Ramsay Hunt Syndrome Revealed by a Severe Vertigo

Ramsay hunt syndrome (RHS) also called herpes zoster oticus, is a clinical presentation of varicella-zoster virus (VZV) reactivation that has remained dormant within geniculate ganglion, after primary varicella infection. Sicard syndrome is the most complete presentation of RHS with 7th and 8th cranial nerve involvement. Diagnosis of RHS is clinical, but further investigations may be necessary for atypical symptoms. We report a 43-year-old woman, referred from the emergency department for a disabling acute vertigo, ongoing for the last 24 hours. The history revealed right otalgia, hearing loss and facial asymmetry that appeared 3 days ealier. Physical examination found a right-sided peripheral facial palsy, right-sided peripheral vestibular syndrome and painful vesicular lesions around the ipsilateral ear in Ramsay Hunt area. Tonal audiometry noted severe right-sided sensorineural hearing loss, and endocochlear impairment on auditory evoked potentials. Temporal bone MRI showed contrast enhancement of the right acoustic facial bundle, the internal auditory canal, and slight contrast of the ipsilateral cochlea and vestibule. Diagnosis of complete RHS also known as Sicard syndrome was confirmed. Treatment, including combined antiviral agents and intravenous corticosteroids was initiated with good outcome. However, mild sensorineural hearing loss was noted after an 8-month follow-up. RHS is a relatively rare condition in our practice. Early and appropriate management could prevent potentially serious complications and limit functional sequelae.