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Nerve damage/possible mass near ear?
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Nerve damage/possible mass near ear?

Here's the perplexing case:

Patient suffers from frequent mirgraines.
Patient decides to have an MRI without contrast.
MRI reveals herniated disc in neck and "something else" near ear?
Neurologist asks patient if she had a recent concussion or injury to the brain. Patient says no. Neurologist asks if patient has trouble hearing. Patient says no.  
Neurologist is evasive in telling patient what the test reveals, subsequently orders further tests in office - e.g. nerve testing on hands. Test results have yet to come back.
Neurologist is concerned and requests second MRI, yet still refuses to tell patient what the other image in the MRI revealed. Patient is now waiting to schedule another MRI.

Is this a tumor, nerve damage, or some other brain malady? Thank you for your time.




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Avatar_n_tn
Hi.

The nerve conduction tests were probably done to determine any nerve injury secondary to the disk herniation found on MRI. Please share with us this information once the results come in.

Do you have the reports of the MRI findings? It would be difficult to say whether the findings on MRI are associated with a tumor or some other brain condition without the imaging results.

It would be best for the patient to wait for the second MRI to be done and talk with the neurologist about this. The second MRI might provide more clues as to the etiology of the lesion.

Hope this helps.
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Avatar_n_tn
Dear Dr. Godofredo,

Thank you for responding. I finally obtained the MRI reports. I would like a second opinion:

PATIENT'S DOB: 1944
12/28/2007 MRI BRAIN WO CONTRAST

Examination consists of T1 weighted sagittal and axial images, T2 weighted axial and FLAIR axial images through the head. No intravenous contrast was administered.

The ventricular system and cortical sulci are midly diffusely prominent consistent with mild cerebral atrophy. There is a mild periventricular T2 signal hyperintesnity appropriate for the patient's age.

No focal mass or focal infarcts are idenified within the brain parenchyma supratentorially or infratentorially.

There is asymmetry of the seventh and eight nerve bundles with that on the right being larger than that on the left. There is particularly increased soft tissue signal related to the seventh and eighth nerve bundles on this noncontrast MRI. This signal alteration measures approximately 4x 1.7 cm in dimension.

The cochlea and vestibule are normal.

The optic globes and retrobular soft tissues are normal.

Paranasal sinuses are remarkable for the presence of mild mucosal thickening to the right maxillary.

IMPRESSION:

1. Mild cerebral atrophy
2. Asymmetry of the seventh and eighth nerve bundles with the right being larger than the left. Possibility of acoustic neuroma is considered (see sagittal images #8 and axial images #36 & #56). Correlation with thin pre and postcontrast MRI through the posterior fossa is recommended.

1/9/08 MRI ADDITIONAL VIEWS

TECHNIQUE: MRI of the brain was performed in multiseuquential, multiplanar images. No contrast was performed due to patient's refusal.

FINDINGS: There is a small soft tissue mass at the region of the right cerebellopontine asngle compatible with an intracanalicular vestibular cochlear schwannoma on the right. The left intracanalicular region is unremarkable.

The remainder of the brain parenchyma is unremarkable. There is no intracranial hemorrhage, mass, mass effect, or midline shift.

The sucli, ventricles, and cisterns are normal for the patient's age.

There is no evidence of fracture.

IMPRESSION: Small soft tissue mass suggestive of intracanalicular vestibular cochlear schwannoma on the right. For further confirmation, contrast enhanced MRI of the brain may provide additional information.
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