Not a Stroke, but a Virus: When a Slurred Call Tells a Different Story.

A skin rash in the auricular and cervical regions, accompanied by severe pain, was identified as an atypical presentation of Ramsay Hunt syndrome (RHS). This condition, resulting from the reactivation of the varicella-zoster virus (VZV) in the geniculate ganglion, is characterized by peripheral facial paralysis, auditory disturbances, and, in some cases, unusual cutaneous manifestations that can complicate diagnosis. We report the case of a 71-year-old male with a history of cardiovascular disease, who presented with insidious onset of dysarthria and right peripheral facial paralysis over the course of 10 days, along with vesiculopustular lesions in the C2-C3 dermatomes, complicated by bacterial superinfection and moderate-to-severe sensorineural hearing loss. A combined treatment regimen of antiviral, antibiotic, and corticosteroid therapy was initiated, followed by an intensive multidisciplinary rehabilitation plan. After 65 days, he continued to experience severe motor deficits and chronic neuropathic pain, despite physiotherapy and gradual optimization of gabapentinoid therapy. This report highlights how atypical presentations and delayed diagnosis can adversely affect prognosis, emphasizing the importance of early antiviral and corticosteroid intervention to minimize motor, auditory, and pain-related sequelae. It also underscores the importance of integration between primary and hospital care to ensure continued rehabilitation, symptomatic control, and preservation of quality of life in elderly patients with comorbidities.