MRI appearances of the facial nerve in an HIV infected patient with acute facial nerve palsy.

MRI appearances of the facial nerve in an HIV infected patient with acute facial nerve palsy A 27 year old white HIV positive homosexual man presented with a 6 day history of right mandibular and posterior auricular pain progressing to right facial weakness on day 7. Examination showed a right lower motor neu-ron facial palsy. On MRI performed on day 7, coronal (fig A) and axial (fig B) T1 weighted unenhanced images showed swelling (arrow) and increased signal (curved arrow) of the int-racanalicular segment of the right facial nerve. Corresponding images post-Gd-DTPA (figs C, D) showed enhancement of the right intraca-nalicular segment (arrow) and the geniculate ganglion (curved open arrow). In view of the well preserved CD4+ lymphocyte count of 460 ×10 6 /l (normal: 350–2200 × 10 6 /l), lumbar puncture was not performed as CSF leucocy-tosis would not have been an indication to start antiretroviral medication. The patient wastreated with 60 mg oral prednisolone daily for 10 days. Follow up MRI on day 76 (the facial palsy having completely resolved), showed reduction in swelling and enhancement of the aVected facial nerve. Facial nerve palsy is part of the clinical range of disease resulting from HIV infection and is more common in asymptomatic patients than in those with more advanced disease.