Ramsay Hunt syndrome is a disorder characterized by herpetic eruptions on the auricle, facial paralysis, and vestibulocochlear dysfunction, and is attributed to varicella zoster virus infection in the geniculate ganglion. Ramsay Hunt syndrome accounts for about 10% cases of facial palsy. We report a 46-year-old healthy man developed left side skin vesicles on the face with severe pain. We thought of the trigeminal herpes zoster. He was treated with intravenous acyclovir, and stellate ganglion block daily. Four days later, brain magnetic resonance imaging revealed small areas of enhancement in the seventh cranial nerve and eighth cranial nerve, not in the fifth cranial nerve. Eight days later, the left facial palsy was come. We confirmed him as Ramsay Hunt syndrome. We started steroid therapy immediately. He recovered completely a month later. The patient was improved through the early antiviral therapy, steroid medication and stellate ganglion block. (Korean J Pain 2008; 21: 237-240)