Ramsay Hunt syndrome
Some patients develop facial paralysis without ear or mouth rash but associated with serologic or DNA evidence of VZV infection (zoster sine herpete, zoster sine zoster). Vesicles may develop only after the onset of facial weakness. It has been estimated that up to one-third of Bell’s palsy cases may be due to zoster sine herpete. Compared with Bell’s palsy, patients with Ramsay Hunt syndrome often have more severe paralysis at onset and are less likely to recover completely.
References
1. Bhupal HK. Ramsay Hunt syndrome presenting in primary care. Practitioner 2010; 254:33-53. 2. Gupta NM, Parikh MP, Panginikkod S, Gopalakrishnan V. Ramsay Hunt syndrome. QJM. 2016 Oct;109(10):693. 3. Serinken M, Eken C, Dal O, Kutlu M. Man With Facial Nerve Palsy and Ear Pain. Ramsay Hunt Syndrome. Ann Emerg Med. 2016 Jan;67(1):141, 148. 4. Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry 2001;71:149-154.