The Ramsay Hunt syndrome, namely herpes zoster, about the ear or face associated with facial paralysis is discussed. Only 4 previous cases with autopsy have been published. These are discussed in the light of Hunt''s two classifications according to the sensory ganglion involved, and the other according to the clinical type. A case of true herpes zoster with vesicles within the ear followed by facial palsy is presented. The patient died 14 months after the onset of the herpetic eruptions of a coronary thrombosis. The geniculate ganglion on the affected side was carefully examined and the brain stem studied by serial section. Serial histologic sections showed an interstitial neuritis both proximal and distal to the geniculate ganglion. The ganglion itself appeared normal. There were no lesions in the brain stem. Evidence for pain fibers in the seventh nerve is corroborated by a case stimulated at operation. The widespread nature of the zoster infection is emphasized by a case involving the mixillary division of the trigeminal nerve with facial palsy.