Presentation
Right facial droop, 36 weeks pregnant
Patient Data
Technique: Multiplanar multi-sequence unenhanced scan of the brain on a 3T platform.
Findings:
The extra-cranial vertical/mastoid and intra-parotid segments of the facial nerve are thickened on the right side and barely visible on the non-symptomatic left side in keeping with facial nerve neuritis. No parotid gland mass lesion.No intracranial hemorrhage or mass lesion. No surface collection. No CP angle mass lesion. The origins of the vestibular cochlea, facial and trigeminal nerves are normal.
Thickening of the cervical and intra-parotid segments of the right facial nerve in keeping with facial nerve neuritis.
Arrows pointing to the thickened hyper-intense right facial nerve.
Case Discussion
Facial nerve enhancement can occur in many pathological conditions including Bell’s Palsy, infections, inflammation, neoplasms, trauma, cholesteatoma and neurofibromatosis 1.
Conventionally the use of MRI in the setting of facial droop has been to eliminate other causes for this condition including aneurysm and tumors. With advancing MRI techniques we are now able to directly visualize the clinical nerve and see its resting state with direct comparison with the opposite presumed normal side. In this case, the contrast could not be used (due to pregnancy), however, this 3D STIR sequence is not reliant on contrast. In this case, the facial nerve demonstrated thickening and increased hyper-intensity on customized advanced flip angle modulated proton density-weighted 3D STIR with MSDE black blood prep pulses imaging showcasing both the severity and extent of the neuritis 1.
This case is also courtesy of Dr Zane Sherif and Mr Ben Kennedy.