

This 49 y/o female complained of right sided ear pain, ringing in the ear with decreased hearing, and slight difficulty with speech. She demonstrated some right facial paresis with flattening of the right naso-labial fold. An MRI both before and after gadolinium was performed and selected images from the posterior fossa are displayed in magnified form above. There is enhancement of the 7th and 8th cranial nerves within the internal auditory canal. The clinical history & examination, combined with this MRI appearance is typical of the Ramsay Hunt Syndrome, a Herpes Zoster viral infection of the facial nerve and often the subjacent vestibulocochlear nerve. A subsequent vesicular eruption or serologic tests confirm the diagnosis.