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A Case of Ramsay Hunt Syndrome That Began with Vestibular Symptoms: A Great Mimicker

Published:October 31, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.09.049
      An 83-year-old woman presented to the emergency department with a 2-day history of persistent vertigo. She also complained of neck pain, lightheadedness, nausea, and vomiting. She had hypertension and had undergone balloon angioplasty for stable angina pectoris 1 month prior. Her medications included enalapril, bisoprolol, aspirin, prasugrel, rosuvastatin, and torsemide. Physical examination revealed that she was afebrile, alert, and oriented. Her gait was wobbly and deviated toward the right. Direction-fixed horizontal nystagmus beating toward the left was noted. No specific findings were detected on laboratory tests, electrocardiography, and head noncontrast computed tomography. The patient was admitted for overnight observation with suspected peripheral vertigo. On day 2, she complained of hearing loss. A repeated finger-rubbing test revealed right-sided hearing loss; however, ear inspection and otoscopic examination showed normal findings. Brain magnetic resonance imaging (MRI) and magnetic resonance angiography did not demonstrate vertebral artery dissection or stroke. On day 3, pain and erythematous vesicles in the auditory canal and auricle in her right ear and ipsilateral facial drooping occurred. She was diagnosed with Ramsay Hunt syndrome (RHS) and treated with valacyclovir and prednisolone.
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