Neuro-ENT Flashcards
When should a neuro exam always be considered in ENT?
Unilateral otological symptoms
What otology symptoms can present in:
Meningitis?
Vascular Brainstem Occlusion?
MS?
Profound deafness
Vertigo/hearing loss
Vertigo/facial weakness
Describe the route and divisions of the facial nerve
Pons/Medulla → Across posterior fossa → IEM with CN8 → Geniculate ganglion (temporal bone)
Gives off greater petrosal / stapedius nn / chord tympani
→ Thru stylomastoid foramen
Gives off Posterior Auricular nn
→ Thru parotid
Temporal/Zygomatic/Buccal/Marginal-Mandib/Cervical
What is the function of the greater petrosal nn?
And the stapedius nn / chord tympani?
→ Secretory-motor to glands
→ Anterior 2/3rd tongue
What are the causes of a UMN facial nn palsy? (3)
= Damage above facial nucleus (motor cortex/pons) Iatrogenic Tumour Neurological Vascular (TIA)
How would a UMN facial nn palsy present?
How would a LMN facial nn palsy present?
UMN: total facial weakness BUT FOREHEAD SPARING (innv contralat motor cortex)
LMN: total facial weakness
What happens in Bell’s Palsy?
How does it present?
How is it managed?
Viral infection of CN7 → swells in bony canal → compression + dysfunction
Preceding UTRI + sudden onset facial palsy
If presenting within 48hrs → high-dose steroid
If later → usually self-resolves (some permanent)
What specific clinical features are seen in Bells Palsy? (BELLS P)
Blink reflex abnormal Earache Lacrimation (defc/excess) Loss of taste Sudden onset Palsy of CN7 nerves
What is the worst kind of skull fracture with regards to facial nerve palsy?
Temporal bone TRANSVERSE (10-20%)
High risk CN7 damage + sensorineural loss
What surgical sites risk facial nn damage? (3)
Parotid
Mastoid
Middle ear
What infections can cause CN7 damage? (2)
Herpes Zoster
Malignant Otitis Externa
What is Ramsay Hunt Syndrome
What are the clinical features (3+2)
Treatment
Herpes zoster (shingles) of facial nerve around ears
Facial palsy / pain / vesicles on drum canals pinna)
+ Poss also vertigo + deafness
Aciclovir (only effective if given early)
What are some intracranial causes of facial nn palsy? (3)
Cerebral ischaemia (stroke) PCA lesions (e.g. aneurysm) MS
What sites may a facial nn tumour (rare) arise in? (4)
PCA
Petrous bone
External/middle ear
Parotid
What types of tumour can occur in the parotid? (3)
What extent of facial nn damage would a tumour/mass cause?
What extent would a smaller mass/surgical damage cause?
Benign pleomorphic adenoma
SCC
Adenocarcinoma
Large mass → complete unilateral LMN palsy
Smaller/surgical → paralysis of certain muscle groups (divides into 5)
What are the 3 categories of causes of vertigo
Peripheral
Central
Cardiovascular
List the peripheral causes of vertigo (6)
Vestibular neuronitis Labyrinthitis Vestibular migraine BPPV Meniere's Drugs
List the central causes of vertigo (5)
Intoxication Post-trauma Space occupying lesions Degenerative diseases (presbyastasis) Vascular processes (presbyastasis)
List the cardiovascular causes of vertigo/dizziness (6)
Postural hypotension Hypertension Hyperventilation Arrhythmias Vasovagal Drugs
What causes vestibular neuronitis?
What are the main features
How is it treated?
Viral infection (usually) of vestibular portion of CN8
Vertigo ± Tinnitus (not hearing loss)
Vestibular sedatives / rest (same as labyrinthitis)
Resolution occurs in wks with compensation
What causes labyrinthitis? (4)
If severe, what can it lead to?
How is it treated?
Usually URTI
Can also be: Middle ear infection, Intracranial sepsis, via blood
Severe → hearing loss + total vestibular destruction
Abx / Vestibular sedatives / rest
Cooksey-Cawthorne exercises
Gradually compensates
Describe the pathophysiology behind BPPV
What are the clinical features (2)
Dislodged otoliths in posterior semicircular canal → irritation with particular movements
Episodic positional vertigo (e.g. turn in bed) lasting mins
+ poss also nystagmus (towards affected ear)
How is BPPV Dx?
How is it managed (4)
Dx with Hallpike manoeuvre
Reassurance that will settle
Epley’s manœuvre
Avoid vestibular sedatives (slows compensation)
Surgery (rarely) on posterior semicircular canal
Presbyastasis:
Causes
Features
Treatment
Small vessel disease in brain (esp elderly)
Momentary unsteadiness (no nausea/vom)
self-limiting / no satisfactory medical Tx
