T1 axial post gad T1 coronal post gad

Diagnosis: Viral neuropathy of the right facial nerve (Bell's palsy)- presumed

Bell's Palsy is defined as the acute onset of paralysis of the muscles of facial expression on one side and may involve any of three special functions of the facial nerve, which are the stapedius reflex via the nerve to the stapedius, taste to the anterior 2/3 of the tongue via the chorda tympani, and lacrimation via the greater superficial petrosal nerve. It is believed to result from viral infection of the facial nerve. Most patients have a complete resolution of the symptoms and do not require imaging unless there are atypical features including progressive or recurrent symptoms, paralysis lasting longer than four months, or other cranial neuropathies. MRI in Bell's Palsy may show non-nodular enhancement at the apex of the internal auditory canal and involving any portion of the facial nerve distally. Some normal enhancement may be seen in the intracanalicular portion of the facial nerve due to vascular supply; however, enhancement involving the labyrinthine or tympanic portion is abnormal. Acoustic schwannoma may present with enhancement of the intracanalicular portion of cranial nerve 8 however there is usually a mass extending out of the acoustic meatus. Things to consider in the general differential of intracanalicular enhancement are hemangioma, meningioma, metastasis, and normal vascular enhancement. The combination here of prominent enhancement of the intracanalicular facial nerve with enhancement of the tympanic portion with acute onset of symptoms is most compatible with Bell's Palsy. Related Cases

Carcinomatosis Labyrinthinitis Idiopathic Bell's Palsy