BMJ Case Reports 2016; doi:10.1136/bcr-2016-215182

Herpetic cranial polyneuritis mimicking brain stem infarction—an atypical presentation of Ramsay Hunt syndrome

  1. Avinash Bharadwaj4
  1. 1Department of Geriatric Medicine, Fremantle Hospital, Perth, Western Australia, Australia
  2. 2Fiona Stanley Hospital, Perth, Western Australia, Australia
  3. 3Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
  4. 4School of Anatomy, Physiology and Human Biology, The University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Sneha Bharadwaj, sneha.bharadwaj{at}
  • Accepted 15 May 2016
  • Published 1 June 2016


An elderly man presented with severe right ear pain and discharge, hoarseness and dysphagia causing significant involuntary weight loss. Extensive investigations by varied specialties only highlighted right vocal cord palsy and right parotid lymphadenitis. Reassessment on transfer to a rehabilitation ward noted clinically subtle right Ramsay Hunt syndrome with multiple lower cranial nerve involvement. We illustrate a case of varicella zoster virus cranial polyneuritis with bulbar symptoms mimicking bulbar stroke, requiring percutaneous endoscopic gastrostomy feeds, with significant clinical and radiological recovery over 1 year.

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