Wk 7, Case 2 - Review

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Report

Patient History
Left-sided facial weakness

Findings
MRI BRAIN: Multifocal areas of enhancement within the left facial nerve including the meatal (fundus), labyrinthine, tympanic, mastoid, and proximal extratemporal segments. Even the intraparotid portion of the left facial nerve enhances more than the right. Right facial nerve is normal.Vestibulocochlear nerves and trigeminal nerves are normal. Oculomotor nerves are normal. Optic nerves are normal.No acute intracranial hemorrhage, mass effect or midline shift. No enhancing intracranial masses. No extra-axial fluid collections. Ventricles and sulci are normal in size for age. Basal cisterns are clear. Major intracranial flow voids are preserved.Orbits are normal. Right maxillary mucous retention cyst. Mastoid air cells and middle ear cavities are clear. No suspicious osseous lesions.

MRI HEAD: Left dominant vertebral artery. Vertebral arteries, basilar artery, superior cerebellar arteries and posterior cerebral arteries are patent. Patent posterior communicating arteries bilaterally. Diminutive left P1 segment. The internal carotid arteries, middle cerebral arteries, anterior cerebral arteries and anterior communicating artery are patent. No high-grade stenosis or aneurysm.

Impressions
1. Multifocal areas of enhancement within the left facial nerve including the meatal, labyrinthine, tympanic, mastoid, and proximal extratemporal and left intraparotid segments. Findings could be seen secondary to an infectious/inflammatory process such as Bell's palsy.

2. Right facial nerve is normal.

3. Normal MRA of the head.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 7, Case 2 - Review