Presentation
Left facial palsy since two week ago, unknown cause.
Patient Data
In echo 2 images, the left facial nerve (CN VII) shows thickening and increased intensity as compared to the right, indicating some degree of neuritis.
Case Discussion
Findings are consistent with Bell's palsy. Our case shows that a new MR protocol, MENSA NERVE, helps to diagnose and manage Bell's palsy by detecting abnormalities in the extracranial segments of the facial nerve.
Bell's palsy results from a malfunction of the facial nerve (cranial nerve VII) with an unknown cause.
Learning points:
The 3D MENSA NERVE sequence is useful for MR neurography imaging of the head and neck. It uses a two-echo steady-state acquisition 1:
FID signal (first echo) provides high SNR anatomical reference
echo-signal (second echo) provides vascular suppression and T2 weighting 2
the second echo evaluates the nerve: nerve damage is indicated by increased thickness and signal intensity compared to the opposite nerve
a water-selective excitation pulse is also used for fat suppression
using a 3 T GE MRI with a 21-channel head and neck coil, the axial direction, FOV covers from the corpus callosum to the end of the mandible
this was achieved using a high-channel-count cervical coil with 3D AIR Recon DL, providing sub-millimetre resolution and excellent vascular suppression
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