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MRI of Cranial Nerve Enhancement

¹ Department of Radiological Sciences, University of California, Irvine, 101 The City Dr., Rte. 140, Orange, CA 92868.
² Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.

View larger version (122K): [in a new window]   Fig. 1A —48-year-old woman with metastatic melanoma and meningeal carcinomatosis. Contrast-enhanced axial (A, B, D, and E) and coronal (C) T1-weighted images show enhancement and involvement of multiple cranial nerves: oculomotor nerves (arrows, A); trigeminal nerves (arrows, B); complex of seventh and eighth cranial nerves (arrows, C); complex of ninth, tenth, and eleventh cranial nerves (long arrows, D and E); and hypoglossal nerves (short arrows, E).

View larger version (114K): [in a new window]   Fig. 1B —48-year-old woman with metastatic melanoma and meningeal carcinomatosis. Contrast-enhanced axial (A, B, D, and E) and coronal (C) T1-weighted images show enhancement and involvement of multiple cranial nerves: oculomotor nerves (arrows, A); trigeminal nerves (arrows, B); complex of seventh and eighth cranial nerves (arrows, C); complex of ninth, tenth, and eleventh cranial nerves (long arrows, D and E); and hypoglossal nerves (short arrows, E).

View larger version (77K): [in a new window]   Fig. 1C —48-year-old woman with metastatic melanoma and meningeal carcinomatosis. Contrast-enhanced axial (A, B, D, and E) and coronal (C) T1-weighted images show enhancement and involvement of multiple cranial nerves: oculomotor nerves (arrows, A); trigeminal nerves (arrows, B); complex of seventh and eighth cranial nerves (arrows, C); complex of ninth, tenth, and eleventh cranial nerves (long arrows, D and E); and hypoglossal nerves (short arrows, E).

View larger version (86K): [in a new window]   Fig. 1D —48-year-old woman with metastatic melanoma and meningeal carcinomatosis. Contrast-enhanced axial (A, B, D, and E) and coronal (C) T1-weighted images show enhancement and involvement of multiple cranial nerves: oculomotor nerves (arrows, A); trigeminal nerves (arrows, B); complex of seventh and eighth cranial nerves (arrows, C); complex of ninth, tenth, and eleventh cranial nerves (long arrows, D and E); and hypoglossal nerves (short arrows, E).

View larger version (103K): [in a new window]   Fig. 1E —48-year-old woman with metastatic melanoma and meningeal carcinomatosis. Contrast-enhanced axial (A, B, D, and E) and coronal (C) T1-weighted images show enhancement and involvement of multiple cranial nerves: oculomotor nerves (arrows, A); trigeminal nerves (arrows, B); complex of seventh and eighth cranial nerves (arrows, C); complex of ninth, tenth, and eleventh cranial nerves (long arrows, D and E); and hypoglossal nerves (short arrows, E).

View larger version (87K): [in a new window]   Fig. 2A —56-year-old woman after resection of adenoid cystic carcinoma of right hard palate. Axial bone window CT image shows widening of right pterygopalatine fossa (arrow).

View larger version (119K): [in a new window]   Fig. 2B —56-year-old woman after resection of adenoid cystic carcinoma of right hard palate. Contrast-enhanced axial T1-weighted MR images reveal infiltrating mass in right pterygopalatine fossa (short arrow, B) and cavernous sinus (short arrow, C). Note abnormal signal intensity in right masticator space (long arrows, B) and right medial temporal lobe (long arrows, C).

View larger version (122K): [in a new window]   Fig. 2C —56-year-old woman after resection of adenoid cystic carcinoma of right hard palate. Contrast-enhanced axial T1-weighted MR images reveal infiltrating mass in right pterygopalatine fossa (short arrow, B) and cavernous sinus (short arrow, C). Note abnormal signal intensity in right masticator space (long arrows, B) and right medial temporal lobe (long arrows, C).

View larger version (126K): [in a new window]   Fig. 3A —43-year-old man with acute lymphoblastic leukemia. Axial FLAIR image reveals leukemic infiltrate of left pons and brachium pontis (arrow).

View larger version (115K): [in a new window]   Fig. 3B —43-year-old man with acute lymphoblastic leukemia. Contrast-enhanced axial T1-weighted images show antegrade perineural extension along course of left spinal trigeminal tract and nuclei (arrow, B) into preganglionic segment of left trigeminal nerve (arrow, C).

View larger version (127K): [in a new window]   Fig. 3C —43-year-old man with acute lymphoblastic leukemia. Contrast-enhanced axial T1-weighted images show antegrade perineural extension along course of left spinal trigeminal tract and nuclei (arrow, B) into preganglionic segment of left trigeminal nerve (arrow, C).

View larger version (111K): [in a new window]   Fig. 4A —7-year-old girl with tuberculous meningitis. Contrast-enhanced axial (A) and coronal (B) T1-weighted images show abnormal peripheral enhancement of oculomotor nerves (long arrows). In addition, there is leptomeningeal enhancement of anterior surface of brainstem (short arrows, A).

View larger version (97K): [in a new window]   Fig. 4B —7-year-old girl with tuberculous meningitis. Contrast-enhanced axial (A) and coronal (B) T1-weighted images show abnormal peripheral enhancement of oculomotor nerves (long arrows). In addition, there is leptomeningeal enhancement of anterior surface of brainstem (short arrows, A).

View larger version (134K): [in a new window]   Fig. 5 —32-year-old man with cryptococcal meningitis and perioptic neuritis. Contrast-enhanced axial T1-weighted image with fat suppression reveals thickening and enhancement of perineural structures of left optic nerve.

