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31b - Answer: 62-year-old female with headaches, hearing loss and buzzing in ear

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 62-year-old female referred for MRI subsequent to mild headaches, hearing loss and buzzing in ear with episodes of vertigo.

(QUIZ ANSWER) NOT A FINDING IN THIS CASE: 

Abnormal corpus callosum and brainstem.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Unremarkable craniocervical junction, partially empty sella turcica. Normal corpus callosum and brainstem. Previous examination was felt to demonstrate left greater than right otomastoid airspace disease. While there is a similar finding today, the left jugular bulb is somewhat high riding and demonstrates slow flow representing increased T1 signal on the pre- and postcontrast-enhanced sequences. However, surrounding the prominent left jugular bulb are multiple small flow voids on the pre- and postcontrast-enhanced T1-weighted data set. This is all situated posteriorly so it is not trapped fluid within the petrous apex. Differential includes high riding jugular bulb versus skull base lesion such as glomus jugulare tumor. High-resolution CT of the temporal bone is recommended for further evaluation in this patient with posterior headaches. 

CP angle cistern, cochlea vestibule, and 7th and 8th cranial nerves are intact. 

Normal-appearing white matter. 

Bilateral mastoid effusions. 

Orbits and intraorbital contents are unremarkable. Cavernous sinuses are unremarkable. 

Vascular arterial flow voids at the base of the brain are unremarkable. 

IMPRESSION:

Bilateral mastoid effusions. 

Cerebellar atrophy. 

Somewhat more prominent than on the previous study is a lesion at the skull base centered in the jugular foramen. While this could represent a high riding jugular bulb - that is unlikely, and inflammatory disease, jugular meningioma or most likely glomus jugulare requires exclusion. High-resolution CT of the temporal bone/skull base recommended for further evaluation. Are there any jugular foramen signs like Verner's syndrome, Villeret's syndrome or deficiency of nerves IX, X, XI, or XII.

LESSON 3, TOPIC 63

Case Challenge: Brain MRI Cases

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Content reviewed: July 23, 2021

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