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


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


  1. Hunt JR. “On herpetic inflammations of the geniculate ganglion, a new syndrome and its complication”. The Journal of Nervous and Mental Disease 34 (1907): 73-96.
  2. Turner JE., et al. “Cranial polyneuropathy— Ramsay Hunt’s syndrome. Case report and discussion”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 83 (1997): 354.
  3. House JW and Brackmann DE. “Facial nerve grading system”. Otolaryngology–Head and Neck Surgery 93.2 (1985): 146-147. 
  4. Monsanto RD., et al. “Treatment and prognosis of facial palsy on Ramsay Hunt Syndrome: Results based on a review of literature”. Archives of Otorhinolaryngology 20 (2016): 394.
  5. Worme M., et al. “An unexpected case of Ramsay Hunt syndrome: case report and literature review”. BMC Research Notes 6 (2013): 337.
  6. Opoku-Buabeng J and Dompreh A. “Ear, nose and throat lesions in hiv/aids patients in komfo anokye teaching hospital, kumasi, ghana”. Journal of the West African College of Surgeons 2.2 (2012): 27-39.
  7. Lamina S and Hanif S. “Pattern of facial palsy in a typical Nigerian specialist hospital”. African Health Science 12.4 (2012): 514-517.
  8. T/Selasic and Zenebe G. “Ramsay Hunt syndrome”. Ethiopia Medical Journal 44.4 (2006): 2014.
  9. Bademosi O., et al. “Clinical study of unilateral peripheral facial nerve paralysis in Nigerians”. African Journal of Medicine and Medical Sciences 16.4 (1987): 197-201.
  10. Bélec L., et al. “Peripheral facial paralysis and HIV infection: report of four African cases and review of the literature”. Journal of Neurology 236 (1989): 411-414.
  11. Sweeney CJ and Gilden DH. “Ramsay Hunt syndrome”. Journal of Neurology, Neurosurgery and Psychiatry 71 (2001): 149-154.
  12. Adour KK. “Otological complications of herpes zoster”. Annuals of Neurology 35 (1994): S62-64. 
  13. Mauprivez C., et al. “Acute facial nerve palsy with Ipsilateral Soft Palate Ulcers”. Journal of Oral and Maxillofacial Surgery (2017).
  14. Robillard ZRB., et al. “Ramsay Hunt facial paralysis: Clinical analysis of 185 patients”. Otolaryngology–Head and Neck Surgery 95 (1986): 292.
  15. Hato N., et al. “Ramsey Hunt syndrome in children”. Annuals of Neurology 48.2 (2000): 254-256.
  16. Rasmussen ER., et al. “Ramsay Hunt syndrome revisited–emphasis on Ramsay Hunt syndrome with multiple cranial nerve involvement”. Virology Discovery 2 (2014): 1
  17. Kennedy PGE., et al. “A comparison of herpes simplex virus type 1 and varicella-zoster virus latency and reactivation”. The Journal of General Virology 96 (2015): 1581-1602.
  18. Eksi G., et al. “The effect of width of facial canal in patients with idiopathic peripheral facial paralysis on the development of paralysis”. European Archives of Otorhinolaryngology 272 (2015): 2283.
  19. Shinha T and Krishna P. “Ramsay Hunt syndrome and zoster laryngitis with multiple cranial nerve involvement”. ID cases 2 (2015): 47-48.
  20. Devriese PP and Moesker WH. “The natural history of facial paralysis in herpes zoster”. Clinical Otolaryngology 13 (1988): 289. 
  21. Murakami S., et al. “Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: significance of early diagnosis and treatment”. Annuals of Neurology 41 (1997): 353-357. 
  22. Ljungman P., et al. “A randomized trial of oral versus intravenous acyclovir for treatment of herpes zoster in bone marrow transplant recipients”. Bone Marrow Transplant 4.6 (1989): 613-615.
  23. Coulson S., et al. “Prognostic factors in herpes zoster oticus (Ramsay hunt syndrome)”. Otology and Neurotology 32 (2011): 1025-1030. 
  24. Zainine R., et al. “Ramsey Hunt syndrome”. European Annals of Otorhinolaryngology, Head and Neck diseases 129 (2012): e22-e25
  25. Ryu EW., et al. “Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome”. American Journal of Otolaryngology 33.3 (2012): 313-318.
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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