{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T11:21:31Z","timestamp":1768389691426,"version":"3.49.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ramsay Hunt syndrome (RHS) typically presents with unilateral otalgia, herpes zoster oticus, ipsilateral peripheral facial palsy, and often ipsilateral vestibulocochlear involvement. Bilateral\/contralateral vestibular dysfunction is extremely rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 60-year-old female with a history of right breast cancer presented to our clinic with 1 week of vertigo, followed by 2 days of right-sided facial deviation and otalgia. Physical examination revealed vesicular eruptions around the right ear and external auditory canal, right-sided peripheral facial palsy, spontaneous horizontal-rotatory nystagmus (with a fast phase to the left), and postural instability. Further evaluation confirmed bilateral vestibular hypofunction: the video head impulse test showed reduced gains and\/or saccades in all canals; bithermal caloric testing demonstrated bilateral vestibular weakness (sum of slow-phase velocity: 10.1\u00b0\/s); and symptom assessments yielded a visual analog scale (VAS) score of 7\/10 and a dizziness handicap inventory (DHI) total score of 52. Facial nerve electrophysiological testing indicated significant impairment of the right facial nerve, with an amplitude reduction exceeding 50%. The stapedial reflex, Hallpike-Dix test, Roll test, pure-tone audiometry, brain and cranial nerve MRI, and routine laboratory tests showed no significant abnormalities. A diagnosis of RHS with bilateral vestibular dysfunction was established, and treatment was administered per current guidelines, including antiviral therapy, oral corticosteroids, analgesics, anti-vertigo medications, acupuncture, and vestibular rehabilitation. After 2 weeks, symptoms (facial palsy, otalgia, herpes zoster, and dizziness) improved slightly, with crusting of the herpes lesions. At the 3-month follow-up, the herpes zoster had resolved without residual pain, though mild residual dizziness (VAS 2, DHI 20) and facial weakness persisted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case shows rare bilateral vestibular involvement and initial vestibular impairment preceding RHS (distinct from classical ipsilateral or rare post-RHS contralateral patterns). Elucidating the specific pathogenic mechanisms underlying this presentation holds significant clinical importance for understanding bilateral vestibular involvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1709001","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T06:41:19Z","timestamp":1768372879000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Ramsay Hunt syndrome with simultaneous bilateral vestibular dysfunction as the initial manifestation in a patient with a history of breast 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