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Ramsay Hunt Syndrome
Philip R. Chapman, MD; H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Ramsay Hunt syndrome (RHS)
          • Synonyms

            • Herpes zoster oticus
          • Definitions

            • Syndrome of facial palsy, ear pain, vestibulocochlear symptoms, and rash of external ear produced by reactivation of varicella-zoster virus in geniculate ganglion of CNVII

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Choi JW et al: Mastoid effusion on temporal bone MRI in patients with Bell's palsy and Ramsay Hunt syndrome. Sci Rep. 11(1):3127, 2021
                                    2. Takahashi M et al: Vestibular and cochlear nerve enhancement on MRI and its correlation with vestibulocochlear functional deficits in patients with Ramsay Hunt syndrome. Auris Nasus Larynx. 48(3):347-52, 2021
                                    3. Kim SH et al: Comparative prognosis in patients with Ramsay-Hunt syndrome and Bell's palsy. Eur Arch Otorhinolaryngol. 276(4):1011-6, 2019
                                    4. Zimmermann J et al: Differential diagnosis of peripheral facial nerve palsy: a retrospective clinical, MRI and CSF-based study. J Neurol. 266(10):2488-94, 2019
                                    5. Kim CH et al: Characteristics of hearing loss in patients with herpes zoster oticus. Medicine (Baltimore). 95(46):e5438, 2016
                                    6. Monsanto RD et al: Treatment and prognosis of facial palsy on Ramsay Hunt syndrome: results based on a review of the literature. Int Arch Otorhinolaryngol. 20(4):394-400, 2016
                                    7. Shin DH et al: Clinical manifestations in patients with herpes zoster oticus. Eur Arch Otorhinolaryngol. 273(7):1739-43, 2016
                                    8. Chung MS et al: The clinical significance of findings obtained on 3D-FLAIR MR imaging in patients with Ramsay-Hunt syndrome. Laryngoscope. 125(4):950-5, 2015
                                    9. Iwasaki H et al: Vestibular and cochlear neuritis in patients with Ramsay Hunt syndrome: a Gd-enhanced MRI study. Acta Otolaryngol. 133(4):373-7, 2013
                                    10. Antón E: Less common MRI findings in ramsay hunt syndrome type I. Ear Nose Throat J. 86(11):649; author reply 649-50, 2007
                                    11. Kim IS et al: Correlation between MRI and operative findings in Bell's palsy and Ramsay Hunt syndrome. Yonsei Med J. 48(6):963-8, 2007
                                    12. Nogueira RG et al: Ramsay Hunt syndrome associated with spinal trigeminal nucleus and tract involvement on MRI. Neurology. 61(9):1306-7, 2003
                                    13. Honda N et al: Swelling of the intratemporal facial nerve in Ramsay Hunt syndrome. Acta Otolaryngol. 122(3):348-52, 2002
                                    14. Lavi ES et al: Enhancement of the eighth cranial nerve and labyrinth on MR imaging in sudden sensorineural hearing loss associated with human herpesvirus 1 infection: case report. AJNR Am J Neuroradiol. 22(7):1380-2, 2001
                                    15. Sartoretti-Schefer S et al: Ramsay Hunt syndrome associated with brain stem enhancement. AJNR Am J Neuroradiol. 20(2):278-80, 1999
                                    16. Steiner I et al: Bell's palsy and herpes viruses: to (acyclo)vir or not to (acyclo)vir? J Neurol Sci. 170(1):19-23, 1999
                                    17. Jonsson L et al: Gd-DPTA enhanced MRI in Bell's palsy and herpes zoster oticus: an overview and implications for future studies. Acta Otolaryngol. 115(5):577-84, 1995
                                    18. Kuo MJ et al: Early diagnosis and treatment of Ramsay Hunt syndrome: the role of magnetic resonance imaging. J Laryngol Otol. 109(8):777-80, 1995
                                    19. Sartoretti-Schefer S et al: Idiopathic, herpetic, and HIV-associated facial nerve palsies: abnormal MR enhancement patterns. AJNR Am J Neuroradiol. 15(3):479-85, 1994
                                    20. Yanagida M et al: Enhanced MRI in patients with Ramsay-Hunt's syndrome. Acta Otolaryngol Suppl. 500:58-61, 1993
                                    21. Korzec K et al: Gadolinium-enhanced magnetic resonance imaging of the facial nerve in herpes zoster oticus and Bell's palsy: clinical implications. Am J Otol. 12(3):163-8, 1991
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Ramsay Hunt syndrome (RHS)
                                            • Synonyms

