Teaching Neuro Images : Classic Ramsay Hunt syndrome and associated MRI findings.

An 85-year-old woman with dementia presented with left ear pain, vertigo, and mild left peripheral facial weakness of unclear chronicity. MRI demonstrated contrast enhancement of cranial nerves (CNs) VII and VIII consistent with Ramsay Hunt syndrome (RHS)1 (figure 1). She was treated with steroids and acyclovir. On evaluation 4 days later, she had developed the classic RHS triad of ear pain, ipsilateral facial paralysis, and vesicular rash, plus hyperacusis and persistent vertigo (figure 2).2