Clinical question: Evaluate sudden left neural sensory hearing loss. Signs and symptoms: Left hearing loss. Pre-and post enhanced MRI of the IACs:Examination demonstrates normal size and morphology of bilateral internal auditory canals.There is normal signal intensity and morphology of bilateral neurovascular bundles across the cerebellopontine angles and within the internal auditory canals bilaterally. There is normal morphology and signal intensity of bilateral cerebellopontine angle cisterns. There is also normal signal intensity and morphology of pons. There is no detectable abnormal enhancement of the pons, bilateral neurovascular bundles, internal auditory canals or within the bilateral petrous bones. There is normal signal intensity and anatomical morphology of visualized inner ear structures on this exam. The signal intensity of bilateral mastoid air cells and middle ear cavities are unremarkable. There is no evidence of abnormal enhancement of the cranial nerves on this exam.Negative diffusion weighted images. Axial T2 flair images demonstrate multiple tiny foci of flair hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in bilateral basal ganglia and questionably within pons which although nonspecific, considering patient's stated age of 69 the findings most likely represent chronic microvascular ischemic changes. Post enhanced images demonstrate no detectable abnormal enhancement the brain parenchyma, leptomeninges, calvarium or the orbits.Minimal mucosal thickening of bilateral ethmoid air cells and unremarkable paranasal sinuses otherwise.
1.Negative pre-and post enhanced MRI of the IACs.2.Negative diffusion weighted images and findings suggestive of mild chronic small vessel ischemic strokes as detailed above.