Ramsay Hunt Syndrome presenting as gait imbalance without facial paralysis: A case report

Ramsay Hunt Syndrome (RHS) is the reactivation of a Varicella Zoster Virus (VZV) infection affecting the geniculate ganglion and is also known as Herpes Zoster Oticus. It is clinically diagnosed with a classical triad of ipsilateral facial paralysis, otalgia, and vesicular rash near the ear and auditory canal. It is not always necessary to have the classical triad, and it can also present atypically without facial nerve palsy, with variants such as Zoster sine herpete. We are presenting a case of Ramsay hunt syndrome with no facial paralysis but with an atypical presentation of gait imbalance, who had a vesicular rash around the ear a week before presentation. He was started on steroids and valacyclovir after confirmation of diagnosis, with which his symptoms improved drastically. Maintaining a high index of clinical suspicion is crucial for diagnosing the syndrome, particularly when it presents without the classic triad of symptoms. The potential involvement of adjacent cranial nerves should also be considered, and a low threshold for suspicion facilitates early diagnosis and treatment, helping to prevent long-term, irreversible complications.