Neuro_MR_IAC: 37 M.

MRI INTERNAL AUDITORY CANAL AND TEMPORAL BONES WITH AND WITHOUT 

CONTRAST:

 

CLINICAL HISTORY: 37-year-old male with left petrous apicitis.

 

FINDINGS:

 

Cerebellopontine angles/IACs: Normal 7th and 8th cranial nerves without evidence of mass or abnormal enhancement.

 

Fluid spaces of the inner ears: Normal.

 

Mastoids and middle ears: Heterogeneous T1 and T2 hyperintense material is present within the left mastoid air cells and petrous apex. The remaining mastoid air cells are clear. There is evidence of diffusion restriction within the left mastoid without extension into the adjacent scalp soft tissues.

 

BRAIN: 

 

Parenchyma: No acute hemorrhage, infarction, or mass.

 

Ventricles and extra-axial spaces: There is enhancement along the left tentorium and around the left sigmoid and transverse sinus extending into the left cavernous sinus. No hydrocephalus.

 

Orbits: Normal.

 

Visualized paranasal sinuses: Clear.

 

Bones: Normal.

 

Additional comment: The venous sinuses are patent. The carotid artery flow voids are present.

  

IMPRESSION:

 

1.  Heterogeneous material within the left mastoid air cells with restricted diffusion but no extension into the adjacent scalp soft tissues.

 

2.  Abnormal enhancement along the left tentorium extending to the left cavernous sinus and along the left sigmoid and transverse sinuses. The dural venous sinuses are patent. These findings are most compatible with an infectious/inflammatory process with intracranial extension to involve the cavernous sinus.

(Petrous apicitis)

Boards trivia:

Gradenigo's syndrome: unilateral retroorbital pain (trigeminal nerve involvement), diplopia due to abducens nerve palsy, otorrhea