Ramsay Hunt syndrome

Case history

A 67-year-old woman presents with right-sided severe ear pain, room-spinning dizziness, and a painful rash on her right ear. She says that the ear pain and dizziness started the night before, and in the morning on awakening water spilled out of the right corner of her mouth when brushing her teeth. She notes that she could not move the right side of her face when looking in the mirror. She presents to the emergency department because she thinks she is having a stroke. She reports no prior history of facial paralysis. She is otherwise healthy. On physical exam, she has a complete right-sided facial paralysis. There are a few vesicular lesions along her concha and helical rim, and her pinna is diffusely tender to the touch. Otoscopy is unremarkable except for a few vesicular lesions along the floor of the cartilaginous ear canal.