later started on acyclovir and prednisolone with some improvement in symptoms after one week of treatment. 

Conclusions: This is a case report from Africa of RHS with ipsilateral hearing loss and bulbar symptoms secondary to multiple adjacent cranial nerve involvement. The report emphasizes the awareness of this syndrome in Africa where resources for PCR viral testing and complex neuroimaging are limited, and its uncommon association with other cranial nerve palsies. Early recognition is paramount as treatment is more effective if it is given early in the course of illness. 

Keywords: Herpes Zoster Oticus; Ramsay Hunt Syndrome; Pharyngitis; VZV; Facial Paralysis; Zoster Polyneuritis

References

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Citation: Neema W Minja., et al. “Ramsay Hunt Syndrome with Multiple Cranial Nerves Involvement: A Case Report and Literature Review from Africa”. EC Neurology 12.3 (2020): 01-09.

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