Journal of NeuroVirology

, Volume 24, Issue 6, pp 776–779 | Cite as

Ramsay Hunt syndrome associated with solitary nucleus, spinal trigeminal nucleus and tract, and vestibular nucleus involvement on sequential magnetic resonance imaging

  • Akira InagakiEmail author
  • Takanari Toyoda
  • Masahiro Mutou
  • Shingo Murakami
Case Report


Ramsay Hunt syndrome (RHS) is an acute peripheral facial nerve paralysis typically accompanied by erythematous vesicular lesions of the auricular skin. The etiology is considered to be geniculate ganglionitis due to reactivation of varicella-zoster virus (VZV). Encephalitis is a rare but serious complication of VZV reactivation. Clarifying the regional and temporal evolution of the lesions on magnetic resonance imaging (MRI) would help with understanding the pathology of the lesion, but this information is lacking in encephalitis with RHS. Therefore, here, we reviewed sequential MR images in three RHS cases complicated by brainstem lesions. All the regions of the lesions represent specific neuronal structures—the ipsilateral solitary nucleus (SN) and spinal trigeminal nucleus and tract (STNT) in case 1; bilateral SN, ipsilateral STNT, and vestibular nucleus in case 2; ipsilateral SN and vestibular nucleus in case 3—and this seems to account for the persistent robust symptoms. Case 1 initially showed no abnormalities on MRI and cases 2 and 3 showed weak signals on the first MRI which subsequently plateaued. These observations suggest the timeframe within which it becomes possible to detect regional and temporal evolution, namely, that the distribution of the affected regions expands between weeks 2 and 5 after onset of facial paralysis. These observations and the findings of a literature review indicate that the SN, STNT, and vestibular nucleus are relatively prone to developing encephalitis after RHS.


Ramsay Hunt syndrome Varicella-zoster virus Brainstem encephalitis Magnetic resonance imaging 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

All patients provided written informed consent, and the institutional review board at Nagoya City University approved this retrospective study.


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Copyright information

© Journal of NeuroVirology, Inc. 2018

Authors and Affiliations

  1. 1.Department of Otolaryngology, Head and Neck SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
  2. 2.Department of NeurologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
  3. 3.Department of RadiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan

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