Síndrome de Ramsay Hunt con páralisis de X par craneal asociada. A propósito de un caso

Abstract

Introduction and objective: Ramsay-Hunt syndrome is a rare complication of the involvement of the geniculate ganglion by VZV that causes peripheral facial paralysis with involvement of the external auditory canal and tympanic membrane. Sometimes it can affect the lower cranial nerves as it is a multiple peripheral neuritis that can affect cranial nerves VII, VIII, IX and X due to their neighboring relationships, their common embryonic origin in the same branchial arch or due to blood involvement through the vessels that nourish them.Method: 93-year-old woman, who presented bullous lesions in the right auricle of 4 days of evolution, with associated otorrhea. Dysphagia for solids with odynophagia. Having started antibiotic and antiviral treatment without clinical improvement. Sudden onset of grade III right facial paralysis (House Brackmann). Examination revealed crusty lesions with edema of the right auricle, painful on palpation, abundant secretion of EAC, and an intact tympanic membrane. Crusty lesions at the level of the right upper eyelid and grade III right facial paralysis. Nasofibroscopy revealed right laryngeal paralysis with lesions compatible with Herpes Zoster. Admission was decided for intravenous treatment and observation, with good evolution.Results: Herpes Zoster with cranial nerve VII and X paralysis.Discussion: The peculiarity of the presented case resides in the association of a Ramsay-Hunt syndrome with a paralysis of the recurrent laryngeal nerve.Conclusions: Ramsay-Hunt syndrome is a rare complication of VZV involvement of the geniculate ganglion. It can present itself under various clinical forms that have cranial nerve neuritis in common in a very diverse way. We must take into account the possible association of paralysis of other cranial nerves with a view to a correct differential diagnosis.