Diplopia from skew deviation in Ramsey-Hunt syndrome. A case report.
OBJECTIVE
Presentation of a 34-year-old pregnant woman with skew deviation due to peripheral vestibular dysfunction caused by herpes zoster oticus.


METHODS
A multidisciplinary approach (neuroophthalmology, otorhinolaryngology, neuroradiology) revealed the diagnosis of Ramsey-Hunt syndrome.


METHODS
The patient presented with painful herpes zoster vesicles of the left ear, associated with a rotatory vertigo and hearing loss. Otorhinolaryngological examination showed a unilateral peripheral vestibular loss, a nystagmus towards the unaffected right side, no facial nerve dysfunction and a left perception hearing loss, mainly in the frequencies between 2-6 KHz. The patient was treated with Zovirax IV. Neuroradiological examination (MRI without contrast) revealed no abnormalities. Vertical diplopia from skew deviation was noted +/- 10 days after onset of herpes zoster oticus. Neuroophthalmological and orthoptic examination showed a comitant right hypertropia of 6 diopters and a spontaneous nystagmus to the right.


CONCLUSIONS
Skew deviation can be caused by a sudden unilateral cochleo-vestibular loss as described by A.B. Safran. (4,6,7,8).
Verhulst
E
E
Department of Ophthalmology, UZ Leuven Kapucijnenvoer 33, 3000 Leuven Belgium.
Van Lammeren
M
M
Dralands
L
L
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D004172:Diplopia / Q000209:etiology*; D005260:Female; D016697:Herpes Zoster Oticus / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy
D000212:Acyclovir