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Herpes zoster oticus: correlations between clinical and MRI findings
S Berrettini1, M C Bianchi, G Segnini
1Department of Neurosciences, Ear, Nose and Throat Unit, University of Pisa, Italy.
Abstract:
Many gadolinium-enhanced magnetic resonance imaging (MRI) studies focusing on the anatomy and pathology of the 7th cranial nerve have already been published. However, only scattered cases of herpes zoster oticus (HZO) have been described and only the MRI appearance of the soft temporal bone structures has been reported. Enhanced MRI was performed in 4 patients with HZO observed at the Department of Otorhinolaryngology of the University of Pisa. A good correlation was found between the clinical data and MRI findings in both the acute and chronic stages of the disease. The 2 cases with complete facial palsy presented prominent and diffuse enhancement of the 7th and 8th cranial nerves on postcontrast MRI, while the patient with grade III facial palsy showed more limited nerve enhancement. The patient with grade II facial palsy presented no MRI abnormalities. In our series, enhancement limited to the geniculate ganglion and to the labyrinthine segment of the facial nerve indicates a good prognosis while a widespread enhancement correlates with a poor prognosis. In conclusion, MRI with contrast may be useful during the acute stage of HZO because it can confirm the diagnosis and can provide prognostic information on the facial function.
Insights
Gadolinium-enhanced MRI can diagnose herpes zoster oticus (HZO) and predict facial nerve function recovery. Prominent nerve enhancement on MRI indicates a poorer prognosis for facial palsy.
Area of Science:
- Neurology
- Radiology
- Otolaryngology
Background:
- Limited research exists on Magnetic Resonance Imaging (MRI) findings in herpes zoster oticus (HZO).
- Previous studies primarily focused on soft temporal bone structures, not cranial nerve involvement in HZO.
Observation:
- Enhanced MRI was conducted on four patients diagnosed with HZO.
- The study correlated clinical data with MRI findings in both acute and chronic HZO stages.
Findings:
- Complete facial palsy cases showed diffuse 7th and 8th cranial nerve enhancement.
- Limited enhancement, particularly in the geniculate ganglion, correlated with a good prognosis.
- Widespread nerve enhancement indicated a poor prognosis for facial function recovery.
Implications:
- Contrast-enhanced MRI is a valuable tool for diagnosing acute HZO.
- MRI findings can provide crucial prognostic information regarding facial nerve function in HZO patients.