title: An unexpected case of Ramsay Hunt syndrome: case report and literature review.
abstract: BACKGROUND
  Ramsay Hunt Syndrome (RHS) is a rare, severe complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion. Facial paralysis is one of the features and without treatment, it fully recovers in as little as 20% of cases; this is much improved if treatment is started within 72 hours. This case is noteworthy in that coexistence of facial palsy with cervical dermatome involvement by VZV is not typical of RHS. Yet, it has been reported before.
  
  
  METHODS
  A 54 year old Caucasian woman presented with right ear discomfort, difficulty hearing and a vesicular rash along the pinnae, 8 days after the eruption of a similar rash in the right C2-C4 dermatomes. 2 days later, she awoke with a partial right-sided facial paralysis, which improved with treatment (valacyclovir and prednisone).
  
  
  CONCLUSIONS
  This case is most pertinent to Family Practice, Otolaryngology and Neurology. It highlights the possible co-existence of RHS with cervical VZV reactivation and encourages physicians to monitor for this complication even before geniculate ganglion reactivation occurs. RHS is a rare disease that can present with vague symptoms. A high index of suspicion and close follow up are essential. Early intervention with antivirals and corticosteroids has shown significantly improved outcomes in these patients.
authors.affiliation: 3474 St, Famille, Apt 2, Montreal, Quebec H2X 2K8, Canada. mali.worme@gmail.com.
authors.forename: Mali
authors.initials: M
authors.lastname: Worme
authors.forename: Reena
authors.initials: R
authors.lastname: Chada
authors.forename: Lilia
authors.initials: L
authors.lastname: Lavallee
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D016697:Herpes Zoster Oticus / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000187:drug effects / Q000472:pathogenicity / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D016896:Treatment Outcome; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014775:Virus Activation
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D014633:Valine; D000077483:Valacyclovir; D011241:Prednisone; D000212:Acyclovir