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Radiology Quiz Case 2

Radiology Quiz Case 2 A 43-year-old man had the sudden onset of vertigo, followed 5 days later by left-sided facial palsy. On admission, he was unable to ambulate because of the severe vertigo, which was associated with spontaneous nystagmus beating toward the right side. He denied having any systemic diseases. An examination of the ear, nose, and throat failed to show any eruption or vesicle formation. There was no evidence of otalgia or neuralgia. Evaluation of facial nerve function revealed no abnormalities on the right side, but a House-Brackmann grade IV/VI paralysis was observed on the left side. Audiometry showed normal hearing in both ears. Caloric and vestibular evoked myogenic potential tests revealed normal responses in the right ear but absent responses in the left ear. An axial T1-weighted postgadolinium fat-saturated image demonstrated a linear-enhanced soft-tissue mass measuring 0.2 cm in greatest dimension in the left internal auditory canal (Figure 1, arrow), without significant expansion of the nerve in the middle ear or internal auditory canal, while the right internal auditory canal was intact. Also, there was enhancement of the labyrinthine segment of the facial nerve on the left side (Figure 1, arrowhead), yet the right side was normal. Furthermore, the geniculate ganglia showed bilateral enhancement but much more so on the left side. Figure 1. View LargeDownload Oral prednisone therapy was initiated at a dosage of 60 mg/d and then tapered within 2 weeks. Results of a serologic assay confirmed the reactivation of varicella-zoster virus (IgG, 190 mIU/mL). Six months later, the patient's facial nerve function, hearing, and caloric and vestibular evoked myogenic potential test results were normal bilaterally. Follow-up magnetic resonance imaging (MRI) demonstrated no enhanced lesion in the internal auditory canals or facial nerves on either side (Figure 2). Figure 2. View LargeDownload What is your diagnosis? http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Radiology Quiz Case 2

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Radiology Quiz Case 2

Abstract

A 43-year-old man had the sudden onset of vertigo, followed 5 days later by left-sided facial palsy. On admission, he was unable to ambulate because of the severe vertigo, which was associated with spontaneous nystagmus beating toward the right side. He denied having any systemic diseases. An examination of the ear, nose, and throat failed to show any eruption or vesicle formation. There was no evidence of otalgia or neuralgia. Evaluation of facial nerve function revealed no abnormalities on...
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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archoto.2008.534-a
Publisher site
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Abstract

A 43-year-old man had the sudden onset of vertigo, followed 5 days later by left-sided facial palsy. On admission, he was unable to ambulate because of the severe vertigo, which was associated with spontaneous nystagmus beating toward the right side. He denied having any systemic diseases. An examination of the ear, nose, and throat failed to show any eruption or vesicle formation. There was no evidence of otalgia or neuralgia. Evaluation of facial nerve function revealed no abnormalities on the right side, but a House-Brackmann grade IV/VI paralysis was observed on the left side. Audiometry showed normal hearing in both ears. Caloric and vestibular evoked myogenic potential tests revealed normal responses in the right ear but absent responses in the left ear. An axial T1-weighted postgadolinium fat-saturated image demonstrated a linear-enhanced soft-tissue mass measuring 0.2 cm in greatest dimension in the left internal auditory canal (Figure 1, arrow), without significant expansion of the nerve in the middle ear or internal auditory canal, while the right internal auditory canal was intact. Also, there was enhancement of the labyrinthine segment of the facial nerve on the left side (Figure 1, arrowhead), yet the right side was normal. Furthermore, the geniculate ganglia showed bilateral enhancement but much more so on the left side. Figure 1. View LargeDownload Oral prednisone therapy was initiated at a dosage of 60 mg/d and then tapered within 2 weeks. Results of a serologic assay confirmed the reactivation of varicella-zoster virus (IgG, 190 mIU/mL). Six months later, the patient's facial nerve function, hearing, and caloric and vestibular evoked myogenic potential test results were normal bilaterally. Follow-up magnetic resonance imaging (MRI) demonstrated no enhanced lesion in the internal auditory canals or facial nerves on either side (Figure 2). Figure 2. View LargeDownload What is your diagnosis?

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Feb 16, 2009

Keywords: diagnostic radiologic examination,radiology specialty

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