Deaf Accountant-Buzz 4

Question 1

A 35 year old male accountant awoke to his alarm clock but then realized that he could not hear with his left ear. He also felt nauseous and when got out of bed, he vomited. he assumed it was because of his excessive partying and alcohol consumption the night before. what are some differential diagnoses for unilateral hearing loss?

Answer 1

1. Otitis media
2. Ear wax blockage
3. Otitis externa
4. Menieres disease
5. Presbyacousis
6. CN VIII lesion
7. Otosclerosis
8. Internal Acoustic Meatus

Question 2

what are the lesions in unilateral hearing loss?

Answer 2

1. External Acoustic Meatus
2. Internal Acoustic Meatus
3. Cochlea
4. CN VIII

Question 3

He managed to get into the bathroom, and, when looking into the mirror realized that his face was asymmetric. When shaving with his razor, he cut himself twice on the left cheek because he was unable to tense the skin. What are the possible causes for asymmetric face?

Answer 3

Cortical Facial Paralysis

Peripheral Facial Paralysis

Question 4

Patient asked his wife to bring him to the hospital but she did not initially understand what he said. Based on the information this is likely to be?

Answer 4

Dysarthria (not able to articulate)

Question 5

what are some things that can cause dysarthria?

Answer 5

Frontal lobe lesion
trigeminal nerve lesion
hypoglossal nerve lesion

Question 6

patient is dysarthric with left sided face drooping, flattened left nasolabial fold, patient unable to raise his left eyebrow. He suffers from?

Answer 6

Left peripheral facial paralysis

Question 7

patient complained about a sense of fullness in his left ear and a constant high pitch ringing sound on the left side. A sense of fullness in the ear is what condition?

Answer 7

tinnitus

Question 8

Weber’s test lateralized toward the right ear.
Rinne’s Test were: r—>AC>BC, l —> AC=BC=0
what does this indicate

Answer 8

Left sensorineural hearing loss
remember that in conductive hearing loss you can never have zero.
Only way to have conductive is a BC>AC situation

Question 9

A pathological nystagmus (Slow phase to the left side) indicates a lesion where?

Answer 9

Left side
remember: that is you spin the head to the left –> excite the left labyrinth and inhibit the right –> and this activates the right abducens and left medial rectus and eyes gaze to the right –> slow phase would then be toward the left.

Question 10

Patient also had a gait disturbance and left sided ataxia. Ataxia indicates a lesion of?

Answer 10

cerebellum and cerebellar peduncle

Question 11

Left sided ataxia indicates a lesion of?

Answer 11

Left cerebellum or cerebellar peduncle

Question 12

Based on all the information given, what is this patient suffering from?

Answer 12

AICA syndrome

Question 13

Anterior Inferior Cerebellar Artery Occlusion is of the lateral pons, what are some classic symptoms associated

Answer 13

loss of pain and temp sensations over the entire contralateral side of the body (ALS) as well as on the ipsilateral face.
coupled with other motor or sensory deficits based on damage to structures these vessels serve.

Question 14

So why does the patient suffer from just unilateral hearing loss if this is a central lesion??

Answer 14

Because AICA gives off a small artery -> Labyrinthine artery
this artery wraps around the facial nerve as well as affecting the CN VIII nerve.