Presentation
Bell's palsy 6 months ago, poor recovery.
Patient Data
Asymmetric enhancement of the facial nerve genicular ganglion as demonstrated, with the right side demonstrating much greater enhancement than the left on the axial fat-saturated postcontrast T1 sequences. This asymmetry is much less marked on the thin 1 mm scan (not shown), indicating that at least part of the asymmetry is due to slice position. Otherwise the facial nerves appear normal bilaterally, and no brainstem lesion or cisternal lesion can be identified. Remainder the brain is unremarkable in appearance.
Conclusion: Probable minor asymmetry of enhancement in the region of the right geniculate ganglion, supporting the diagnosis of prior Bell's palsy. No central abnormality identified as an alternative explanation.
Case Discussion
Imaging of Bell's palsy is difficult and is in most ways more to exclude another cause for facial nerve palsy.
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