View larger version (155K): [in a new window]   Fig. 6A —61-year-old man with perineural spread of rhinocerebral mucormycosis who presented for follow-up after right orbital exenteration. Axial T2-weighted (A) and contrast-enhanced T1-weighted (B) images show recurrence of infection with invasion of right cavernous sinus (long arrows, A) and retrograde involvement of trigeminal nerve along cavernous, ganglionic, and cisternal segments (arrows, B). Abnormal signal within right pons indicates edema (short arrow, A).

View larger version (121K): [in a new window]   Fig. 6B —61-year-old man with perineural spread of rhinocerebral mucormycosis who presented for follow-up after right orbital exenteration. Axial T2-weighted (A) and contrast-enhanced T1-weighted (B) images show recurrence of infection with invasion of right cavernous sinus (long arrows, A) and retrograde involvement of trigeminal nerve along cavernous, ganglionic, and cisternal segments (arrows, B). Abnormal signal within right pons indicates edema (short arrow, A).

View larger version (146K): [in a new window]   Fig. 7A —17-year-old boy with neuroschistosomiasis. Contrast-enhanced T1-weighted images show range of involvement of CNS in schistosomiasis. Sagittal image shows enhancing masses within chiasmatic-hypothalamic (short arrow) and pineal (long arrow) regions.

View larger version (129K): [in a new window]   Fig. 7B —17-year-old boy with neuroschistosomiasis. Contrast-enhanced T1-weighted images show range of involvement of CNS in schistosomiasis. Coronal image shows thickened and enhancing trigeminal nerves (arrows).

View larger version (137K): [in a new window]   Fig. 7C —17-year-old boy with neuroschistosomiasis. Contrast-enhanced T1-weighted images show range of involvement of CNS in schistosomiasis. Axial image reveals enhancing mass (arrow) in right cerebellopontine angle with extension into internal auditory canal.

View larger version (94K): [in a new window]   Fig. 8A —32-year-old man with Bell's palsy. Contrast-enhanced axial (A) and coronal (B and C) T1-weighted images show abnormal enhancement of right facial nerve extending from distal intracanalicular segment (arrows, A and B) to distal mastoid segment (arrow, C).

View larger version (121K): [in a new window]   Fig. 8B —32-year-old man with Bell's palsy. Contrast-enhanced axial (A) and coronal (B and C) T1-weighted images show abnormal enhancement of right facial nerve extending from distal intracanalicular segment (arrows, A and B) to distal mastoid segment (arrow, C).

View larger version (86K): [in a new window]   Fig. 8C —32-year-old man with Bell's palsy. Contrast-enhanced axial (A) and coronal (B and C) T1-weighted images show abnormal enhancement of right facial nerve extending from distal intracanalicular segment (arrows, A and B) to distal mastoid segment (arrow, C).

View larger version (84K): [in a new window]   Fig. 9A —57-year-old man with ophthalmoplegic migraine. Unenhanced axial (A) and enhanced axial (B) and coronal (C) T1-weighted images reveal smooth enlargement and homogeneous enhancement of cisternal segment of left oculomotor nerve (arrows).

View larger version (100K): [in a new window]   Fig. 9B —57-year-old man with ophthalmoplegic migraine. Unenhanced axial (A) and enhanced axial (B) and coronal (C) T1-weighted images reveal smooth enlargement and homogeneous enhancement of cisternal segment of left oculomotor nerve (arrows).

View larger version (124K): [in a new window]   Fig. 9C —57-year-old man with ophthalmoplegic migraine. Unenhanced axial (A) and enhanced axial (B) and coronal (C) T1-weighted images reveal smooth enlargement and homogeneous enhancement of cisternal segment of left oculomotor nerve (arrows).

View larger version (92K): [in a new window]   Fig. 10A —58-year-old man with neurosarcoidosis. Contrast-enhanced axial T1-weighted images show enhancement and involvement of cisternal segments of right and left seventh and eighth cranial nerve complexes (arrows, A) and root entry zones of preganglionic trigeminal nerves (arrows, B).

View larger version (125K): [in a new window]   Fig. 10B —58-year-old man with neurosarcoidosis. Contrast-enhanced axial T1-weighted images show enhancement and involvement of cisternal segments of right and left seventh and eighth cranial nerve complexes (arrows, A) and root entry zones of preganglionic trigeminal nerves (arrows, B).

View larger version (115K): [in a new window]   Fig. 11A —35-year-old woman with Tolosa-Hunt syndrome presenting with painful ophthalmoplegia. Enhancement and enlargement of left cavernous sinus are illustrated on contrast-enhanced coronal T1-weighted image (arrow).

View larger version (124K): [in a new window]   Fig. 11B —35-year-old woman with Tolosa-Hunt syndrome presenting with painful ophthalmoplegia. Extension of enhancing tissue into left orbital apex (arrow) is seen on contrast-enhanced axial T1-weighted image.

View larger version (153K): [in a new window]   Fig. 12 —48-year-old woman with postradiation optic neuritis who presented with loss of vision in left eye 8 months after radiation therapy. Patient had previously undergone resection of adenoid cystic carcinoma of right maxillary sinus. Contrast-enhanced axial T1-weighted image shows enhancement of intracranial portion of left optic nerve (long arrow). Note large enhancing tumor (short arrows) with internal hemorrhage in right temporal lobe.

View larger version (89K): [in a new window]   Fig. 13A —48-year-old woman with schwannoma arising from left inferior vestibular nerve. Contrast-enhanced axial (A) and coronal (B) T1-weighted images show small enhancing tumor (arrows).

View larger version (110K): [in a new window]   Fig. 13B —48-year-old woman with schwannoma arising from left inferior vestibular nerve. Contrast-enhanced axial (A) and coronal (B) T1-weighted images show small enhancing tumor (arrows).

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