Ressonância magnética dos nervos cranianos em doenças congênitas, traumáticas e vasculares: ensaio iconográfico

Os nervos cranianos representam extensões das estruturas funcionais do cérebro que cruzam a cabeça e o pescoço. Eles estão ligados a diferentes estruturas cranianas e se relacionam com diversas doenças. Uma compreensão profunda de sua complexa anatomia e aparência normal de imagem permite ao examinador identificar e caracterizar com mais precisão as anormalidades. A ressonância magnética com contraste é uma importante ferramenta para avaliar essas estruturas, especialmente as sequências tridimensionais de precessão livre de estado estacionário, que proporcionam alta resolução espacial e de partes moles, apesar da fina espessura dos nervos cranianos. Na maioria dos casos, os achados de imagem são inespecíficos, e uma anamnese completa, exame físico dirigido e testes laboratoriais são necessários para estreitar o diagnóstico diferencial. Este ensaio iconográfico ilustra e discute doenças congênitas, traumáticas e vasculares dos nervos cranianos, mostrando imagens em uma abordagem fisiopatológica.

Unitermos:
Neuroimagem/métodos; Radiologia/métodos; Ressonância magnética/métodos; Nervos cranianos/diagnóstico por imagem

Autoria

Mariana Dalaqua Correspondence: Mariana Dalaqua, MD. Hôpital du Valais - Service D’Imagerie Diagnostique et Interventionelle. Avenue du Grand-Champsec 80, Case postale 736, Sion, Valais 1950, Switzerland. Email: mari.dalaqua@gmail.com.

Department of Diagnostic and Interventional Imaging, Hôpital du Valais, Sion, Valais, Switzerland.Hôpital du ValaisSwitzerlandSion, Valais, SwitzerlandDepartment of Diagnostic and Interventional Imaging, Hôpital du Valais, Sion, Valais, Switzerland.

http://orcid.org/0000-0001-9360-0547

Felipe Barjud Pereira do Nascimento

Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Hospital Israelita Albert EinsteinBrazilSão Paulo, SP, BrazilImaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

http://orcid.org/0000-0003-4319-3386

Larissa Kaori Miura

Department of Radiology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.Universidade Estadual de CampinasBrazilCampinas, SP, BrazilDepartment of Radiology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.

http://orcid.org/0000-0003-0547-1795

Fabiano Reis

http://orcid.org/0000-0003-2256-4379

Márcio Ricardo Taveira Garcia

Diagnósticos da América S/A (DASA), Barueri, SP, Brazil.Diagnósticos da América S/ABrazilBarueri, SP, BrazilDiagnósticos da América S/A (DASA), Barueri, SP, Brazil.

http://orcid.org/0000-0002-9097-6546

Alcino Alves Barbosa Júnior

http://orcid.org/0000-0002-8373-0054

Correspondence: Mariana Dalaqua, MD. Hôpital du Valais - Service D’Imagerie Diagnostique et Interventionelle. Avenue du Grand-Champsec 80, Case postale 736, Sion, Valais 1950, Switzerland. Email: mari.dalaqua@gmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Diagnósticos da América S/A (DASA), Barueri, SP, Brazil.Diagnósticos da América S/ABrazilBarueri, SP, BrazilDiagnósticos da América S/A (DASA), Barueri, SP, Brazil.

Figuras

Figuras (13)

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Figure 1
Septo-optic dysplasia. A 30-year-old female with headache and constant dizziness. Coronal T2-weighted MRI scan showing absence of the septum pellucidum and hypoplasia of the optic chiasm (arrow).

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Figure 2
Septo-optic dysplasia plus. A 6-year-old male with eyelid myoclonus. Coronal T2-weighted MRI scan showing absence of the septum pellucidum and a wide cerebrospinal fluid-filled cleft (arrow) in the right frontal lobe (extending from the polar region to the medium convexity) and the anterior horn of the right lateral ventricle, wrapped in a thickened cortex. The right Sylvian fissure was flat and vertical, with thickened cortical segments, and there was, on the ipsilateral side, polymicrogyria of the insula and frontal operculum (not shown).

