Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
권호 표지
DOI QR코드

DOI QR Code

Early Diagnosis of Aseptic Meningitis in Ramsay Hunt Syndrome on 10-Minute Delayed CE 3D FLAIR Image: a Case Report

  • Kang, Mi Hyun (Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kim, Da Mi (Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Lee, In Ho (Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Song, Chang June (Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine)
  • Received : 2021.05.26
  • Accepted : 2021.07.15
  • Published : 2021.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Ramsay Hunt syndrome (RHS) is a disease caused by varicella-zoster virus (VZV) infection that can be diagnosed through clinical symptoms with or without imaging evaluations. The typical features of RHS on imaging evaluation include signal changes and enhancement in the internal auditory canal (IAC) nerves, and the labyrinthine segment of cranial nerve VII (CN VII) and cranial nerve VIII (CN VIII). In some patients, inner ear structure (cochlear and vestibular apparatus) is involved in RHS. Neurologic complications, such as encephalitis and meningitis, are rare in RHS, but are known to occur. Therefore, magnetic resonance imaging (MRI) is necessary to detect both abnormal signal intensity in the IAC, CN VII, CN VIII, inner and ear structure, and CNS complications. We report an RHS patient with CN VII, VIII, and leptomeningeal enhancement within the cerebellar folia on 10-min delayed, contrast-enhanced (CE), three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) imaging.

Keywords

References

  1. Lee Y, Lee D. Ramsay Hunt syndrome complicated by meningoencephalitis and radiologic findings: a rare case report. Investig Magn Reson Imaging 2019;23:65-69 https://doi.org/10.13104/imri.2019.23.1.65
  2. Ricigliano VAG, Saraceno L, Cavalli M, Rodegher M, Meola G. Slowly progressing varicella zoster brainstem encephalitis complicating Ramsay Hunt syndrome in an immunocompetent patient: case report and review of the literature. J Neurovirol 2017;23:922-928 https://doi.org/10.1007/s13365-017-0575-3
  3. Ashour A, Obeidat K, Azrieh B, Alsaud A, Yassin M. An association of Varicella Zoster virus, facial palsy, and meningitis in a young immunocompetent male. Case Rep Neurol 2020;12:136-139 https://doi.org/10.1159/000506192
  4. Bienkowski C, Kowalczyk M, Talarek E, Pokorska-Spiewak M, Kierdaszuk B, Marczynska M. Meningitis and Ramsay-Hunt syndrome in a 17-year old girl. Neuro Endocrinol Lett 2019;40:149-151
  5. Kim TY, Park DW, Lee YJ, et al. Comparison of inner ear contrast enhancement among patients with unilateral inner ear symptoms in MR images obtained 10 minutes and 4 hours after gadolinium injection. AJNR Am J Neuroradiol 2015;36:2367-2372 https://doi.org/10.3174/ajnr.A4439
  6. Naganawa S. The technical and clinical features of 3D-FLAIR in neuroimaging. Magn Reson Med Sci 2015;14:93-106 https://doi.org/10.2463/mrms.2014-0132
  7. Lee EK, Lee EJ, Kim S, Lee YS. Importance of contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging in various intracranial pathologic conditions. Korean J Radiol 2016;17:127-141 https://doi.org/10.3348/kjr.2016.17.1.127
  8. Kremer S, Abu Eid M, Bierry G, et al. Accuracy of delayed post-contrast FLAIR MR imaging for the diagnosis of leptomeningeal infectious or tumoral diseases. J Neuroradiol 2006;33:285-291 https://doi.org/10.1016/S0150-9861(06)77286-8
  9. Park YW, Ahn SJ. Comparison of contrast-enhanced T2 FLAIR and 3D T1 black-blood fast spin-echo for detection of leptomeningeal metastases. Investig Magn Reson Imaging 2018;22:86-93 https://doi.org/10.13104/imri.2018.22.2.86
  10. Chung MS, Lee JH, Kim DY, et al. The clinical significance of findings obtained on 3D-FLAIR MR imaging in patients with Ramsay-Hunt syndrome. Laryngoscope 2015;125:950-955 https://doi.org/10.1002/lary.24973