                                              • Herpes zoster oticus
                                            • Definitions

                                              • Syndrome of facial palsy, ear pain, vestibulocochlear symptoms, and rash of external ear produced by reactivation of varicella-zoster virus in geniculate ganglion of CNVII

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Gross Pathologic & Surgical Features

                                                          • Microscopic Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Choi JW et al: Mastoid effusion on temporal bone MRI in patients with Bell's palsy and Ramsay Hunt syndrome. Sci Rep. 11(1):3127, 2021
                                                                      2. Takahashi M et al: Vestibular and cochlear nerve enhancement on MRI and its correlation with vestibulocochlear functional deficits in patients with Ramsay Hunt syndrome. Auris Nasus Larynx. 48(3):347-52, 2021
                                                                      3. Kim SH et al: Comparative prognosis in patients with Ramsay-Hunt syndrome and Bell's palsy. Eur Arch Otorhinolaryngol. 276(4):1011-6, 2019
                                                                      4. Zimmermann J et al: Differential diagnosis of peripheral facial nerve palsy: a retrospective clinical, MRI and CSF-based study. J Neurol. 266(10):2488-94, 2019
                                                                      5. Kim CH et al: Characteristics of hearing loss in patients with herpes zoster oticus. Medicine (Baltimore). 95(46):e5438, 2016
                                                                      6. Monsanto RD et al: Treatment and prognosis of facial palsy on Ramsay Hunt syndrome: results based on a review of the literature. Int Arch Otorhinolaryngol. 20(4):394-400, 2016
                                                                      7. Shin DH et al: Clinical manifestations in patients with herpes zoster oticus. Eur Arch Otorhinolaryngol. 273(7):1739-43, 2016
                                                                      8. Chung MS et al: The clinical significance of findings obtained on 3D-FLAIR MR imaging in patients with Ramsay-Hunt syndrome. Laryngoscope. 125(4):950-5, 2015
                                                                      9. Iwasaki H et al: Vestibular and cochlear neuritis in patients with Ramsay Hunt syndrome: a Gd-enhanced MRI study. Acta Otolaryngol. 133(4):373-7, 2013
                                                                      10. Antón E: Less common MRI findings in ramsay hunt syndrome type I. Ear Nose Throat J. 86(11):649; author reply 649-50, 2007
                                                                      11. Kim IS et al: Correlation between MRI and operative findings in Bell's palsy and Ramsay Hunt syndrome. Yonsei Med J. 48(6):963-8, 2007
                                                                      12. Nogueira RG et al: Ramsay Hunt syndrome associated with spinal trigeminal nucleus and tract involvement on MRI. Neurology. 61(9):1306-7, 2003
                                                                      13. Honda N et al: Swelling of the intratemporal facial nerve in Ramsay Hunt syndrome. Acta Otolaryngol. 122(3):348-52, 2002
                                                                      14. Lavi ES et al: Enhancement of the eighth cranial nerve and labyrinth on MR imaging in sudden sensorineural hearing loss associated with human herpesvirus 1 infection: case report. AJNR Am J Neuroradiol. 22(7):1380-2, 2001
                                                                      15. Sartoretti-Schefer S et al: Ramsay Hunt syndrome associated with brain stem enhancement. AJNR Am J Neuroradiol. 20(2):278-80, 1999
                                                                      16. Steiner I et al: Bell's palsy and herpes viruses: to (acyclo)vir or not to (acyclo)vir? J Neurol Sci. 170(1):19-23, 1999
                                                                      17. Jonsson L et al: Gd-DPTA enhanced MRI in Bell's palsy and herpes zoster oticus: an overview and implications for future studies. Acta Otolaryngol. 115(5):577-84, 1995
                                                                      18. Kuo MJ et al: Early diagnosis and treatment of Ramsay Hunt syndrome: the role of magnetic resonance imaging. J Laryngol Otol. 109(8):777-80, 1995
                                                                      19. Sartoretti-Schefer S et al: Idiopathic, herpetic, and HIV-associated facial nerve palsies: abnormal MR enhancement patterns. AJNR Am J Neuroradiol. 15(3):479-85, 1994
                                                                      20. Yanagida M et al: Enhanced MRI in patients with Ramsay-Hunt's syndrome. Acta Otolaryngol Suppl. 500:58-61, 1993
                                                                      21. Korzec K et al: Gadolinium-enhanced magnetic resonance imaging of the facial nerve in herpes zoster oticus and Bell's palsy: clinical implications. Am J Otol. 12(3):163-8, 1991