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Figure 3
Absence and hypoplasia of the abducens nerve. A one-month-old male with congenital lateral rectus muscle palsy and globe retraction and presenting upshoot and downshoot with certain eye movements, therefore being diagnosed with Duane syndrome. Axial 3D-SSFP MRI sequence showing the right abducens nerve (arrow), whereas the left one is not visible.

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Figure 4
Moebius syndrome. Axial and sagittal 3D-SSFP MRI sequences (A and B, respectively) showing the absence of the facial nerve (arrow).

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Figure 5
Olfactory bulb trauma. A 35-year-old male with anosmia after cranial trauma. Coronal fluid-attenuated inversion recovery MRI sequence showing a hyperintense signal in the olfactory bulbs (arrows).

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Figure 6
Abducens nerve trauma. A 50-year-old male with convergent strabismus after a motor vehicle accident. A: Axial contrast-enhanced T1-weighted spoiled gradient-recalled MRI sequence showing enhancement of the abducens nerve. B: Axial T2-weighted MRI scan showing a hyperintense signal, consistent with acute denervation, in the left lateral rectus muscle.

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Figure 7
Facial nerve trauma. CT scans showing a transverse fracture of the left mastoid (arrows in A), resulting in incudomalleolar dislocation (arrow in B) and fracture of the canal of the tympanic segment of the facial nerve (arrow in C).

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Figure 8
Cervical internal carotid artery aneurysm. An 82-year-old male with swallowing disturbance. CT angiography (coronal/sagittal in A; axial in B) showing a vascular loop with a partially thrombosed aneurysm in the right internal carotid artery (arrows in A and B). The lesion is along the course of the hypoglossal nerve.

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Figure 9
Ophthalmic artery aneurysm. A 65-year-old female with right temporal visual loss. Sagittal 3D time-of-flight magnetic resonance angiography (A) showing an aneurysm at the origin of the right ophthalmic artery (arrow). Coronal T2-weighted MRI scan (B) showing compression of the medial surface of the right optic nerve (oblique arrow) by the aneurysm (horizontal arrow).

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Figure 10
Neurovascular conflict. A 68-year-old female with right trigeminal neuralgia. Axial contrast-enhanced T1-weighted MRI scan showing a tortuous right superior cerebellar artery loop (medial arrows), tapering and displacing (laterally and inferiorly) the cisternal segment of the right trigeminal nerve (lateral arrow), including its origin at the pons.

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Figure 11
Carotid artery dissection. A 48-year-old male with sudden left cervical pain accompanied by gustatory changes. Axial T1-weighted fat-saturated MRI sequence (A) and coronal 3D time-of-flight magnetic resonance angiography (B) showing signs of recent dissection of the left internal carotid artery, depicting a crescent-shaped mural hematoma of methemoglobin, causing moderate to severe stenosis of the distal cervical segment. The accompanying focal dilation (0.7 cm) in the upper cervical segment is consistent with a pseudoaneurysm.

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Figure 12
Carotid-cavernous fistula. Axial CT angiography showing dilation and early enhancement of the cavernous sinus and superior ophthalmic vein, resulting in right exophthalmia and convergent strabismus due to abducens nerve compression

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Figure 13
Venous thrombosis. A 36-year-old male presenting with dysphagia, dysphonia, and right-sided neck pain. Coronal contrast-enhanced T1-weighted MRI scan showing a focal thrombus within the right jugular bulb and the cranial segment of the internal jugular vein, near the jugular foramen, along the course of the ninth through twelfth cranial nerves (circle), which explained the symptoms.

Figure 1 Septo-optic dysplasia. A 30-year-old female with headache and constant dizziness. Coronal T2-weighted MRI scan showing absence of the septum pellucidum and hypoplasia of the optic chiasm (arrow).

Figure 2 Septo-optic dysplasia plus. A 6-year-old male with eyelid myoclonus. Coronal T2-weighted MRI scan showing absence of the septum pellucidum and a wide cerebrospinal fluid-filled cleft (arrow) in the right frontal lobe (extending from the polar region to the medium convexity) and the anterior horn of the right lateral ventricle, wrapped in a thickened cortex. The right Sylvian fissure was flat and vertical, with thickened cortical segments, and there was, on the ipsilateral side, polymicrogyria of the insula and frontal operculum (not shown).

