Session 12 Flashcards
(38 cards)
Imging madilities used to look at head and neck pathology
• Radiographs – X Ray beam onto a plate detector – Quick, Cheap, Readily Available, Low ionising radiation dose – Low Contrast (see different things), 2D images • US – Handheld probe using soundwaves – Cheap, No ionising radiation – Operator Dependent, Limited by Bone – Useful for thyroid and superficial soft tissue only • CT – X Ray beam from passing through a doughnut shaped scanner – Quick, Readily Available – High Radiation Dose • MRI – Images acquired from within a magnet • Usually shaped like a long tunnel. – Best contrast, No ionising radiation – Slow, Expensive, Limited availability
Uses – Radiographs
• Minor skull trauma – Not meeting NICE criteria for CT for head injuries. • Cervical spine trauma • Foreign bodies within neck
Uses – US
• Thyroid evaluation • Superficial head and neck masses (low or indeterminate malignancy • Superficial infection • Carotid doppler
Uses – CT
• Trauma – NICE criteria • Acute focal neurological symptoms – Particularly to evaluate for haemorrhagic strokes • Malignancy – CT Head not routine for non-melanoma staging. – Neck for tumours which spread to neck nodes. • Infection • Angiographic imaging of the arteries and veins.
Use panopto to go over nice guidelines and use LOs
Uses - MRI
• Best imaging of the brain – Tumour evaluation – Epilepsy • Cervical spinal cord traumatic injury • Head and Neck tumours
Orientation for imaging
• For Radiographs describe where you are standing in relation to the patient (if they are stood up) • Frontal (in front) • Lateral (to the side) • Oblique (at an angle)
Skull Radiograph
• Skull # (sharp lines / depressed) – Remember sutures • Pneumocranium • Fluid level • Deposits ‐ Mets / Myeloma / Pepperpot skull • Paget’s
Facial Radiograph - What to look for?
• Tripod # • Black eyebrow • Gas in orbit • TMJ dislocation • Mandible #
Orthopantomogram
panopto
Cervical spine Radiograph what to look for?
• Fractures / subluxation • Atlanto‐axial subluxation • Facet dislocation ‐ unilateral / bilateral • Vertebral erosion • Soft tissue widening • Lung lesion/pneumothorax.
Cervical spine imaging overview
use panopto
Jefferson fracture
panopto
Denis spinal columns
panopto
Caution for spinal radiographs
• RADIOGRAPHS CANNOT SEE LIGAMENTOUS INJURY • Therefore significant injury can be present with normal radiographs – Consider CT if significant mechanism of injury – Consider MRI if spinal cord injury suspected (neurology)
Subarachnoid space - Ventricles
panopto
Meningeal layers from deep to superficial
Pia mater subarachnoid space / leptomeningeal space filled with cerebrospinal fluid arachnoid mater Subdural space dura mater extra Dural space
Extradural haemorrhage
• Defined Traumatic cause • Usually Arterial Bleed – Middle meningeal artery • Biconvex • Associated with fractures (75%) • ‘Lucid interval’ • Neurosurgical emergency
slide 69 lec 1
Subdural haemorrhage
• Causes – Paediatric • Trauma or NAI – Adult • Trauma – Elderly • Trauma (often mild)
• Usually venous Bleed – Bridging veins • Crescentic • Acute – History of trauma and symptoms • Chronic – Confusion
• Correct anticoagulation – Associated with Warfarin • Small can be managed conservatively – Futher CT if deteriorate • Large or symptomatic – Neurosurgical emergency
slide 72 lec 1
Subarachnoid haemorrhage
• Causes – Trauma – Rupture Aneurysm
Subarachnoid - Trauma
• Small vessel bleeds • Peripheral hyperdensity following sulci • Can be asymptomatic • Small with normal GCS can be managed conservatively – Correct anticoagulation – Further CT if deteriorate • Consider neurosurgical opinion
Subarachnoid – Ruptured Aneurysm • Arterial bleed due to aneurysm • Central hyperdensity within subarchnoid space • Thunderclap headache • LP if normal • Neurosurgical emergency – Require angiographic imaging and treating of aneurysm
slide 76
A 47 year old woman presents with a right-sided facial droop. She first noticed this at breakfast when some juice fell out of the side of her mouth. She breaks down in tears stating her salmon tasted very bland and she is worried she is having a stroke. On further questioning, she also reports sensitivity to loud noises.
The doctor suspects a facial nerve lesion.
Where is the lesion most likely to have occurred?
panopto
slide 7 lec 2
A patient presents to the Eye Clinic with a 2 month history of blurring of vision. The doctor examines the patient’s pupillary light reflexes. On shining the light in the RIGHT eye, neither pupil reacts. However, when the light is shone in the left eye both pupils constrict
On the basis of the clinical findings described, specifically where within the pupillary light reflex is the problem?
Where is the lesion most likely to have occurred?
panopto
slide 10
Cranial Nerve II Optic
Clinical Examination
Testing function:
• Origin- retinal ganglion cells of retina
• Route • Axons converge at optic disc • Forming optic nerve • Exit via optic canal • Merge at and mix optic chiasm • Continue as optic radiations
• Function- special sense vision
Larynx pathology overview
Inflammation of supraglottis (including epiglottis)
• Epiglottitis • Rare but airway threatening! • Typical aged 2- 6 years (but also any age) • Stridor, drooling, unwell ++, ‘sniffing position’ • H. Influenzae but also Strep pneumoniae
Impaired action of vocal cords e.g. inflammation of cord(s) [laryngitis], nodule, cancer
e.g. paralysis of muscles moving vocal cord(s); injury to RLN, injury to external branch of superior laryngeal nerve, laryngospasm, laryngeal oedema
Inflammation of larynx, trachea and bronchi
• Croup (“laryngotracheobronchitis”) • Common: typically caused by parainfluenza virus • 6 months- 3 years • Characteristic ‘cough’ (seal-like bark), sometimes stridor, increased respiratory effort
- A man with an recent URTI and sore throat complains of ear pain. Examination of the ear is normal. What cranial nerve has mediated the sensation of otalgia?
- A woman drinks a glass of water too quickly, and starts to cough.
What cranial nerve(s) mediated the cough reflex? - A man uses a cotton wool bud (q-tip) to clean wax from his ear; he starts to gag. What cranial nerve has mediated this response?
use panopto
Cranial Nerve IX and X
• Both CN IX & X have some sensory function relating to the ear, but to different parts
• IX: Eustachian tube and middle ear • X: external ear (part) and TM (part)
How do we clinically examine these CNS?
panopto
