662 Bilateral Vocal Cord Paralysis and Cranial Polyneuropathy: A Rare Presentation of Ramsay Hunt Syndrome

Abstract Case Presentation A 61-year-old gentleman with chronic lymphocytic leukaemia presented right sided disseminated vesicles, otalgia, hearing loss, facial weakness, dysphagia, hoarseness, breathlessness, and stridor. In the preceding 48 hours he had two A&E presentations only throat tightness mild breathlessness. Cranial nerve (CN) examination demonstrated cheek numbness absent jaw jerk reflex (CNV), grade 6 lower motor neuron palsy (CNVII), impaired (CNVIII), dysphonia, asymmetric palate elevation (CNIX X). Fibreoptic nasendoscopy (FNE) bilateral vocal cord palsy. He was diagnosed Ramsay Hunt syndrome (RHS) herpes zoster (HZ) requiring intubation ventilation, intravenous steroids, aciclovir, antibiotics a prolonged intensive care admission. discharged after three months. Eight months later, has long-term tracheostomy, gastrostomy, live-in carer. Discussion This is case found in literature of RHS associated cranial polyneuropathy tracheostomy. It highlights significant morbidity attached complications, particularly patient underlying malignancy. Awareness these rare potentially life-threatening complications should be raised to avoid investigation treatment delay. HZ considered patients CNVII or without vesicles. Clinicians perform full CN including FNE assess for polyneuropathy. can present making it indistinguishable from Bell's Palsy. Therefore, we consider treating Palsy aciclovir. Furthermore, multidisciplinary management essential.