Figure 3 Absence and hypoplasia of the abducens nerve. A one-month-old male with congenital lateral rectus muscle palsy and globe retraction and presenting upshoot and downshoot with certain eye movements, therefore being diagnosed with Duane syndrome. Axial 3D-SSFP MRI sequence showing the right abducens nerve (arrow), whereas the left one is not visible.

Figure 4 Moebius syndrome. Axial and sagittal 3D-SSFP MRI sequences (A and B, respectively) showing the absence of the facial nerve (arrow).

Figure 5 Olfactory bulb trauma. A 35-year-old male with anosmia after cranial trauma. Coronal fluid-attenuated inversion recovery MRI sequence showing a hyperintense signal in the olfactory bulbs (arrows).

Figure 6 Abducens nerve trauma. A 50-year-old male with convergent strabismus after a motor vehicle accident. A: Axial contrast-enhanced T1-weighted spoiled gradient-recalled MRI sequence showing enhancement of the abducens nerve. B: Axial T2-weighted MRI scan showing a hyperintense signal, consistent with acute denervation, in the left lateral rectus muscle.

Figure 7 Facial nerve trauma. CT scans showing a transverse fracture of the left mastoid (arrows in A), resulting in incudomalleolar dislocation (arrow in B) and fracture of the canal of the tympanic segment of the facial nerve (arrow in C).

Figure 8 Cervical internal carotid artery aneurysm. An 82-year-old male with swallowing disturbance. CT angiography (coronal/sagittal in A; axial in B) showing a vascular loop with a partially thrombosed aneurysm in the right internal carotid artery (arrows in A and B). The lesion is along the course of the hypoglossal nerve.

Figure 9 Ophthalmic artery aneurysm. A 65-year-old female with right temporal visual loss. Sagittal 3D time-of-flight magnetic resonance angiography (A) showing an aneurysm at the origin of the right ophthalmic artery (arrow). Coronal T2-weighted MRI scan (B) showing compression of the medial surface of the right optic nerve (oblique arrow) by the aneurysm (horizontal arrow).

Figure 10 Neurovascular conflict. A 68-year-old female with right trigeminal neuralgia. Axial contrast-enhanced T1-weighted MRI scan showing a tortuous right superior cerebellar artery loop (medial arrows), tapering and displacing (laterally and inferiorly) the cisternal segment of the right trigeminal nerve (lateral arrow), including its origin at the pons.

Figure 11 Carotid artery dissection. A 48-year-old male with sudden left cervical pain accompanied by gustatory changes. Axial T1-weighted fat-saturated MRI sequence (A) and coronal 3D time-of-flight magnetic resonance angiography (B) showing signs of recent dissection of the left internal carotid artery, depicting a crescent-shaped mural hematoma of methemoglobin, causing moderate to severe stenosis of the distal cervical segment. The accompanying focal dilation (0.7 cm) in the upper cervical segment is consistent with a pseudoaneurysm.

Figure 12 Carotid-cavernous fistula. Axial CT angiography showing dilation and early enhancement of the cavernous sinus and superior ophthalmic vein, resulting in right exophthalmia and convergent strabismus due to abducens nerve compression

Figure 13 Venous thrombosis. A 36-year-old male presenting with dysphagia, dysphonia, and right-sided neck pain. Coronal contrast-enhanced T1-weighted MRI scan showing a focal thrombus within the right jugular bulb and the cranial segment of the internal jugular vein, near the jugular foramen, along the course of the ninth through twelfth cranial nerves (circle), which explained the symptoms.

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Ressonância magnética dos nervos cranianos em doenças congênitas, traumáticas e vasculares: ensaio iconográfico

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[1] Correspondence: Mariana Dalaqua, MD. Hôpital du Valais - Service D’Imagerie Diagnostique et Interventionelle. Avenue du Grand-Champsec 80, Case postale 736, Sion, Valais 1950, Switzerland. Email: mari.dalaqua@gmail.com.