||If herpes zoster involves the sensory portion of the geniculate ganglion of the facial nerve, it may produce a lower motor neuron facial paralysis. In some cases, additional involvement of the auditory and/or vestibular portions of the VIII cranial nerve will cause a concomitant sensorineural hearing loss or vertigo.
The Ramsay Hunt syndrome is currently considered to be a cranial polyneuropathy. After the facial nerve, the other cranial nerves most frequently involved in order of decreasing frequency are the eighth, ninth, fifth, tenth, and sixth nerves.
Herpes zoster should be distinguished from herpes simplex. Herpes simplex most commonly causes an acute viral vesicular eruption of the skin and mucous membranes, caused by herpesvirus hominis. The lesions of herpes simplex originate as erythematous papules which develop into a small localized group of vesicles.
The diagnosis of herpes simplex can be confirmed by viral culture, since material aspirated from an early vesicle will ,row readily in tissue culture, usually within one to three days. Herpes simplex, unlike herpes zoster, is not associated with cranial nerve involvement, and is consequently not confined to specific dermatomes in the head and neck area.
This patient developed a temporary and incomplete left facial nerve paralysis as the result of a herpes zoster infection.