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Comparison between temporal bone MRI and TBCT in a representative case of Ramsay Hunt syndrome with mastoid effusion on the right side. Non-contrast axial T2-weighted image at the level of IAC and mastoid air cells shows high signal intensity from the fluid in the right mastoid suggesting mastoid effusion (dotted circle, A), which was not easily identifiable in TBCT (dotted circle, B).
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This study aimed to investigate the incidence of mastoid effusion on temporal bone magnetic resonance imaging (MRI) in patients with Bell’s palsy (BP) and Ramsay Hunt syndrome (RHS), and evaluate the usefulness of mastoid effusion in early differential diagnosis between BP and RHS. The incidence of mastoid effusion on 3.0 T—temporal bone MRI, which...
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Background
Observable symptoms of Bell’s palsy following vaccinations may arouse concern over the safety profiles of novel COVID-19 vaccines in the general public. However, there are only a few studies on Bell’s palsy following mRNA COVID-19 vaccination with inconclusive findings. This study aimed to update the previous analysis on the risk of Bell...
Bell’s palsy is the most common cause of unilateral facial paralysis and is defined as an idiopathic and acute inability to control movements of the facial muscles on the affected side. While the pathogenesis remains unknown, previous studies have implicated post-viral inflammation and resulting compression of the facial nerve. Reported heritabilit...
Objective
The aim of this study was to report the incidence and clinical course of a series of patients who were misdiagnosed with Bell’s palsy and were eventually proven to have occult neoplasms.
Methods
Two hundred forty patients with unilateral facial paralysis who were assessed at the facial nerve reanimation clinic, Victoria Hospital, London...
The clinician should put MIS‐A at the top of differential diagnoses of a patient with febrile illness and multiple organ dysfunction during the early post‐COVID‐19 period. Also, facial nerve palsy might follow COVID‐19, related to the autoimmune phenomenon. The clinician should put MIS‐A at the top of differential diagnoses of a patient with febril...
Bell's palsy is the most common form of facial nerve palsy. This study aimed to explore the pathogenesis of Bell's palsy by investigating the effect of cold-stimulated adipocyte supernatant on adhesion molecule expression in Schwann cell line. Schwann cells were cultured in regular or adipocyte-conditioned medium and analyzed using RNA sequencing....
Citations
... Furthermore, MRI can help to differentiate between Bell's palsy of the peripheral facial nerve and RHS. Early diagnosis is crucial to support rapid initiation of a combination therapy with systemic steroids and antiviral agents [92]. ...
Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient’s otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given.
... Есть работа по применению МРТ в оценке ЛН у пациентов с синдромом Рамсея Ханта (ассоциирован с вирусом герпеса III типа -Varicella Zoster), в которой отмечается повышенное накопление контрастного вещества в лабиринтном отделе ЛН и в коленчатом узле [34]. Другие авторы считают, что наличие отечных изменений в ячейках сосцевидного отростка может служить дифференциально-диагностическим критерием при синдроме Рамсея Ханта, так как при ПБ они обычно не выявляются [35]. ...
Facial neuropathy (FN) is a complex multicausal problem that, with a seemingly obvious clinical picture, might be challenging to diagnose. Up to 5% of FN cases could be caused by neoplastic or otogenic processes, necessitating an interdisciplinary approach to its treatment by various specialties and in some cases a surgical intervention. In addition, in the early stages of FN, it is difficult to predict its outcomes. Therefore, beyond usual neurological exam and widely used electromyography (EMG), other additional diagnostic tools are used to ensure extended diagnosis, including cancer awareness.
In this paper we have analyzed the principles, role and value of computed tomography, magnetic resonance imaging (MRI), diagnostic transcranial magnetic stimulation combined with EMG, and ultrasound assessment with a high-frequency linear transducer in acute FN. We present our own clinical cases of pediatric patients with FN, who were assessed with EMG and multiparametric MRI including diffusion tensor imaging. These cases illustrate both the abnormalities found in the typical course of Bell's palsy, as well as the abnormalities in neoplasm-associated FN that clinically fully mimic the Bell's palsy. Based on the world experience in multiparametric MRI, including the use of extended protocols in the Pediatric Research and Clinical Center for Infectious Diseases, in case of suspected FN, the most important are high-resolution structural submillimeter sequences based on the gradient echo (SSFP) and diffusion tensor imaging (DTI). Measurement and assessment of fractional anisotropy at the motor nuclei of the facial nerves in the pons look promising for further research. The paper is the first to describe a modified combination diagnostic approach to Bell's palsy with the use of diagnostic transcranial magnetic stimulation with round coil, supramaximal stimulation with identification of the motor evoked response threshold (minimal inducer power to register a reproducible evoked motor response of 50-100 mV in amplitude) in the occipito-parietal area of the ipsilateral muscle.
