title: Diplopia from skew deviation in Ramsey-Hunt syndrome. A case report.
abstract: 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).
authors.affiliation: Department of Ophthalmology, UZ Leuven Kapucijnenvoer 33, 3000 Leuven Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Verhulst
authors.forename: M
authors.initials: M
authors.lastname: Van Lammeren
authors.forename: L
authors.initials: L
authors.lastname: Dralands
mesh_terms: 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
chemical_list: D000212:Acyclovir