- What Is It?
- Is It Contagious?
- vs. Bell's Palsy
- Is It Serious?
What is Ramsay Hunt syndrome? What causes it?
- Ramsay Hunt syndrome (also termed Hunt's Syndrome and herpes zoster oticus) is a herpes zoster virus infection of the geniculate ganglion of the facial nerve.
- It is caused by the reactivation of the herpes zoster virus that has previously caused chickenpox in the patient.
- Ramsay Hunt syndrome results in paralysis of the facial muscles on the same side of the face as the infection. So, the virus infects the facial nerve that normally controls the muscles on one side of the face.
- Ramsay Hunt syndrome is typically associated with a red rash and blisters (inflamed vesicles or tiny water-filled sacks in the skin) in or around the ear and eardrum and sometimes on the roof of the mouth or tongue.
What are the signs and symptoms of Ramsay Hunt syndrome?
The classic symptom that clinically distinguishes Ramsay Hunt syndrome is a red painful rash associated with blisters in the ears and facial paralysis (for example, eyelid or mouth) on one side of the face. Other symptoms are:
How do medical professionals diagnose Ramsay Hunt syndrome?
Diagnosis of the syndrome is most often made by observing the symptoms described above (red painful rash with ear and or mouth blisters and one-sided facial paralysis). Also, a PCR test (polymerase chain reaction) can be performed on the fluid from the blisters to demonstrate the viral genetic material, but this test is not done routinely.
Is Ramsay Hunt syndrome contagious?
The syndrome is not contagious; however, the herpes zoster virus that can be found in the blisters of Ramsay Hunt syndrome can be transmitted to other people and cause chickenpox in those who are unvaccinated against chickenpox and who have never had chickenpox. Individuals with Ramsay Hunt syndrome should avoid contact with newborns, pregnant women, immunodepression individuals, and people with no history of chickenpox, at least until all the blisters chance to scabs.
How does Ramsay Hunt syndrome compare with Bell's palsy?
Bell's palsy also is a result of injury to the facial nerve by a viral infection, but the suspected viral cause of Bell's palsy has not been identified. Ramsay Hunt syndrome is caused by the Varicella virus (Herpes zoster) that also causes chickenpox and shingles (a painful, blister-producing Herpes zoster reinfection that usually occurs on one side of the body). There is no red rash associated with Bell's palsy as there is with Ramsay Hunt syndrome. Additionally, Ramsay Hunt syndrome is commonly more painful than Bell's palsy. However, both can cause eyelid and mouth paralysis on one side of the face.
Dyssynergia cerebellaris myoclona is a rare degenerative disease of the nerves characterized by epilepsy, muscle spasms, and gradually increasing tremors. Like Bell's palsy, this disease complex mimics many symptoms of Ramsay Hunt syndrome. Some investigators term the disease complex Ramsay Hunt syndrome type 2.
What are treatments for Ramsay Hunt syndrome? Is it possible to prevent it?
Treatment consists of antiviral agents (for example, acyclovir, valacyclovir, or famciclovir) for about one week, steroids (prednisone), and pain medications. Best results are reported when treatment protocols are started within three days after symptoms appear.
Early treatment usually results in a better prognosis (see below). For children, the varicella vaccine can reduce the chance of getting chickenpox from which the syndrome comes (reactivation of the virus). However, once a person gets chickenpox, the person is susceptible to reactivation of the virus and thus can develop shingles and/or Ramsay Hunt syndrome.
Fortunately, there is another vaccine, Zostavax, which is helpful in preventing viral reactivation. Consequently, shingles and Ramsay Hunt syndrome can be either prevented or their symptoms reduced if the vaccine is administered. Usually, this vaccine is given to individuals that have had chickenpox as children and are now age 60 or older. The CDC (U.S. Centers for Disease Control and Prevention) suggests the vaccine be routinely given to individuals aged 60 or older, as about 90% of the population has been exposed to chickenpox, and about 20% of people had chickenpox are likely to get shingles without the vaccine.
What is the prognosis for patients with Ramsay Hunt syndrome? Is it serious?
- The prognosis for Ramsay Hunt syndrome is not as good as that for Bell's palsy.
- People with Ramsay Hunt syndrome may not recover completely, especially if treatment is not initiated within three days (72 hours) of symptom onset.
