Pathology · single question

A 28-year-old male presents with unilateral facial crusting ulcers, limited facial muscle mobility, and tinnitus on the same side. The MOST likely diagnosis and nerve involved are:

Trigeminal neuralgia — trigeminal nerve (CN V)
Herpes labialis — trigeminal nerve (V1)
Ramsay Hunt syndrome — facial nerve (CN VII, geniculate ganglion VZV reactivation)
Bell's palsy — facial nerve (idiopathic)

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Correct answer: C. Ramsay Hunt syndrome — facial nerve (CN VII, geniculate ganglion VZV reactivation)

A. Trigeminal neuralgia causes sharp lancinating facial pain (not paralysis), and has no vesicular rash or auditory symptoms.
B. Herpes labialis (cold sores) involves VZV reactivation at the lips — it does not cause facial paralysis or tinnitus.
C. Correct. Ramsay Hunt syndrome (herpes zoster oticus) is caused by reactivation of varicella-zoster virus (VZV) in the geniculate ganglion of the facial nerve (CN VII). Classic triad: (1) painful vesicular rash on the ear/face, (2) ipsilateral facial muscle paralysis, (3) auditory symptoms (tinnitus, hearing loss, vertigo). Treatment is acyclovir + prednisone.
D. Bell's palsy is idiopathic facial nerve palsy WITHOUT the vesicular rash or auditory symptoms described here.

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