A Case of Ramsay Hunt Syndrome with Trochlear Nerve Palsy

Abstract

We report a case of a 70-year-old man with Ramsay Hunt syndrome and trochlear nerve palsy. He presented with vesicular lesions over the left auricle, left facial nerve palsy, left sensorineural hearing loss, and dizziness. His dizziness gradually developed despite steroid therapy. Twelve days after the first medical examination, he presented with vertical strabismus, and ophthalmological examination revealed trochlear nerve palsy. Based on the elevated titers of VZV antibodies in the cerebrospinal fluid, he was diagnosed as having polyneuropathy caused by zoster virus infection. Despite receiving high-dose acyclovir and steroid pulse therapy, he still suffered from dizziness and strabismus about half a year after the onset. Diagnosis of trochlear palsy requires visual examination of both eyes. Thus, not spontaneous gaze test using Frenzel glasses, but gaze nystagmus test is important to avoid misdiagnosing trochlear palsy.