<unk>  can be diagnosed based on clinical features, however, in ambiguous cases PCR or direct immunofluorescent assay of vesicular fluid can help with the diagnosis. Laboratory studies such as WBC count, ESR and electrolytes should be obtained to distinguish infectious versus inflammatory etiologies. Clinical diagnosis On physical exam look for vesicular exanthema on the external auditory canal, concha and or pinna. Dry eyes with possible lower cornea epithelium damage due to incomplete closure of eyelids. It is possible to have<unk>  without an external rash present. This is called "RHS sine herpete" and this may occur in up to 30% of patients. Diagnostic procedures<unk>  can usually be diagnosed based on clinical features. However, for suspected cases with unclear presentation, varicella zoster virus can be isolated from vesicle fluid. Tear culture PCR can have positive varicella zoster virus. However<unk> 5-35% of patients with Bell's palsy can have false positive varicella zoster virus detected in tears. If central nervous system complications such as meningitis, ventriculitis or meningoencephalitis are suspected, prompt lumbar puncture with spinal fluid analysis and imaging (CT head) are recommended. An MRI with contrast may be ordered if the diagnosis is ambiguous to rule out other causes of acute facial paralysis such as a stroke, Lyme Disease, Multiple Sclerosis, cancer or tumors. This test is most commonly ordered if the patient presents atypically with RHS sine herpete.
Ramsay Hunt syndrome type 2
Bell's palsy
Ramsay Hunt syndrome type 1
Tolosa–Hunt syndrome
Robinow syndrome
Autosomal dominant porencephaly type I
Seaver Cassidy syndrome
Dandy–Walker malformation