Pathology · patient case with 2 questions
Case: facial palsy with an ipsilateral rash
Scenario: The case describes unilateral facial paralysis accompanied by a vesicular rash on the same side.
Question 1
Which virus is involved?
Show answer and explanation
Correct answer: C. Varicella zoster virus (HHV-3)
- A. CMV causes disease mainly in the immunocompromised and in congenital infection; it does not produce this picture.
- B. HSV-1 is implicated in idiopathic Bell palsy, but Bell palsy has no rash. The rash is what makes this zoster.
- C. Correct. Facial palsy with a vesicular rash in the ear or on the same side of the face is Ramsay Hunt syndrome — reactivation of varicella zoster in the geniculate ganglion.
- D. EBV causes infectious mononucleosis, hairy leukoplakia and nasopharyngeal carcinoma — not a dermatomal vesicular rash with palsy.
Note: Ramsay Hunt carries a worse prognosis for recovery than Bell palsy, so prompt antiviral plus corticosteroid therapy matters.
Question 2
A patient is drooling and cannot close the eye on the affected side. All of the following may occur EXCEPT:
Show answer and explanation
Correct answer: A. Glaucoma
- A. Correct — this is the exception. Glaucoma results from raised intraocular pressure and has nothing to do with facial nerve function. The eye complication here is surface drying, not pressure.
- B. This does occur, and it is the key distinction: a lower motor neuron lesion paralyses the forehead too. In a stroke the forehead is spared.
- C. This does occur. Without a blink reflex the cornea dries and ulcerates, which is why these patients need lubricating drops, a patch, and often taping of the lid at night.
- D. This does occur. Loss of buccinator and orbicularis oris tone lets the commissure droop and food collect in the vestibule.