Clinical investigation of Ramsay–Hunt syndrome with glossopharyngeal and vagal nerve involvement

Abstract

Introduction: Ramsay–Hunt syndrome is a peripheral facial nerve palsy accompanied by an erythematous vesicular rash in the ear (zoster oticus). Although involvement of the facial and vestibulocochlear nerves is typical in Ramsay–Hunt syndrome, multiple cranial neuropathies are rare, and are often associated with poorer prognosis and systemic complications. Here, we evaluated the clinical course of a rare case of Ramsay–Hunt syndrome associated with glossopharyngeal and vagal nerve disorders. Case Report: A 75-year-old man presented with right facial paralysis, hoarseness, and dysphagia, leading to the diagnosis of Ramsay–Hunt syndrome with glossopharyngeal and vagal nerve disorders. The time between onset and initiation of antiviral drug administration was six days. Five years earlier, the patient had developed deafness on the same side along with dizziness. Facial paralysis and dysphagia improved nine months after onset; however, deafness, dizziness, and hoarseness persisted. The possibility of vestibulocochlear nerve palsy due to Zoster sine herpete was therefore considered. Conclusion: Ramsay–Hunt syndrome with multiple cranial neuropathies is rare and is usually associated with a poorer prognosis. In this case, facial paralysis and dysphagia improved nine months after onset;however, deafness, dizziness, and hoarseness persisted. Therefore, attention must be paid to unilateral cranial nerve disorders, including Zoster sine herpete, during the assessment process.