- Good clinical evidence suggests that treatment with steroids, pain medications, and antiviral agents (like acyclovir, valacyclovir, or famciclovir) improves recovery and lessens extreme facial discomfort. However, infrequent complications can develop, such as synkinesis (inappropriate nerve responses such as blinking or tear formation while trying to talk), eye damage, or rarely, viral spread to other nerves causing many other problems (for example, pain, confusion, weakness).
- Postherpetic neuralgia (pain due to nerve fiber damage by the virus) may also develop and persist for months to years.
Albrecht, Mary A. "Clinical manifestations of varicella-zoster virus infection: Herpes zoster." UptoDate.com. Jan. 21, 2019. <http://www.uptodate.com/contents/clinical-manifestations-of-varicella-zoster-virus-infection-herpes-zoster?source=search_result&search=Clinical+manifestations+of+varicella-zoster+virus+infection%3A+Herpes+zoster&selectedTitle=1~150>.
Top Ramsay Hunt Syndrome Related Articles
acyclovirAcyclovir is an antiviral drug prescribed to treat genital herpes, shingles, and chickenpox. The most common side effects are nausea, vomiting, diarrhea, and headache. Other reported side effects include agitation, confusion, rash, anemia, hypersensitivity reactions, seizures, agitation, confusion, anemia, hepatitis, and muscle pain. Consult your doctor if pregnant or breastfeeding.
Bell's Palsy (Facial Nerve Problems)Bell's palsy is one type of facial nerve paralysis. The seventh cranial nerve controls the muscles of the face, and although scientists do not know the exact cause of Bell's palsy, they think it may be due to nerve damage from an infection, for example, the flu, common cold viruses, and more serious infections like meningitis. The symptoms of Bell's palsy vary from person to person, but can include mild weakness to total paralysis, dry eye, dry mouth, eyelid drooping, drooling, mouth drooping, dry mouth, changes in taste, and excessive tearing in one eye.
Muscle SpasmsMuscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
PCR (Polymerase Chain Reaction)PCR (polymerase chain reaction) is a method to analyze a short sequence DNA or RNA. PCR (polymerase chain reaction) has many uses, for example, it is used to diagnose genetic diseases, establish paternity or biological relationships, DNA fingerprinting, DNA forensics, and finding bacteria and viruses.
prednisolone (Orapred, Pediapred)Prednisolone (Flo-Pred, Pediapred, Orapred, Orapred ODT) is a corticosteroid prescribed to achieve prompt suppression of inflammation due to inflammatory and allergic conditions (for example, rheumatoid arthritis, lupus, gout, ulcerative colitis, Crohn's disease, hay fever, types of dermatitis, and many others. Side effects, drug interactions, dosage, storage, and pregnancy safety information should be reviewed prior to taking this medication.
Prednisone is a drug that belongs to the corticosteroid drug class, and is an anti-inflammatory and immune system suppressant. It's used to treat a variety of diseases and conditions, for example: inflammatory bowel disease (Crohn's disease and ulcerative colitis), lupus, asthma, cancers, and several types of arthritis.
Common side effects are weight gain, headache, fluid retention, and muscle weakness. Other effects and adverse events include glaucoma, cataracts, obesity, facial hair growth, moon face, and growth retardation in children. This medicine also causes psychiatric problems, for example: depression, insomnia, mood swings, personality changes, and psychotic behavior. Serious side effects include reactions to diabetes drugs, infections, and necrosis of the hips and joints.
Skin RashThe word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Shingles (Herpes Zoster)Shingles, or herpes zoster, is a painful rash caused by the varicella zoster virus. Other shingles symptoms include headache, fever, nausea, and body aches. Treatment focuses on pain management and shortening the duration of the illness with antiviral medications.
What Is the Main Cause of Shingles Rash? Signs, Symptoms, VaccineShingles occurs when the varicella-zoster virus, the same virus that causes chickenpox, re-emerges due to a weakened immune system. Tingling may occur before herpes zoster blisters appear, usually on the side of the body. The shingles vaccine can boost the immune system to lower the risk of shingles outbreaks.
Valacyclovir (Valtrex) is an antiviral drug prescribed for the treatment of herpes viruses such as shingles, genital herpes, and cold sores. Side effects include abdominal pain, diarrhea, dizziness, nausea, vomiting, and headache. Drug interactions, warnings and precautions, and pregnancy and breastfeeding safety information should be reviewed before taking any medication.
What Triggers Ramsay Hunt Syndrome?Ramsay Hunt syndrome is caused by the reactivation of varicella zoster virus in the facial nerve. Conditions that may compromise or weaken the immune system may trigger RHS.