Ramsay hunt syndrome with cranial polyneuropathy involving cranial nerves VII, VIII, IX, and X

Abstract

In addition to facial and vestibular nerve paralysis, patients with Ramsay Hunt syndrome may also show glossopharyngeal, vagal, and hypoglossal nerve paralysis. We report a case of Ramsay Hunt syndrome with cranial polyneuropathy including cranial nerves VII, VIII, IX, and X. A 58-year-old rheumatic woman suffering from vertigo, right earache, and sore throat suffered right-side facial palsy, hoarseness, and swallowing difficulty on day 5. Admitted on day 6, she was treated with antiviral medication and steroids. Although vertigo, facial palsy, and hearing loss gradually improved, hoarseness required over three months to recover. Of the 33 patients with Ramsay Hunt syndrome we have seen, 9 (27%) had cranial polyneuropathy, including cranial nerves IX and X in 4 years. Of these, 9% involved total paralysis of nerves IX and X. Physical symptoms of those with polyneuropathy, especially vagal nerve palsy, tended to worsen, making it important to observe other cranial nerve signs, such as for IX and X carefully, in addition to VII and VIII.