뇌신경마비를 동반한 두개저부골절에서의 자기공명영상촬영의 진단적 가치

초록

To report a case of basal skull fracture with multiple cranial nervep alsies and another case of basal skull fracture with carotid artery occlusion in children, and to discuss their MRI finding and its value in diagnosis. CASE 1. A 5-year-old boy, suffered a occipital skull fracture with extraocular movement limitation and facial palsy. Axial CT scan of head showed left occipital and temporal bone fracture and Brain MRI showed severe swelling of left facial nerve. This clinical presentation correlated well with the anatomical location and extension of the respective cranial nerves at the level of the skull base and the fracture line extending from occipital to temporal bone. Case 2. Another case of 9-year old man suffering a stuporous consciousness. The head CT revealed both occipital and left temporal bone fracture and the brain MRI showed left proximal ICA occlusion and left cerebellar and pontine infarction.First case, MRI of the skull base revealed severe swelling of the VII and VIII nerve. And 4-month follow up of the patient showed partial improvement in the VI, VII and the VIII function. Second case, MRI and MRA of the brain on day 5 revealed infarction in left cerebellum, brain stem and occlusion of left proximal ICA. The consciousness of this patient was improved but hearing deficit remained unchanged.Initial neurological and neuroradiological investigations should be aimed at promptly detecting cranial nerve injuries and their correlating fracture at the skull base. Computed tomography of the head is superior in detecting basal skull fracture but confirmative diagnosis of the complications of basal skull fracture such as multiple cranial nerve injury and vascular injury using MRI is also necessary, to explain the clinical manifestation exactly and to give optimal management