PMC6931020_01
(a) Full left facial droop. (b) Left otic vesicles on the pinna.
CRIOT2019-7605056.001.jpg
PMC6931020_01_CRIOT2019-7605056.001.jpg
fig1
On hospital day two, the patient's condition continued to worsen and neurological exam indicated left cranial nerve (CN) VI and VII nerve palsies, horizontal diplopia of the left eye, conductive hearing loss, skew deviation, and persistent herpetic lesions on the hard palate and the outer ear (Figure 1).
FLAIR (fluid-attenuated inversion recovery) images. (a) Focus of increased signal intensity noted at the level of the fourth ventricle involving the left CN VI (abducens) nucleus, left CN VII (acial) nucleus, and left middle cerebellar peduncle. (b) Focus of increased signal extends caudally to the level of the cerebellar vermis involving the middle cerebellar peduncle. (c) Further to the level of the cerebellar vermis with involvement of the medulla oblongata and left pyramid. (d) Terminating at the level of the cerebellar tonsils involving the left inferior cerebellar peduncle (restiform body).
CRIOT2019-7605056.002.jpg
PMC6931020_01_CRIOT2019-7605056.002.jpg
fig2
Brain MRI showed a hyperintense lesion along the left middle and inferior cerebellar peduncle along the fourth ventricle (Figures 2-4).
T2 images. (a) Focus of the increased signal at the level of the fourth ventricle involving the middle cerebellar peduncle. (b) Focus of the increased signal at the level of the cerebellar vermis involving the inferior cerebellar peduncle.
CRIOT2019-7605056.003.jpg
PMC6931020_01_CRIOT2019-7605056.003.jpg
fig3
Brain MRI showed a hyperintense lesion along the left middle and inferior cerebellar peduncle along the fourth ventricle (Figures 2-4).
(a) T1 postcontrast image: lesion demonstrates lack of contrast enhancement. (b) Diffusion-weighted image (DWI) b1000: lesion demonstrates area of restricted diffusion at the level of the fourth ventricle involving the middle cerebellar peduncle.
CRIOT2019-7605056.004.jpg
PMC6931020_01_CRIOT2019-7605056.004.jpg
fig4
Brain MRI showed a hyperintense lesion along the left middle and inferior cerebellar peduncle along the fourth ventricle (Figures 2-4).