1/152. Facial canal decompression leads to recovery of combined facial nerve paresis and trigeminal sensory neuropathy: case report.BACKGROUND: Trigeminal sensory neuropathy is often associated with facial idiopathic nerve paralysis (Bell's palsy). Although a cranial nerve viral polyneuropathy has been proposed as the usual cause, in many instances the etiology remains unclear. This case report of recovery of both trigeminal and facial neuropathy after surgical decompression of the facial nerve suggests an anatomic link. methods: A case of a 39-year-old woman presenting with recurrent unilateral facial paralysis is summarized. Her fifth episode, which did not spontaneously recover, was associated with retroorbital and maxillary pain as well as sensory loss in the trigeminal distribution. RESULTS: A middle cranial fossa approach for decompression of the lateral internal auditory canal, labyrinthine segment of the facial nerve and the geniculate ganglion was performed. The patient's pain and numbness resolved immediately postoperatively, and the facial paralysis improved markedly. CONCLUSION: This result implicates a trigeminal-facial reflex as hypothesized by others. It suggests that decompression of the facial nerve can lead to improvement in motor and sensory function as well as relief of pain in some patients with combined trigeminal and facial nerve dysfunction.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
2/152. Facial diplegia complicating a bilateral internal carotid artery dissection.BACKGROUND AND PURPOSE: We report a case of facial diplegia complicating a bilateral internal carotid artery dissection. CASE DESCRIPTION: A 49-year-old patient presented with unilateral headache and oculosympathetic paresis. cerebral angiography revealed a bilateral internal carotid artery dissection. A few days later, the patient developed a facial diplegia that regressed after arterial recanalization. An arterial anatomic variation may explain this ischemic complication of carotid dissection. CONCLUSIONS: Double carotid dissection should be included among the causes of bilateral seventh nerve palsy.- - - - - - - - - - ranking = 0.2keywords = canal (Clic here for more details about this article) |
3/152. Pontine cryptococcoma in a nonimmunocompromised individual: MRI characteristics.The case of a pontine cryptococcoma in a nonimmunocompromised, previously healthy 16-year-old boy is presented. The patient had slowly progressive brainstem signs with right cranial nerves V, VII, and VIII palsies, and contralateral corticospinal and spinothalamic deficits. Magnetic resonance images (MRI) revealed, within the right pons, a 1-cm diameter round mass lesion, hypointense on T1-weighted images, hyperintense on T2-weighted images, and with rim enhancement after infusion of gadopentetate dimeglumine. This is the only report of the MRI findings in an isolated pontine cryptococcoma in an immunocompetent patient. Early recognition of this specific MRI pattern is essential, because complete recovery can be achieved with prompt antifungal treatment.- - - - - - - - - - ranking = 0.0016842930292276keywords = spinal (Clic here for more details about this article) |
4/152. cholesteatoma extending into the internal auditory meatus.We report our experiences in managing a patient with cholesteatoma complicated by meningitis, labyrinthitis and facial nerve palsy. The antero-inferior half of the tympanum was aerated but the postero-superior portion of the tympanic membrane was tightly adherent to the promontry mucosa. An attic perforation was present at the back of the malleolar head. High-resolution computed tomography also uncovered a fistula in the lateral semicircular canal. Surgical exploration of the middle ear cavity demonstrated that both the vestibule and cochlea were filled with cholesteatoma, and the cholesteatoma extended into the internal auditory meatus through the lateral semi-circular canal fistula. The cholesteatoma was removed by opening the vestibule and cochlea with a preservation of the facial nerve. Post-operatively, an incomplete facial palsy remained, but has improved slowly. There is no sign of recurrence to date after a 3-year period of observation.- - - - - - - - - - ranking = 0.4keywords = canal (Clic here for more details about this article) |
5/152. Facial palsy in Heerfordt's syndrome: electrophysiological localization of the lesion.Heerfordt's syndrome is characterized by fever, uveitis, swelling of the parotid gland, and facial nerve palsy and represents a variety of neurosarcoidosis. Since the first description of the syndrome, discussion about the lesion site has been controversial and has included the assumption of direct nerve compression by parotid gland swelling or a lesion within the facial canal in light of observations of accompanying taste disturbance. We report on a 26-year-old man with typical Heerfordt's syndrome who developed bilateral facial nerve palsy. Electrical and magnetic stimulation of the whole facial motor path provided strong evidence for a pathological process that: (i) began in the cerebellopontine angle; (ii) spread distally into the facial canal; and (iii) could be characterized by proximal demyelination. The patient recovered completely within 6 weeks under immunosuppressive therapy with steroids.- - - - - - - - - - ranking = 0.4keywords = canal (Clic here for more details about this article) |
