Lyme: Living in an endemic area, exposure to ticks
Syphilis: Sexual activity
Ramsay Hunt: age, lack of vaccination, immunocompromised
Symptoms
May be abrupt
Syphilis: Would be neurosyphilis, so could have gait problems, other neuro issues; hearing loss can be unilateral or bilateral; can be abrupt
Lyme: would be neuro lyme; May be unilateral or bilateral
Antecedent history erythema migrans
Zoster: Unilateral ar pain, peripheral facial nerve palsey with Ramsay-Hunt from CN7 involvement; due to proximity w/CN8, may also have hearing loss, hyperacusis, tinnitus, vertigo
Physical Exam Findings
Neurosyphilis: gait problems, cognitive impairment, hearing loss (bilateral or unilateral)
Lyme: Prior episode erythema migrans
Ramsay Hunt--> vessicles on ear drum/canal, face, CN7 palsy