Abstract Ramsay Hunt syndrome (RHS) is a rare manifestation of varicella zoster virus reactivation, typically characterized by the triad of ipsilateral facial paralysis, otalgia, and vesicular rash. Atypical presentations with polycranial nerve involvement are uncommon and often difficult to diagnose and manage. We describe the case of a 22-year-old male who presented with acute left-sided facial paralysis, otalgia, dysphagia, dysphonia, vesicular eruptions, and vestibular symptoms, in whom simultaneous involvement of cranial nerves VI, VII, VIII, IX, X, and XI was documented. The diagnostic workup included audiometry, fiberoptic endoscopic evaluation of swallowing, brain magnetic resonance imaging, cerebrospinal fluid analysis, and electromyography. Treatment consisted of intravenous antiviral therapy, neuroprotective and symptomatic medications, rehabilitation with speech and swallowing therapy, and botulinum toxin injections, while surgical options were considered for residual deficits. Over a 17-month follow-up period, the patient experienced gradual neurological improvement, with complete recovery of cranial nerves X and XI, partial recovery of facial nerve function to House–Brackmann Grade III, and persistence of moderate synkinesis and high-frequency sensorineural hearing loss. This case highlights an unusual and extensive presentation of RHS, underlining the importance of early recognition, comprehensive neurological assessment, and an individualized multidisciplinary approach to optimize outcomes.
Caragli et al. (Thu,) studied this question.