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ENT > Neuro-ENT > Flashcards

Neuro-ENT Flashcards

1
Q

When should a neuro exam always be considered in ENT?

A

Unilateral otological symptoms

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2
Q

What otology symptoms can present in:
Meningitis?
Vascular Brainstem Occlusion?
MS?

A

Profound deafness
Vertigo/hearing loss
Vertigo/facial weakness

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3
Q

Describe the route and divisions of the facial nerve

A

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

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4
Q

What is the function of the greater petrosal nn?

And the stapedius nn / chord tympani?

A

→ Secretory-motor to glands

→ Anterior 2/3rd tongue

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5
Q

What are the causes of a UMN facial nn palsy? (3)

A 
= Damage above facial nucleus (motor cortex/pons)
Iatrogenic
Tumour
Neurological
Vascular (TIA)
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6
Q

How would a UMN facial nn palsy present?

How would a LMN facial nn palsy present?

A

UMN: total facial weakness BUT FOREHEAD SPARING (innv contralat motor cortex)
LMN: total facial weakness

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7
Q

What happens in Bell’s Palsy?
How does it present?
How is it managed?

A

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)

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8
Q

What specific clinical features are seen in Bells Palsy? (BELLS P)

A 
Blink reflex abnormal
Earache
Lacrimation (defc/excess)
Loss of taste
Sudden onset
Palsy of CN7 nerves
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9
Q

What is the worst kind of skull fracture with regards to facial nerve palsy?

A

Temporal bone TRANSVERSE (10-20%)

High risk CN7 damage + sensorineural loss

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10
Q

What surgical sites risk facial nn damage? (3)

A

Parotid
Mastoid
Middle ear

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11
Q

What infections can cause CN7 damage? (2)

A

Herpes Zoster

Malignant Otitis Externa

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12
Q

What is Ramsay Hunt Syndrome
What are the clinical features (3+2)
Treatment

A

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)

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13
Q

What are some intracranial causes of facial nn palsy? (3)

A 
Cerebral ischaemia (stroke)
PCA lesions (e.g. aneurysm)
MS
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14
Q

What sites may a facial nn tumour (rare) arise in? (4)

A

PCA
Petrous bone
External/middle ear
Parotid

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15
Q

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?

A

Benign pleomorphic adenoma
SCC
Adenocarcinoma

Large mass → complete unilateral LMN palsy
Smaller/surgical → paralysis of certain muscle groups (divides into 5)

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16
Q

What are the 3 categories of causes of vertigo

A

Peripheral
Central
Cardiovascular

17
Q

List the peripheral causes of vertigo (6)

A 
Vestibular neuronitis
Labyrinthitis
Vestibular migraine
BPPV
Meniere's
Drugs
18
Q

List the central causes of vertigo (5)

A 
Intoxication
Post-trauma
Space occupying lesions
Degenerative diseases (presbyastasis)
Vascular processes (presbyastasis)
19
Q

List the cardiovascular causes of vertigo/dizziness (6)

A 
Postural hypotension
Hypertension
Hyperventilation
Arrhythmias
Vasovagal
Drugs
20
Q

What causes vestibular neuronitis?
What are the main features
How is it treated?

A

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

21
Q

What causes labyrinthitis? (4)
If severe, what can it lead to?
How is it treated?

A

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

22
Q

Describe the pathophysiology behind BPPV

What are the clinical features (2)

A

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)

23
Q

How is BPPV Dx?

How is it managed (4)

A

Dx with Hallpike manoeuvre

Reassurance that will settle
Epley’s manœuvre
Avoid vestibular sedatives (slows compensation)
Surgery (rarely) on posterior semicircular canal

24
Q

Presbyastasis:
Causes
Features
Treatment

A

Small vessel disease in brain (esp elderly)
Momentary unsteadiness (no nausea/vom)
self-limiting / no satisfactory medical Tx

25
Q

What is the Dx criteria for vestibular migraine? (4)

How is it treated?

A

Episodic vestibular symps (mins)
Current/previous migraines
Exclusion of other causes (BPPV)
Migraine symps on ≥ occasions of vertigo attack

Treat same as migraines

26
Q

What are the features of central vertigo? (3+4)

A

Ataxia
Unsteadiness
Gradual feeling of being off balance

Poss Nausea/Vom / hearing loss / tinnitus

27
Q

What are the features of cardiovascular vertigo / dizziness? (4)

A

Syncope
Light-headedness
Faints
Unsteadiness

28
Q 
What is meniere's disease?
Pt presentation (triad)
A

Poss distension of membranous labyrinth / overflow of fluid

Middle aged person
Vertigo (attacks: nausea/vom/nystagmus - hrs)
Tinittus (+fullness feeling before attack)
Sensorineural hearing loss (fluctuating but deteriorating)

29
Q

What other conditions must be excluded before Dx Meniere’s disease? (6)

A

Labyrinthitis
Tumours
Epilepsy / MS / BPPV
Vascular

30
Q

List the treatment options for Menieres (5)

A 
Avoidance of caffeine/salt
Vestibular sedatives (acute)
Betahistine (vasodilator) (long-term)
Diuretics
Surgery (decompressive/chemical/destructive)
31
Q

What is nystagmus?

A

Involuntary conjugated rhythmic to/fro movements of eyes - clinical sign of vestibular abnormality

32
Q

How does it present peripherally vs centrally?

A

Peripheral - rotary/horizontal

Central - vertical/changes direction

33
Q

Which direction will nystagmus go in a:
Destructive lesion
Irritative lesion
Cerebellar lesion

A

Destructive - away from affected ear
Irritative - towards affected ear
Cerebellar lesion - ipsilateral side

ENT (6 decks)

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