Ramsay Hunt syndrome is caused by the virus that causes chickenpox. After chickenpox clears, the virus lies dormant in nerves. Years later, it may reactivate. If the virus reactivates and affects the facial nerve, then it results in Ramsay Hunt syndrome. Complications include permanent facial muscle weakness and deafness. Symptoms include Ear pain, Hearing loss, tinnitus, Difficulty closing one eye, A sensation of spinning or moving (vertigo), dry eyes.

1. CASE ON RAMSAY HUNT
SYNDROME
PRESENTED BY:-
B. Sunil kumar Nayak
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2. INTRODUCTION
• Ramsay Hunt syndrome is caused by the virus that causes
chickenpox. After chickenpox clears, the virus lies dormant in
nerves. Years later, it may reactivate. If the virus reactivates and
affects the facial nerve, then it results in Ramsay Hunt syndrome.
• Complications include permanent facial muscle weakness and
deafness.
• Symptoms include Ear pain, Hearing loss, tinnitus, Difficulty
closing one eye, A sensation of spinning or moving (vertigo), dry
eyes.
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3. The two main signs of Ramsay
Hunt syndrome are:
• A painful red rash with fluid-
filled blisters on, in and around
one ear
• Facial weakness or paralysis on
the same side as the affected ear
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4. PROBLEMS LIST
• Patient Demographics
Age: 75 years
Sex : Male
Unit: Male Medical Ward
No. of days hospitalised:- 12 days
• C/O Fever, Generalized weakness, Vomitings since 3 days
• MEDICAL HISTORY: Eye operation 1 month back
• MEDICATION HISTORY: Nothing significant
• SOCIAL HISTORY: occasionally toddy consumption
• FAMILY HISTORY: Nothing significant
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5. GENERAL PHYSICAL EXAMINATION
• BP- 110/70 mm Hg
• PR- 72 bpm
LABORATORY INVESTIGATIONS:-
HAEMATOLOGY
• RBC- 4.4 mill.cells/cumm
• Hb-13.9 (13-17 g/dl)
• PLATELETS- 1.72 (1.5-4 lakhs cells/mm3)
• WBC- 7200 cells/mm3( 4000-11000 cells/mm3)
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6. • N- 74 % (40-80 %)
• L- 20 % (20-40 %)
• M- 04 % (2-10 %)
• E- 02 % (1-6 %)
• B- 00 % (0-1 %)
BIOCHEMISTRY
• Blood urea:- 21mg/dl (15-45 mg/dl)
• Serum creatinine:-1.0 mg/dl (0.7-1.5 mg/dl)
• Serum electrolytes:-
Na-135 mmol/lit(135-145 mmol/lit)
K- 3.9 mmol/lit (3.5-5 mmol/lit)
Cl-96 mmol/lit(95-110 mmol/lit)
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7. • CUE :- Normal
• LFT’S :- Normal
• MP :- Negative
• Widal :- Negative
• USG Abdomen
Impression :-
No sonographic abnormality was detected.
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8. SUBJECTIVE EVIDENCE
• Fever, Generalized weakness,
Vomitings since 3 days
• Discharge from the left ear
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9. ASSESSMENT
• From subjective evidence , the patient was finally diagnosed with
RAMSAY HUNT SYNDROME.
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10. DAY WISE ASSESSMENT
Day 2:-
• BP – 110/70 mm of Hg
• PR – 80 bpm
Day 3:-
c/o discharge from left ear
• BP- 110/70 mm of Hg
• PR- 72bpm
Day 4:-
• BP- 110/70 mm of Hg
• PR- 70 bpm
Day 5:-
• BP- 110/70 mm of Hg
• PR- 90bpm
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11. • Day-6:-
• BP :- 100/60 mmHg
• PR :- 80 bpm
• Day-7 :-
• BP:- 120/80 mm Hg
• PR :- 70 BPM
• Day-8 :-
• No fresh complaints
• BP :- 130/80 mm Hg
• PR :- 72 bpm
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12. OPTIMAL THERAPY
Diagnosis of Ramsay Hunt syndrome is based on medical
history, a physical exam and the disorder's distinctive signs and
symptoms.
Antiviral drugs
Acyclovir, Famciclovir, Valacyclovir
Corticosteroids
Prednisolone- Reduces the inflammation
Anti-histamines
Dimenhydrinate - To relieve vertigo
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13. CURRENT TREATMENT
S.NO CURRENT DRUGS DOSE ROA FREQ DA DS
1 RL, NS 2 pint IV 50ml/hr 1 5
2 Inj.Ceftriaxone 1 g IV BID 1 5
4 Inj.Pantoprazole 40 mg IV OID 1 5
5 Inj.Ondansetron 4 mg IV BID 1 5
6 Tab.Paracetamol 650mg PO TID 1 9/sos
7 Inj. MethylPrednisolone 1 g in 100ml
NS
IV OD 1 2
8 Inj.Metronidazole 500mg IV TID 1 2
9 Eye vista drops 2 drops Opthlmic BID 1 9
10 Tab.Acyclovir 600mg PO TID 3 9
11 Fluticasone Ointment -- LA QID 3 9
12 Tab.Prednisolone 30mg PO BID 3 9
13 Tab.Levocetrizine 5mg PO OID 2 9
14 Tab.Cinnarizine+
Dimenhydrinate
20+40 mg PO TID 1 5
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14. DISCHARGE MEDICATION
1.Tab.Prednisolone
30mg-po-bid
2. Tab.Paracetamol
650mg-po-sos
3. Tab.Levocetrizine
5mg-po-oid
4. Fluticasone ointment
LA-bid
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15. PATIENT EDUCATION
About disease
• Ramsay Hunt syndrome is caused by the virus that causes
chickenpox. Symptoms include Ear pain, Hearing loss, tinnitus,
Difficulty in closing one eye, A sensation of spinning or moving
(vertigo), dry eyes.
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16. About drugs
• Tab.Prednisolone should be taken twice daily for 5 days.
• Tab.Paracetamol should be taken when ever there is elevation in
temperature.
• Tab.levocetrizine should be taken once daily for at night for 5 days.
• Fluticasone ointment should be locally applied on to the rashes
twice daily.
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17. Lifestyle remedies
• Keep areas affected by the rash clean.
• Apply cool, wet compresses to the rash to decrease the pain.
• Use moisturizing eye drops throughout the day if the eye becomes
dry.
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18. Thank you
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19. • Donati D, De Santi L, Ginanneschi F, Cerase A, Annunziata P.
Successful response of non-recovering Ramsay Hunt syndrome to
intravenous high dose methylprednisolone. J Neurol Sci. 2012 Jul
15. 318 (1-2):160-2.
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