Radiology, Vol 151, 671-676, Copyright © 1984 by Radiological Society of North America
A CT-clinical approach to patients with symptoms related to the V, VII, IX-XII cranial nerves and cervical sympathetics
A Kalovidouris, AA Mancuso and W Dillon
Forty-three patients who had signs and symptoms possibly related to the
extracranial course of cranial nerves V, VII, IX, X-XII, and the cervical
sympathetics were examined prospectively using high resolution CT to obtain
images of thin sections during rapid drip infusion of contrast material.
Anatomic areas in the scan protocols included the posterior fossa,
cavernous and paranasal sinuses, skull base, temporal bone, nasopharynx,
parotid gland, tongue base, and neck. Nine of the 23 patients with possible
fifth nerve deficits had extracranial structural lesions that explained the
symptoms; none of these nine, however, had typical trigeminal neuralgia. Of
eight patients with peripheral seventh nerve abnormalities, two had
positive findings on scans. No patient with classic Bell palsy had a
positive finding on CT. Two of five patients presenting with the Horner
syndrome had positive findings on CT. Of five patients presenting with
referred ear pain, three had carcinoma of the upper aerodigestive tract.
Our experience suggests that patients at high risk for structural lesions
responsible for cranial nerve deficits can be selected by clinical
criteria. Moreover, it is essential to extend the CT examination of such
patients beyond the skull base when clinically indicated. Protocols for
each clinical setting are presented.