... Facial nerve hemangiomas can also arise in the geniculate ganglion; however, these can be differentiated from FNS as they have irregular borders on HRCT and a "honeycomb" appearance, while FNS have a smooth well-defined border [8 ,18 ,20 ,33] . Bell's palsy is able to show postcontrast T1 enhancement of the geniculate ganglion and facial nerve segments, but is differentiated from a FNS due to the quicker onset and potential for spontaneous resolution of symptoms [34] . Congenital cholesteatomas can also affect the facial nerve intratemporally; however, they do not enhance with contrast on MRI, whereas FNS do [14 ,18 ,20] . ...
Schwannomas are rare nerve sheath tumors that can occur throughout the body, and are symptomatic based on location, size, and impingement on adjacent structures. These tumors are often benign lesions and occur sporadically or from genetic conditions such as neurofibromatosis. Schwannomas may arise from peripheral nerves, gastrointestinal nerves, spinal nerve roots and cranial nerves. Facial nerve schwannomas arise from cranial nerve VII, commonly involving the geniculate ganglion, labyrinthine segment, and internal auditory canal. While small lesions are asymptomatic, larger lesions can cause facial nerve paralysis, and facial spasms. Lesions in the internal auditory canal can cause hearing loss, tinnitus, vertigo, and otalgia. High-resolution CT imaging and MRI imaging are useful for distinguishing between other pathologies that arise from the same region. High-resolution CT scans can show bony degeneration of nearby structures such as the labyrinth or ossicles. MRI imaging shows hypo intensity on T1 imaging, and hyperintensity on T2 imaging. On T1 postcontrast, enhancement can be homogenous or heterogeneous with cystic degeneration if the lesion is large. Nodular enhancement is commonly seen on facial nerve schwannomas within the internal auditory canal. Vestibular schwannomas involving CN VIII are more common, and appear similar to facial nerve schwannomas, but can be distinguished apart due to growth in the geniculate ganglion and/or the labyrinthine segment. Management of asymptomatic or mild lesions is typically conservative with follow up imaging, and surgery for larger lesions. Here, we present a case of a facial nerve schwannoma in a 57-year-old woman.
... While clinical symptoms have been the driving factor in reaching a clinical diagnosis, findings on various imaging modalities have shown to have diagnostic value. Current literature explores the use of temporal bone magnetic resonance imaging in characterizing the severity of RHS [6,7] and diagnostic value [8]. Temporal bone mastoid effusion has been reported in patients diagnosed with Ramsay Hunt and has been used to differentiate between the diagnosis of Bell's Palsy [8]. ...
... Current literature explores the use of temporal bone magnetic resonance imaging in characterizing the severity of RHS [6,7] and diagnostic value [8]. Temporal bone mastoid effusion has been reported in patients diagnosed with Ramsay Hunt and has been used to differentiate between the diagnosis of Bell's Palsy [8]. In this paper, we report a case of a patient being diagnosed with and successfully treated for Ramsay Hunt after receiving a diagnosis on Computed Tomography Scan (CT). ...
... It is characterized by a triad of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal or on the auricle, which is also known as zoster oticus [1,9]. While RHS has been extensively studied to cause external ear changes, recent reports have shown that RHS can lead to changes within the internal cavities, particularly within the mastoid cavity [8]. Diagnosis of RHS primarily relies on medical history and physical examination, and radiological findings provide additional support in confirming the diagnosis. ...
... The FNP is generated by reactivation of dormant VZV in the geniculate ganglion, and this was confirmed by DNA detection of VZV in the geniculate ganglion [1]. In RHS, symptoms of audio-vestibular deficits, such as hearing loss and vertigo, are commonly accompanied by FNP [2][3][4][5][6][7][8][9]. In addition, paralysis of other cranial nerves can be associated with RHS [10][11][12][13][14][15]. ...
