Facial Paresis and Pulsatile Middle Ear Mass

Significance Statement Head and neck paragangliomas are uncommon pathologies that present with common symptoms such as pulsatile tinnitus and aural pressure. This article highlights an unusual presentation of a patient with facial paresis who was found to have a jugular paraganglioma. Emphasis is placed on how the otologic examination showed a pulsatile middle ear mass that led to the diagnosis. This case illustrates the importance of maintaining a healthy degree of clinical suspicion when encountering common complaints.

The Sensorineural Hearing Loss Related to a Rare Infratentorial Developmental Venous Angioma: A Case Report and Review of Literature

Background Developmental venous anomaly (DVA) is a benign venous abnormality draining normal brain parenchyma. It is mostly asymptomatic; however, rare complications such as hemorrhage may lead to symptomatic conditions. Headache and seizure are the most common symptoms. Hearing loss is an extremely rare presentation of DVA. To our knowledge, only five cases of DVA, presenting with hearing loss, had been reported so far. Case Presentation We report the case of a 27-year-old woman who presented with a sensorineural hearing loss followed by facial paresis. Magnetic resonance imaging (MRI) and computed tomography (CT) angiography revealed hematoma with adjacent converging veins showing a typical “caput medusa” sign in the left middle cerebellar peduncle, in favor of DVA. Due to the compression effect of hematoma, she underwent surgery. Hearing loss and facial paresis improved significantly during the postoperative follow-up. Conclusion Although DVA is mostly benign and asymptomatic, complications such as hemorrhage rarely occur. Hearing loss is an extremely rare presentation that can be attributable to the compression effect on the cranial nerve VII to VIII complex. In the case of compression effect or progression of symptoms, surgical intervention is necessary. A good clinical outcome could be expected postoperatively.

Facial nerve preservation in stereotactic radiosurgery of tumors of the cerebellopontine cistern

Introduction. Surgery has traditionally remained the main treatment for tumors of the cerebellopontine cistern but is associated with high risks of dysfunction of the cranial nerves. Radiosurgery is usually performed both as an adjuvant treatment and as an independent option.The study objective is to assess the safety of routine use of radiosurgery to preserve facial nerve function in the treatment of tumors of different origins located in the cerebellopontine cistern.Materials and methods. Since March 2018 to March 2020 there were 145 patients with tumors of cerebellopontine cistern (CPC) at the Center for High-Precision Radiology. Vestibilar schwannomas were detected in 116 (80 %) patients, in 37 cases - relapses or remains after surgery. The 22 patients had meningiomas, 6 after open surgery (WHO I). Trigeminal schwannomas - in 3 patients, facial schwannomas - in 2, jugular schwannomas - in 1 and metastasis of prostate cancer - in 1. 31 patients had facial paresis of different degrees after previous surgery. Among non-operated patients, facial paresis before radiosurgery was observed in only 1 patient. Radiosurgery was performed using the Leksell Gamma Knife Perfexion, the mean marginal dose was 12.2 Gy (11-15 Gy), the mean tumor volume was 3.98 cm3 (0.06-17.47 cm3).Results. Follow-up was performed in 85 patients. The mean follow-up was 359.3 days (91-776), the median follow-up was 367 days. Reduction of the tumor volume was detected in 27 patients, stabilization of the process in 15. The average decrease was 23.9 % (95 % CI 16.8-31.0 %). Transient postirradiation increase was observed in 30 patients only in the group of schwannomas and mean tumor volume increase was 53.7 % (95 % CI 38.5-68.9 %). In patients with previous surgery there were not cases of decline or regression facial paresis. Among patients who had not been operated on before radiosurgery, only in 1 case was the development of facial paresis (House-Brackman III) 5 months after irradiation, which amounted to 1.8 %. It should be especially noted that facial nerve function remained unchanged (House-Brackman I) in both patients with facial schwannomas. Also, not a single case of hemifacial spasm was identified.Conclusion. Radiosurgery of CPC tumors with a marginal dose from 12 to 15 Gy has a high degree of safety in relation to the facial nerve. This makes it possible to justify radiosurgery as alternative to traditional neurosurgical interventions.

The course of facial corticobulbar tract fibers in the dorsolateral medulla oblongata

Background The course of the corticobulbar tract (CBT) to the facial nucleus has been investigated by some previous studies. However, there are some unclear points of the course of the CBT to the facial nucleus. This study aimed to elucidate the detailed course of the CBT to the facial nucleus through the analysis of lateral medullary infarction (LMI) cases. Methods The neurological characteristics and magnetic resonance imaging findings of 33 consecutive patients with LMI were evaluated. The location of the lesions was classified rostro-caudally (upper, middle, or lower) and horizontally. Further, we compared the neurological characteristics between the groups with and without central facial paresis (FP). Results Eight (24%) patients with central FP ipsilateral to the lesion were identified. Dysphagia and hiccups were more frequently observed in the group with central FP than in the group without central FP. In patients with central FP, middle medullary lesions and those including the ventral part of the dorsolateral medulla were more frequently observed. Contrastingly, patients with lesions restricted to the lateral and dorsal regions of the dorsolateral medulla did not present with central FP. Conclusion The results of this study indicate that the CBT to the facial nucleus descends with the corticospinal tract at least to the middle portion of the medulla, and then ascends to the facial nucleus through the medial and ventral areas of the dorsolateral medulla after decussation.

Aneurysmal Bone Cyst (ABC) Involving Petrous Apex Treated by Microsurgical Removal: A Case Report

Aneurysmal bone cyst (ABC) is a benign progressive expansile bone lesion that usually involves often located in vertebrae, long tubular bones and flat bones. A small percentage of aneurysmal bone cysts arise from the skull base. Skull base involvement is very rare. Here, we describe a 22-year young man presented with diplopia, right sided facial paresis and right sided sensori-neural hearing loss. CT scan and MRI showed a right petrous apex skull base mass that was confirmed as ABC in histopathology after surgical removal. Journal of Science Foundation, January 2020;18(1):25-28

Peripheral Facial Paresis and COVID-19 Case Report

Among the neurological complications that occurred during Corona Virus Disease 2019 (COVID-19) infection, peripheral facial paresis is one of the conditions that can occur both during and after the Severe Acute Respiratory Tract Syndrome Corona Virus 2 (SARS-CoV-2) infection period. We present the case of a young man, aged 29 years, who presented the appearance of a peripheral facial paresis on the 14th day after the onset of symptoms, isolation and PCR detection of SARS-CoV-2 infection. The patient was evaluated clinically, neurologically, underwent laboratory tests, EKG, chest Radiography, Magnetic Resonance Imaging (MRI)/Magnetic resonance Angiography (MRA) and received corticotherapy, gastric antisecretory medication, antiviral medication, vitamin B group, neurotrophic medication and facial gymnastics, with good evolution and complete remission of clinical symptoms after 21 days. It is particularly important to carefully evaluate patients during the isolation period, symptomatic/asymptomatic for COVID-19 infection, as a possible complication could be peripheral facial paresis, which is why, we should evaluate, detect and treat early to reduce any persistent long-term neurological effects. Future studies are needed to identify and correlate peripheral facial paresis with SARS-CoV-2 infection as well as to detect the causes of neurological complications during or after COVID-19 infection.