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Images in Neurology |

Sudden-Onset Right Facial Drooping in a Patient With Ramsay Hunt Syndrome

Yinghao Lim, MBBS; Mei-Ling Sharon Tai, MD; Li Ling Tan, MBBS; Vijay K. Sharma, MRCP
Arch Neurol. 2011;68(9):1198-1199. doi:10.1001/archneurol.2011.197.
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A 50-year-old woman arrived at our hospital with a daylong history of right facial drooping of sudden onset. She also experienced reduced sensations on the right side of her face. She reported that she did not experience any weakness of her extremities or disturbance of her senses of hearing or taste. She did not appear to have any significant medical illness.

On examination, she was conscious, oriented to her surroundings, and afebrile; her blood pressure was 135/85 mm Hg. A lower motor neuron pattern of severe weakness of the right facial nerve was evident (Figure 1A). Examination of her oral cavity revealed a vesicular rash that clearly was restricted to the right side of the soft palate (Figure 1B). No rashes were noted in the external auditory canal. Also, mild hypoaesthesia was observed in the maxillary distribution of the right trigeminal nerve. The results of the other parts of the neurological examination, including those involving hearing and taste, were unremarkable. The patient received a 10-day supply of prednisolone and acyclovir. At the 3-week follow-up visit, she had experienced a nearly complete recovery.

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Figure 1. Lower motor neuron pattern right facial weakness (A) and vesicular rashes on the right soft palate (B).

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Figure 2. Blink reflex findings. Stimulating the right supraorbital area (A) resulted in absent ipsilateral R1 and R2 potentials but a normal contralateral R2. However, stimulating the left area (B) resulted in normal ipsilateral R1 and R2 but absent contralateral R2 potentials. The findings suggest a complete isolated right facial neuropathic condition.

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