6/152. adult T-cell leukemia/lymphoma with initial deafness.In July 1995, a 43-year-old Japanese man presented with deafness in the right ear. On hospital admission, he had deafness in both ears and right facial palsy. Variously sized lymphoid cells with convoluted nuclei were observed in the cerebrospinal fluid. Surface marker analysis revealed monoclonality of T lymphocytes in the spinal fluid. Similar abnormal cells were observed in peripheral blood and bone marrow. biopsy specimens of the stomach and prostate showed tight proliferation of large lymphoid cells in the interstitium and epithelium. Antibody against human T-lymphotrophic virus type 1 (HTLV-1) was present. The diagnosis of non-Hodgkin's lymphoma, diffuse type, was made. Seven months later, the patient died of sepsis. autopsy revealed multiple lymphadenopathy in the abdomen and the infiltration of atypical lymphocytes to the pancreas, kidneys, and other organs. A monoclonal band of HTLV-1 provirus was detected by Southern blot analysis. To our knowledge, this is the first report of adult T-cell leukemia/lymphoma with auditory nerve abnormalities as the initial symptom.- - - - - - - - - - ranking = 0.0033685860584552keywords = spinal (Clic here for more details about this article) |
7/152. Facial neuroma in the internal auditory canal.Authors presented two cases of facial neuromas in the internal auditory canal, one without facial palsy and the other with facial palsy. In both cases neuromas were occult and undiagnosed. Although in the first case neuroma was greater than the other, facial palsy was not developed. The mechanism of the facial palsy due to neuromas could not be clearly clarified.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
8/152. yolk sac tumor of the temporal bone: report of a case.yolk sac tumor (endodermal sinus tumor) is rarely encountered in the temporal bone. facial nerve paralysis can be a primary manifestation of this condition. Histologically, the tumor can be difficult to diagnose, although elevated levels of alpha fetoprotein can facilitate its identification. In this report, we describe the case of an 18-month-old girl who developed peripheral VIIth nerve palsy and a polypoid mass in the left external ear canal 3 months following myringotomy. Computed tomography and magnetic resonance imaging revealed that the tumor involved the left external ear canal, middle ear space, and mastoid air cells. Biopsies were consistent with a yolk sac tumor. Special staining demonstrated that only a very few tumor cells were positive for alpha fetoprotein, despite the markedly elevated level of alpha fetoprotein in her serum. The patient was treated with chemotherapy, which included cisplatin, etoposide, and bleomycin. Within a period of weeks, she experienced a complete reversal of her left VIIth nerve palsy, a marked decrease in her serum alpha fetoprotein levels, and a dramatic resolution of the tumor as demonstrated radiographically. Such a successful chemotherapeutic response in this case argues against surgical intervention in other cases, particularly in view of the risk of serious complications with surgery.- - - - - - - - - - ranking = 0.4keywords = canal (Clic here for more details about this article) |
9/152. A case of malignant otitis externa following mastoidectomy.We present a case of a 63-year-old diabetic male who developed malignant otitis externa following mastoidectomy. Extensive skull base osteomyelitis caused thrombosis of the jugular bulb and subsequent paralysis of cranial nerves VII, IX, X and XII. He was treated aggressively with intravenous antibiotics and debridement of granulation tissue in the mastoid bowl with full recovery of the cranial nerve palsies associated with recanalization of the jugular bulb. We believe this is the first reported case of malignant otitis externa to occur following mastoidectomy with complete recovery of the cranial nerve paresis.- - - - - - - - - - ranking = 0.2keywords = canal (Clic here for more details about this article) |
10/152. Facial palsy in cerebral venous thrombosis : transcranial stimulation and pathophysiological considerations.BACKGROUND: Cranial nerve palsy in cerebral sinovenous thrombosis (CVT) is rare, its pathophysiology remains unclear, and data from electrophysiological examinations in such patients are missing. CASE DESCRIPTION: We report the case of a 17-year-old woman with familial protein s deficiency who was admitted with extensive multiple CVT. Two weeks after onset of symptoms, she developed isolated right peripheral facial palsy, and MR venography showed segmental occlusion of the ipsilateral transverse sinus. Complete recovery of facial palsy occurred concomitant with recanalization of the transverse sinus. Facial neurography, including transcranial magnetic stimulation of the facial nerve and related motor cortex, ruled out a coincidental idiopathic palsy and revealed conduction block proximal to the facial canal. CONCLUSIONS: Facial palsy in our patient was caused by transient neurapraxia in the intracranial segment of the nerve. We suggest that elevated venous transmural pressure in the nerve's satellite vein, which belongs to the affected drainage territory of the transverse sinus, might have caused venous blood-brain barrier dysfunction in the intrinsic vascular system of the nerve, with leakage of fluids and ions into the endoneurial space and thus an increase in interstitial resistance.- - - - - - - - - - ranking = 0.4keywords = canal (Clic here for more details about this article) |
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