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Homepage > Articles > Least to Last—Imaging the Cranial Nerves

Least to Last—Imaging the Cranial Nerves

cranialnerves

Published March 1, 2022

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Ashok Srinivasan

Clinical Professor of Radiology, Division of Neuroradiology
Associate Chair of Operations, Quality, and Safety
University of Michigan

    Presented as a featured Sunday Session at the 2022 ARRS Annual Meeting, “Cranial Nerve Imaging: From the Least to the Last” is specifically designed to explore the approaches to evaluating different symptomatology arising from cranial nerve pathologies.

    Our sense of olfaction is a vital contribution to how we experience the world, both as the sense of smell and as a strong provider to the experience of “taste.” This session will investigate olfaction from sensory bodies in the olfactory mucosa to the olfactory cortex, along with an evaluation of the myriad causes of anosmia and dysosmia.  

    Fig. 1—Anterior skull base anatomy at level of cribriform plate depicted on coronal CT and MRI images.

    Hearing loss can be caused by diseases of the external, middle, or inner ears leading to either a conductive, sensorineural, or mixed dysfunction. Imaging plays a central role in the management of these conditions by providing important diagnostic clues and detailed information to help medical and/or surgical treatment. This session offers an overview of these disease conditions and discusses important points that assist diagnosis. 

    Fig. 2—Axial CT image through temporal bone shows soft tissue lesion in epitympanum in patient with conductive hearing loss. Location of lesion and associated ossicular destruction (yellow arrow) suggest diagnosis of cholesteatoma.

    The facial nerve can be affected by a number of central and peripheral pathologies that result in weakness or paralysis of the facial musculature. Detailed knowledge of the normal course of the facial nerve is essential to recognize various pathologies. During “Cranial Nerve Imaging: From the Least to the Last,” we will review the complex imaging anatomy of the facial nerve in the brainstem, temporal bone, and extracranial soft tissues and review the characteristic imaging findings of common pathologies affecting the facial nerve. 

    Fig. 3—First image: Axial CT demonstrates abnormality (guess what?) at level of right geniculate ganglion. Second image: Axial MRI at level of pons traces course of facial nerve.

    Hoarseness is a common clinical problem with a lifetime prevalence of 30%. Initial evaluation requires clinical assessment, with endoscopy reserved for hoarseness persisting more than 2 weeks in duration without benign etiology. Imaging is important to characterize and stage laryngeal masses and to investigate other structural lesions causing hoarseness, usually from vocal cord paralysis. Reviewing anatomy relevant to the workup of hoarseness, this session will also present classic imaging examples of pathology.

    After attending this Sunday Session—presented in partnership with the American Society of Head and Neck Radiology—radiologists will have a more thorough understanding of both common and uncommon conditions affecting the cranial nerves, as well as updated insights regarding their imaging findings and treatment options.


    The opinions expressed in InPractice magazine are those of the author(s); they do not necessarily reflect the viewpoint or position of the editors, reviewers, or publisher.

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