662 Bilateral Vocal Cord Paralysis and Cranial Polyneuropathy: A Rare Presentation of Ramsay Hunt Syndrome. (19th August 2022)

• Record Type: Journal Article
• Authors: Dhar, P; Brimioulle, M; Nair, D
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 6
• Publication Date: 2022-08-19
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac269.145
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Case Presentation: A 61-year-old gentleman with chronic lymphocytic leukaemia presented with right sided disseminated vesicles, otalgia, hearing loss, facial weakness, dysphagia, hoarseness, breathlessness, and stridor. In the preceding 48 hours he had two A&E presentations with only right otalgia, facial weakness, throat tightness and mild breathlessness. Cranial nerve (CN) examination demonstrated right cheek numbness and absent jaw jerk reflex (CNV), right grade 6 lower motor neuron facial palsy (CNVII), impaired hearing (CNVIII), dysphonia, dysphagia, and asymmetric palate elevation (CNIX and X). Fibreoptic nasendoscopy (FNE) demonstrated bilateral vocal cord palsy. He was diagnosed with Ramsay Hunt syndrome (RHS) and disseminated herpes zoster (HZ) requiring intubation and ventilation, intravenous steroids, aciclovir, antibiotics and a prolonged intensive care admission. He was discharged after three months. Eight months later, he has a long-term tracheostomy, gastrostomy, and live-in carer. Discussion: This is the only case found in the literature of RHS and associated bilateral vocal cord palsy with cranial polyneuropathy requiring a long-term tracheostomy. It highlights the significant morbidity attached with RHS complications, particularly in a patient with underlying malignancy. Awareness of these rare and potentially life-threatening complications should be raised to avoid investigation and treatment delay. HZ should be considered in patients with CNVII palsy and otalgia, with or without vesicles. Clinicians should perform full CN examination including FNE to assess for cranial polyneuropathy. RHS can present without vesicles, making it indistinguishable from Bell's Palsy. Therefore, we should consider treating Bell's Palsy with aciclovir. Furthermore, multidisciplinary management of disseminated HZ is essential.