![]() ![]() (b) Enhancement of the cisternal segment of right vagus nerve (arrow) is visualised. (a) There is the enhancement of the labyrinthine segment of the right facial nerve (small arrow) and right vestibular nerve (large arrow). Post-contrast 3D T1-weighted image of IAC MRI in a patient with Ramsay Hunt syndrome showing cranial polyneuropathy. Consequently, there was a significant improvement in hoarseness and hearing impairment, and only slight facial weakness persisted during a follow-up period of 6 months. Later, the patient was given acyclovir and methylprednisolone. While IAC MRI showed enhancement of the right CN VII, VIII, IX and X. Otolaryngological examinations suggested right vocal fold paralysis and hearing loss in his right ear. Most importantly, PCR for VZV in serum and CSF was positive. This hypothesis was evaluated with GM1, GQ1b, GD1b antibodies in CSF and serum and needle electromyography, nerve conduction velocity, all of which were negative. Given his multiple CN involvement, Guillain-Barré spectrum disorders were highest on our differential diagnosis. Analysis of the cerebrospinal fluid (CSF) revealed a WBC count of 39 × 10 6/L including 71.8% monocytes and 28.2% polykaryocytes, and protein 50.9 mg/dL (normal: 15–45 mg/dL). Serological investigations included the percent of neutrophile granulocyte which elevated up to 80% (normal: 50–70%). His neurologic exam was remarkable for peripheral facial paralysis, vestibular ataxia, in addition to lower motor neuron paralysis of the right-sided glossopharyngeal vagus nerve and vestibulocochlear nerve. After 3 days of admission, he developed dystaxia. Vesicular eruptions manifested itself in the right ear auricle, behind the ear and on the face on the second day of admission. Right facial paralysis started after 2 days accompanied by hoarseness, slight choking, hearing loss and tinnitus on the right side after 4 days. Herein, we present a case of the clinical and IAC MRI characteristic of RHS with multiple cranial involvements.Ī 68-year-old male presented to the hospital with a 4-day history of right-sided otalgia and upper respiratory tract infection. Conversely, MRI of the internal auditory canal (IAC) was seldom applied, which was helpful in the diagnosis and differential diagnosis. In most cases, brain magnetic resonance image (MRI) shows no abnormalities. However, multiple cranial nerve (CN) involvement is rare in RHS and its diagnosis is further difficult. Please make sure to notify your doctor, our scheduling department or your technician if you have any implanted medical device or metallic shrapnel in your body.Acute infection with the varicella-zoster virus (VZV) causes a series of neurological syndromes including Ramsay Hunt syndrome (RHS).Credit card and ATM card magnetic codes will be erased by the MRI’s magnetic field if brought into the room. We ask that patients do not enter the scanning room with jewelry, watches, keys, coins or other metal objects. Each patient is provided their own private locked dressing room which has an area to hang their clothing.While it is very rare to have an allergy to MRI contrast please tell your doctor, the scheduling department or you technician if you have previously had a problem with MRI contrast.Gadolinium is a natural element that enhances image quality.One of our certified MRI technologists or nursing staff will start an intravenous line to administer contrast prior to the examination. During the scan, you will hear faint hums and thumping. In addition, safety permitting, you may bring a companion into the room with you. You will be in constant contact with a caring technologist and have a control button to alert the technologist, if the need arises. The body part being studied will be located in the center of the MRI machine. The MRI will be performed on one of our high-strength GE 1.5/3.0T MRI scanners which provide the optimal image quality for this particular type of exam. MRI Internal Auditory Canal With and Without Contrast (Gadolinium) ![]()
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