Complete Peripheral Vestibulopathy & Ipsilateral Facial Palsy

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 60-yo-man who suffered the fairly abrupt onset (over hours) of right lower motor neuron facial nerve palsy (7th cranial nerve), vertigo and deafness in the right ear (8th cranial nerve). Vesicles were noted on otoscopy, and herpes zoster infection (Ramsay Hunt) was diagnosed. Whereas many cases of "typical" vestibular neuritis are thought to involve the superior division of the vestibular nerve (mainly innervates anterior and horizontal canals, utricle) much more than the inferior division (posterior canal, saccule), in herpes zoster, there's commonly extensive damage to the 8th cranial nerve which leads to weakness of all three semicircular canals. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This patient experienced the onset of right facial weakness, vertigo and right hearing loss over several hours, and was found to have a right lower motor neuron facial nerve palsy, deafness in the right ear, spontaneous left-beating nystagmus, and vesicles were noted in and around the right external acoustic meatus on otoscopy, leading to the diagnosis of herpes zoster infection (Ramsay- Hunt syndrome). Steroids and anti-virals were given acutely. This examination was performed several weeks later, and there were abnormal head impulses in the planes of right horizontal, anterior, and posterior semicircular canals. Severe unilateral vestibular loss was responsible for his significant head movement dependent oscillopsia, which improves with time and physical therapy. https://collections.lib.utah.edu/ark:/87278/s68s7zm7