A 78-year-old woman presents with a two-day history of severe left earache with a burning sensation in the ear, vertigo and loss of taste. There is left-sided weakness of both the upper and the lower facial muscles. Facial sensation is normal.
What is the most likely diagnosis?
A . Ramsay Hunt syndrome
B . Bell’s palsy
C . Acoustic neuroma
Answer: A
Explanation:
Ramsay Hunt syndrome is caused by infection of the geniculate ganglion of the facial nerve, together with invasion of the eighth nerve ganglia, by the herpes zoster virus. This produces ear pain, hearing loss, vertigo and facial nerve paralysis. A vesicular rash is usually present in in the outer ear, and sometimes also the soft palate or anterior two thirds of the tongue. Other cranial nerves apart from the VII nerve also be involved. Lymphocytes in the cerebrospinal fluid (CSF) and a mildly elevated CSF protein are recognized.