Brainstem and Cerebellar Involvement in Ramsay Hunt Syndrome.

We present a case of a 62-year-old Caucasian male with laryngeal cancer and Ramsay Hunt Syndrome otherwise known as herpes zoster oticus due to reactivation of the varicella zoster virus. Classic findings include the triad of ipsilateral facial paralysis, otic pain, and herpetic lesions in the sensory supply of the facial nerve. The common pathogenesis is associated with anterograde axonal reactivation of the varicella zoster virus in the geniculate ganglion.

The role of laboratory testing in the evaluation of headache.

Blood tests have a minor role in headache management and that role is limited to a few secondary headache conditions. In headache, as with any symptom, laboratory tests should be chosen based on solid clues derived from the targeted history and physical examination. A shotgun approach to blood tests that includes rare diseases or those with low local prevalence frequently yields false-positive results, which exposes the patient to the expense, anxiety, and risk inherent in misdiagnosis.

The role of the physical examination in the evaluation of headache.

The population of patients suffering with headaches is vast and underserved. The most critical element in headache evaluation is the history. The targeted history not only differentiates primary from secondary headaches but also provides a realistic list of conditions associated with secondary headache.