![]() ![]() Given his multiple CN involvement, Guillain-Barré spectrum disorders were highest on our differential diagnosis. Analysis of the cerebrospinal fluid (CSF) revealed a WBC count of 39 × 10 6/L including 71.8% monocytes and 28.2% polykaryocytes, and protein 50.9 mg/dL (normal: 15–45 mg/dL). Serological investigations included the percent of neutrophile granulocyte which elevated up to 80% (normal: 50–70%). His neurologic exam was remarkable for peripheral facial paralysis, vestibular ataxia, in addition to lower motor neuron paralysis of the right-sided glossopharyngeal vagus nerve and vestibulocochlear nerve. After 3 days of admission, he developed dystaxia. Vesicular eruptions manifested itself in the right ear auricle, behind the ear and on the face on the second day of admission. Right facial paralysis started after 2 days accompanied by hoarseness, slight choking, hearing loss and tinnitus on the right side after 4 days. Herein, we present a case of the clinical and IAC MRI characteristic of RHS with multiple cranial involvements.Ī 68-year-old male presented to the hospital with a 4-day history of right-sided otalgia and upper respiratory tract infection. Conversely, MRI of the internal auditory canal (IAC) was seldom applied, which was helpful in the diagnosis and differential diagnosis. In most cases, brain magnetic resonance image (MRI) shows no abnormalities. However, multiple cranial nerve (CN) involvement is rare in RHS and its diagnosis is further difficult. 2016.Acute infection with the varicella-zoster virus (VZV) causes a series of neurological syndromes including Ramsay Hunt syndrome (RHS). Nederlandse Vereniging voor Keel–Neus–Oorheelkunde en Heelkunde van het Hoofd Halsgebied. Algorithm for evaluation of pulsatile tinnitus. Neuroradiologic assessment of pulsatile tinnitus. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Evaluation of Tinnitus and Hearing Loss in the Adult. Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up. Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management. A Compartment-Based Approach for the Imaging Evaluation of Tinnitus. E02 Sensorineural hearing loss and other inner ear symptoms. RCR iRefer guidelines: Making the best use of clinical radiology, version 8.0.1. Non-pulsatile tinnitus is mostly due to systemic causes (such as hyperdynamic circulation) or non-treatable structural causes (such as vascular loops near the internal auditory canal), and very rarely due to vestibular schwannoma, which is best diagnosed by MRI. NICE is in the process of producing guidelines regarding tinnitus, this is to be published in 2020. Pulsatile tinnitus is usually due to a vascular abnormality or a middle ear tumour and therefore contrast enhanced CT is the study of choice. There is additional literature in agreement with this, stating that pulsatile and non-pulsatile tinnitus have separate imaging pathways based on the most common underlying pathologies, if any. These both indicate that distinction between types of tinnitus determines the most appropriate imaging study: for pulsatile tinnitus, it is contrast-enhanced CT of the petrous bone, upper neck and posterior fossa, while non-pulsatile tinnitus should be investigated by MRI. Clinical data provided does not always specify the type of tinnitus (whether pulsatile or non-pulsatile), and all cases are referred for MRI of the IAM as a screening test for vestibular schwannoma.Īlthough to date there is no official UK guidance published regarding which imaging modality to choose in such cases, the RCR has cited the ACR Appropriateness criteria and Australian Diagnostic Imaging Pathways in its iRefer guidelines. Increased availability and easy access to MRI has led to a steady increase in imaging requests for patients with tinnitus. ![]()
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