3D-FLAIR MRI findings in a patient with Ramsay Hunt syndrome

Abstract

Three-dimensional, fluid-attenuated inversion recovery (3D-FLAIR) of magnetic resonance imaging (MRI) has recently been developed to detect hemorrhage or high concentrations of protein. We present a patient with Ramsay Hunt syndrome, in whom high signals in the cochlear and vestibular apparatus were identified with 3D-FLAIR. The high signal areas in 3D-FLAIR were not detected by T1- and T2-weighted MRI in this case. This is the first report of high concentrations of protein in the inner ear in Ramsay Hunt syndrome using 3D-FLAIR, and suggests that high concentrations of protein in the inner ear are associated with hearing deterioration in some patients with Ramsay Hunt syndrome. 3D-FLAIR could be a useful diagnostic tool in the early stages of Ramsay Hunt syndrome.

The Technical and Clinical Features of 3D-FLAIR in Neuroimaging

“…63 Prognosis for hearing was not good in ears with a high signal on precontrast 3D-FLAIR. 65,66 Inflammation A signal increase in the labyrinthine fluid on 3D-FLAIR in various inflammatory diseases such as acute meningitis, acute otitis media, Wegener's granulomatosis, 27 mumps deafness, 26 RamsayHunt syndrome, [67][68][69] and labyrinthine fistula by a cholesteatoma 70 has been reported. Signal increase in the labyrinthine fluid on precontrast 3D-FLAIR suggests the presence of a small degree of hemorrhage or protein, and on post-contrast 3D-FLAIR, enhancement of the labyrinthine fluid suggests the active breakdown of the blood-labyrinthine barrier.…”

Imaging Endolymphatic Hydrops at 3 Tesla Using 3D-FLAIR with Intratympanic Gd-DTPA Administration

“…Thus, 3D-FLAIR-VFL has been used to evaluate various inner ear disorders. [4][5][6][7][8][9][10] The pre-contrast 3D-FLAIR-VFL scan was used to detect subtle changes in labyrinthine ‰uid composition, and the post-contrast 3D-FLAIR-VFL scan (following intravenous Gd-DTPA administration) was used to detect disruption of the blood labyrinthine barrier. 4,8 We evaluated whether 3D-FLAIR-VFL could replace 3D-FLAIR-CONV for detecting endolymphatic hydrops after intratympanic Gd-DTPA administration.…”

Clinical Significance of an Increased Cochlear 3D Fluid-Attenuated Inversion Recovery Signal Intensity on an MR Imaging Examination in Patients with Acoustic Neuroma

“…Increased signal intensity of the fluid on FLAIR MR images has been reported in various diseases, including sudden sensorineural hearing loss, labyrinthine hemorrhage, otosclerosis, Ramsay Hunt syndrome, and acoustic neuromas (ANs). [1][2][3][4][5][6] The increased cochlear signal on FLAIR images in patients with ANs is explained by an increased concentration of protein in the perilymphatic space. [7][8][9][10][11][12] FLAIR MR imaging is sensitive to fluids with a high protein content.…”