Neurologic evaluation
- Indicate what each of these findings means
No carotid or vertebral bruits
Vertebral artery compression test is negative
Normal ocular fixation
Pupils are round, reactive and isocoric, no ptosis.
Tongue is midline
No upper extremity drift; no focal weakness of arms or legs
Reflexes are 2 throughout
Plantar stimulation elicits a flexor response bilaterally
Normal gait, stance, romboid and tandem
Positioning and position tests are negative; Dix-Hallpike is negative
There is no dysmetria, discoordination, past pointing or synkinesis
On Valsavlva she was not able to insufflate either ear, the maneuvers did not produce vertigo or nystagmus
MRA, MRV and MRI of the brain are ordered. CT scan ordered. (And as seen previously, audiogram and VEMP was ordered).
MRA and MRV
- Indicate what each of these findings means
No carotid or vertebral bruits
Vertebral artery compression test is negative
Normal ocular fixation
Pupils are round, reactive and isocoric, no ptosis.
Tongue is midline
No upper extremity drift; no focal weakness of arms or legs
Reflexes are 2 throughout
Plantar stimulation elicits a flexor response bilaterally
Normal gait, stance, romboid and tandem
Positioning and position tests are negative; Dix-Hallpike is negative
There is no dysmetria, discoordination, past pointing or synkinesis
On Valsavlva she was not able to insufflate either ear, the maneuvers did not produce vertigo or nystagmus
MRA, MRV and MRI of the brain are ordered. CT scan ordered. (And as seen previously, audiogram and VEMP was ordered).
MRA and MRV reports came back with the following impressions “Unremarkable screening survey of the proximal intracranial arterial circulation” and “no evidence of dural venous sinus thrombosis.”
- What is sinus thrombosis?
MRI complete findings were “No hydrocephalus is seen. The left ventricle is slightly larger than the right which could be a variant of normal. Right maxillary sinus is small, presumably congenital. No acute infarct is seen on diffusion weighted images. No suspicious foci seen with brain parenchyma. No fluid is seen within the paranasal sinuses or mastoid.”
- Interpret “no acute infarct”
- What is the brain parenchyma, and what would “suspicious foci” be?
- What does absence of fluid in the sinuses/mastoid indicate? Is that a good or bad finding?
CT scans
Technique: multiple continuous axial CT images were obtained through the temporal bone without administration of intravenous contrast. Coronal and sagittal reconstructions were also obtained.
- When is imaging ordered with and without contrast, and just what is “contrast”?
- What does a CT image do, what are axial, coronal and sagittal images?
Findings: There is bilateral superior semicircular canal dehiscence. Otherwise, the osseous labyrinths are unremarkable in appearance bilaterally. The bony facial nerve canals are intact. The ossicles are intact. The tegment tympani and mastoid are intact. The mastoid cells are well pneumatizied and well-aerated. No suspicious lytic or sclerotic osseous lesions are seen.
- What is superior canal dehiscence?
- What is the tegmen tympani?
- What is a lytic lesion?