In Ramsay Hunt syndrome, where does varicella-zoster virus (VZV) remain latent before reactivating to cause the syndrome?

Correct answer: A. Geniculate ganglion of the facial nerve (CN VII)

• A. CORRECT. Ramsay Hunt syndrome results from reactivation of VZV from the GENICULATE GANGLION of the facial nerve (CN VII). The geniculate ganglion is where VZV lies dormant within the facial nerve. Reactivation causes the classic triad: auricular herpes zoster (ear lesions), ipsilateral facial nerve palsy, and taste disturbance from chorda tympani involvement.
• B. The trigeminal (Gasserian) ganglion is where VZV lies latent for herpes zoster involving CN V branches (V1 = ophthalmic zoster/HZO; V2/V3 = oral/facial zoster). This does NOT produce Ramsay Hunt syndrome.
• C. Dorsal root ganglia are the site of VZV latency for spinal nerve (dermatomal) herpes zoster — causing shingles of the trunk or extremities, not Ramsay Hunt syndrome.
• D. The superior cervical ganglion is a sympathetic ganglion — VZV does not typically remain latent there.