Pathology · single question
A patient presents with a vesicular rash on the RIGHT side of the face that does NOT cross the midline, along with ipsilateral facial muscle weakness. Which syndrome is MOST likely?
Show answer and explanation
Correct answer: B. Ramsay Hunt syndrome
Ramsay Hunt syndrome = VZV reactivation in the geniculate ganglion of CN VII, causing unilateral vesicles + ipsilateral facial nerve palsy.
- A. Guillain-Barré is bilateral ascending weakness following infection/vaccination — bilateral, not associated with unilateral vesicles.
- B. CORRECT. Ramsay Hunt syndrome = VZV reactivation in CN VII geniculate ganglion → unilateral facial vesicles (not crossing midline) + ipsilateral facial nerve palsy. Classic triad: otalgia + facial palsy + auricular/facial vesicles.
- C. Bell's palsy causes ipsilateral facial paralysis but does NOT present with vesicular rash. Ramsay Hunt is distinguished from Bell's palsy by the presence of vesicles.
- D. Trigeminal neuralgia causes severe lancinating unilateral facial pain but NO vesicular rash or facial muscle weakness.