Clinical question: Per Neurology, concern about facial nerveSigns and Symptoms: right sided facial droop, right sided eye weakness BRAINThe CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional foci of T2 and FLAIR signal hyperintensity are present in the brainstem and internal capsulesNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery is larger than the right vertebral artery and invades into the left cervical medullary junction.There is hypertrophy of the cruciate ligaments are present associated with narrowing of the cervical medullary junction and effacement of spinal fluid ventral and posterior to the cervical medullary junction.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Incidental note is made of hyperostosis frontalis interna.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.Enhancement of the right facial nerve is slightly more conspicuous than enhancement of the left facial nerve. This could be considered a variation of normal.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.
1.No evidence for acute ischemic cerebral infarction. 2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.No mass lesion associated with the facial nerve is appreciated. Some minor asymmetry in the enhancement pattern of the right facial nerve relative to the left is nonspecific. This could imply inflammation but it could be variation of normal as well.