Herpes zoster oticus (HZO) is characterized by otalgia and erythematous vesicles in the auricle or external auditory canal. Ramsay Hunt syndrome (RHS) can be diagnosed when facial nerve palsy is accompanied by these symptoms of HZO, and in this case, audio-vestibular symptoms such as hearing loss or dizziness often develop. Recently, 3D-fluid-attenuated inversion recovery sequence (3D-FLAIR) magnetic resonance imaging (MRI) has been introduced in order to evaluate the inner ear structure pathology. The purpose of this study was to investigate the audio-vestibular characteristics in correlation with temporal bone MRI findings in HZO patients. From September 2018 to June 2022, 18 patients with HZO participated in the study. Thirteen patients (77%) showed high-signal intensity in the inner ear structures in 4 h post-contrast 3D-FLAIR images. In a bithermal caloric test, the lateral semicircular canal showed high signal intensity in 4 h post-contrast 3D-FLAIR images in 75% of patients with abnormal canal paresis. While the cochlea showed high signal intensity in 4 h post-contrast 3D-FLAIR images in 75% of patients with hearing loss, the vestibulo-cochlear nerve showed enhancement in post-contrast T1-weighted images in only 33% of patients with hearing loss. The present study demonstrates that audio-vestibular deficits are well-correlated with increased signal intensity of the inner ear endorgans in 4 h post contrast 3D-FLAIR MRI.
... In some cases, if patients present with atypical symptoms like eye tremors, hearing loss, or tinnitus, magnetic resonance imaging (MRI) may be used to rule out more serious conditions like brain tumors or cerebrovascular diseases [29,30,31,32]. However, for most Bell's palsy patients, MRI results may appear normal, highlighting the importance of relying on clinical 5 assessment in the absence of precise biomarkers [33,34,35]. ...
Early diagnosis of Bell's palsy is crucial for effective patient management in primary care settings. This study aimed to develop a simplified diagnostic tool to enhance the accuracy of identifying Bell's palsy among patients with facial muscle weakness. Data from 240 patients were analyzed using seven potential clinical evaluation indicators. Two diagnostic benchmarks were established: one based on clinical assessment and the other incorporating magnetic resonance imaging (MRI) findings. A multivariate logistic regression model was developed based on these benchmarks, resulting in the construction of a predictive tool evaluated through latent class models. Both models retained four key clinical indicators: absence of forehead wrinkles, accumulation of food and saliva inside the mouth on the affected side, presence of vesicular rash in the ear or pharynx, and lack of pain or symptoms associated with tick exposure, rash, or joint pain. The first model demonstrated excellent discriminative ability (area under the curve [AUC] = 0.96, 95% confidence interval [CI] 0.94 - 0.99) and calibration (P < 0.001), while the second model also showed good performance (AUC = 0.88, 95% CI 0.83 - 0.92) and calibration (P = 0.005). Bootstrap validation indicated no significant overfitting. The latent class defined by the first model significantly aligned with the clinical diagnosis group, while the second model showed lower consistency.
When head and neck infection is suspected, appropriate imaging contributes to treatment decisions and prognosis. While contrast-enhanced CT is the standard imaging modality for evaluating head and neck infections, MRI can better characterize the skull base, intracranial involvement, and osteomyelitis, implying that these are complementary techniques for a comprehensive assessment. Both CT and MRI are useful in the evaluation of abscesses and thrombophlebitis, while MRI is especially useful in the evaluation of intracranial inflammatory spread/abscess formation, differentiation of abscess from other conditions, evaluation of the presence and activity of inflammation and osteomyelitis, evaluation of mastoid extension in middle ear cholesteatoma, and evaluation of facial neuritis and labyrinthitis. Apparent diffusion coefficient derived from diffusion-weighted imaging is useful for differential diagnosis and treatment response of head and neck infections in various anatomical sites. Dynamic contrast-enhanced MRI perfusion may be useful in assessing the activity of skull base osteomyelitis. MR bone imaging may be of additional value in evaluating bony structures of the skull base and jaw. Dual-energy CT is helpful in reducing metal artifacts, evaluating deep neck abscess, and detecting salivary stones. Subtraction CT techniques are used to detect progressive bone-destructive changes and to reduce dental amalgam artifacts. This article provides a region-based approach to the imaging evaluation of head and neck infections, using both conventional and advanced imaging techniques.
