2 days of right eye redness and irritation, blurry vision, and one day of right face weakness. On examination, also has decreased sensation to light touch in V2 and V3 distribution. The brain shows normal signal and no abnormal contrast enhancement, diffusion restriction or susceptibility effect. Tiny focal CSF-intensity in the very posterior aspect of the left external capsule is most probably a dilated perivascular space, which is a normal variation. The CSF-containing spaces, including the ventricles, are normal in size. There is no abnormal extra-axial fluid collection.There is asymmetrically increased contrast enhancement along the anterior and superior margins of the right internal carotid canal which may represent dural thickening and enhancement. In addition, there is asymmetrically increased contrast enhancement in the fundus of the right internal auditory canal that appears to extend into the labyrinthine segment and geniculate ganglion of the right facial nerve, which is best seen on axial images #90 and 91 of series #1101). The finding is not as reproducible on the coronal images but the examination is not optimized for cranial nerve assessment. Contrast enhancement along the tympanic and mastoid segments of the right facial nerve is symmetric compared to the left side and within normal limits. There is no gross evidence of abnormal enhancement along the membranous labyrinth. There is minimal, equivocal increased contrast enhancement along the posterior/inferior aspect of the medial end of the cartilaginous right external auditory canal but there is no correlating finding on physical examination. Mastoid air cells show no gross abnormality. There is a small retention cyst/polypoid mucosal thickening in the left sphenoid sinus. There is minimal mucosal thickening in the ethmoid sinuses. These findings are nonspecific.There is a 7 mm soft tissue nodule in the superficial part of the right parotid gland, which is most probably an intraparotid lymph node. The parotid glands are otherwise normal. There is a 10 mm, mildly enlarged upper right lateral retropharyngeal lymph node and a smaller one on the left side (node of Rouvière). This is nonspecific but possibly reactive.
1.No definite acute intracranial abnormality.2.While the study is not optimized for cranial nerve assessment, there is questioned abnormal, asymmetric contrast enhancement in the right internal auditory canal fundus and asymmetrically along the labyrinthine segment and genu ganglion of the right facial nerve, which is nonspecific in isolation. This is nonspecific and could relate infection/inflammation. Additional mural enhancement along the right IAC which may be dural in location, possibly relating to venous engorgement. Follow-up imaging with dedicated cranial nerve sequences may be obtained as clinically indicated. Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Matthew Burns over the phone on January 2, 2016 at 1300 hours. Given the current management plan, dedicated cranial nerve MRI imaging will be performed if clinically indicated.