Bell's palsy [351.0] / Disturbance of skin sensation [782.0], Reason for Study: ^Reason: right Bell's palsy, right hand numbness History: as above On post enhanced images, there are multifocal asymmetric enhancing lesions on the course of the right facial nerve. The enhancing lesion starts with right facial nerve intracanalicular segment (series 1201, image 42/150), geniculate ganglion (series 1201, image 43/150), tympanic segment (series 1201, image 40/150), mastoid segment (series 1201, image 34/150) and stylomastoid foramen (series 1201, image 24/150). These findings are consistent with Bell's palsy involving peripheral 7th nerve. There is enlarged right middle cerebral vein without associated MR evidence of brain arteriovenous malformation. There is no abnormal parenchymal enhancement.Possibilities of above findings include 1) normal variation of enlarged right middle cerebral vein and 2)arteriovenous shunting such as focal arteriovenous fistulae or small arteriovenous malformation. Since CT angiography and MR angiography do not provide temporal resolution of the lesion, they cannot exclude possibility of arteriovenous shunting. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Multifocal right peripheral facial nerve enhancements as described above which is consistent with Bell's palsy.2. Enlarged left middle cerebral vein as described above. The diagnostic possibilities include 1) normal variation of the left middle cerebral vein and 2) arteriovenous shunting. Diagnostic catheter angiography is the only way to exclude the possibility of arteriovenous shunting.Discussed with Dr.Rubeiz at the time of this dictation. 