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ENT
Neurotologic Manifestations of Stroke
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
9 sections · 112 slides
Overview
- Scope of this topic
- Epidemiology and burden of stroke
- Functional outcome after stroke
- Care team in neurotologic stroke
Peripheral vascular compromise
- Prevalence of hearing loss
- Prevalence of vestibular dysfunction
- Sound conduction from pinna to cochlea
- Cochlear transduction and the auditory nerve
- Vestibular end organs and their reflexes
- Arterial supply of the inner ear
- Branches of the labyrinthine artery
- Territories of the labyrinthine branches
- Labyrinthine artery branching sequence
- Occlusion of the labyrinthine artery
- Differential ischaemic vulnerability in the inner ear
- Labyrinthine infarction as a marker of AICA stroke
Central vascular compromise
- Central auditory dysfunction after stroke
- Presentations of central dizziness
- Localising features of vertebrobasilar stroke
Anatomy of the posterior circulation
- Normal vertebrobasilar angiographic anatomy
- Segments of the vertebral artery
- The three long circumferential arteries
- Terminal branches of PICA
- Posterior fossa vasculature and brainstem perforators
- Perforator supply of the brainstem
- Arterial supply along the auditory pathway
- Auditory pathway by arterial territory
Brainstem and cerebellum
- Overview of brainstem structure
- Dorsal column and pyramidal pathways in the medulla
- The inferior olive and the fourth ventricle
- Midbrain and pontine surface anatomy
- Nuclei on the floor of the fourth ventricle
- Nuclei of the rostral medulla
- Cranial nerve exit points in the brainstem
- Cerebellar peduncles and afferent fibres
- Deep cerebellar nuclei and their output
- Functional zones of the cerebellum
- Clinical syndromes of cerebellar lesions
- Cerebellar lesion localisation
Imaging of acute stroke
- Sequence of acute stroke imaging
- Acute stroke imaging pathway
- Acute infarction on non-contrast CT
- Signs of acute infarction on non-contrast CT
- Basilar tip thrombosis on CT angiography
- CT perfusion showing ischaemia without infarction
- Interpreting CT perfusion maps
- Core infarct versus ischaemic penumbra
- MRI acute stroke protocol
- Restricted diffusion in acute infarction
- Diffusion imaging and the T2 shine-through pitfall
- Severe carotid stenosis on contrast-enhanced MRA
- MR perfusion showing brain at risk beyond the core
- MR perfusion and MRA in the stroke protocol
Topographic syndromes
- Acute lateral medullary infarct with vertebral dissection
- Onset and vestibular features of lateral medullary infarction
- Oculomotor and sensory findings in lateral medullary infarction
- Frequency of clinical features in lateral medullary infarction
- Patterns of sensory dysfunction in lateral medullary infarction
- Vascular territories of the cerebellum
- Three cerebellar arterial territories
- Epidemiology and symptoms of cerebellar infarction
- Red flags in the dizzy patient
- Acute right PICA territory cerebellar infarct
- Patterns of PICA territory infarction
- Medial PICA infarct versus vestibular neuritis
- Sudden deafness from PICA territory infarction
- Wallenberg's syndrome
- Localising the signs of Wallenberg's syndrome
- Territory of the anterior inferior cerebellar artery
- Clinical features of AICA infarction
- Hearing loss in AICA infarction
- Vertebrobasilar insufficiency and isolated dizziness
- Acute superior cerebellar artery territory infarcts
- Classical clinical picture of SCA infarction
- Actual presentation of SCA infarction
- Vertigo as a discriminator between cerebellar territories
- Acute left temporal lobe infarct
- Cortical deafness
- Auditory agnosia and its subtypes
HINTS in acute vestibular syndrome
- Burden of dizziness in the emergency department
- Diagnostic performance of HINTS
- Nystagmus patterns in acute vestibular syndrome
- Technique of the bedside head impulse test
- Interpretation of the head impulse test
- Test of skew technique and meaning
- The three components of HINTS
- Action after a central HINTS result
- Additional bedside signs favouring stroke
- AICA stroke despite a positive head impulse test
- Peripheral versus central acute vestibular syndrome
Summary
- Key anatomical facts
- Key clinical rules
- Key imaging rules
- Conclusion
- References
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- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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