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Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
John I. Lane, MD Mayo Clinic ASNR 2016
No Disclosures
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Infection
•
Acute vertigo
•
Sudden hearing loss
•
Facial paralysis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Infection
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Infection (EAC) Malignant External Otitis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Malignant External Otitis MDCT Axial
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Malignant External Otitis MDCT Axial
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Infection (Middle Ear) Coalescent Mastoiditis Labyrinthitis Meningitis / cerebral abscess Dural venous thrombosis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Complication of acute otitis media
Coalescent Mastoiditis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Complication of acute otitis media
Mastoiditis + subperiosteal abcess
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Complication of acute otitis media
Mastoiditis + subperiosteal abcess
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Complication of acute otitis media
Courtesy of Dave DeLone. MD
Mastoiditis + Bezold’s abcess
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Complication of acute otitis media
Labyrinthitis / Ossificans
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Complication of acute otitis media
Subdural Sequestrum Abscess Labyrinthine
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Complication of acute otitis media
Cerebral Abscess
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Complication of acute otitis media
Dural Venous Thrombosis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone CSF leak / Encephalocele
O
Recurrent Meningitis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone CSF leak / Encephalocele
Recurrent Meningitis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Inflammatory Mimics
Langerhans Cell Histiocytosis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Infection
•
Acute vertigo
•
Sudden hearing loss
•
Facial paralysis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Infection
•
Acute vertigo
•
Sudden hearing loss
•
Facial paralysis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo Vertebrobasilar ischemia Meniere’s (15 min – 24 hours) Vestibular Neuritis (daysweeks) Vestibulocochlear Migraine Perilymph Fistula BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo Mandatory imaging if: Focal neurologic deficit Gait or truncal ataxia Positional nystagmus Intact Head Impulse Test
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Head Impulse Test
Normal Vestibular Response H
Peripheral Vestibular Deficit
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Labyrinthine Artery (AICA)
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Posterior Circulation Stroke
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Vertebral Dissection
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Dural Arteriovenous Fistula
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo Vertebrobasilar ischemia Meniere’s (15 min – 24 hours) Vestibular Neuritis (daysweeks) Vestibulocochlear Migraine Perilymph Fistula BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Menieres Endolymphatic Hydrops
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo Vertebrobasilar ischemia Meniere’s (15 min – 24 hours) Vestibular Neuritis (daysweeks) Vestibulocochlear Migraine Perilymph Fistula BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Vestibular Neuritis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo Vertebrobasilar ischemia Meniere’s (15 min – 24 hours) Vestibular Neuritis (daysweeks) Vestibulocochlear Migraine Perilymph Fistula BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo Vertebrobasilar ischemia Meniere’s (15 min – 24 hours) Vestibular Neuritis (daysweeks) Vestibulocochlear Migraine Perilymph Fistula BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Perilymph Fistula
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo Vertebrobasilar ischemia Meniere’s (15 min – 24 hours) Vestibular Neuritis (daysweeks) Vestibulocochlear Migraine Perilymph Fistula BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo: BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo: BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo: BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo: BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Acute vertigo: BPPV
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Infection
•
Acute vertigo
•
Sudden hearing loss
•
Facial paralysis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Sudden hearing loss Conductive (CHL) Sensorineural (SNHL)
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Sudden hearing loss Conductive (CHL) Sensorineural (SNHL)
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Manubrium of Malleus Fx
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Sudden SNHL / Tinnitus Vertebrobasilar ischemia Meniere’s Labyrinthine fistula Viral / auto-immune labyrinthitis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Sudden SNHL / Tinnitus Vertebrobasilar ischemia Meniere’s Labyrinthine fistula Viral / auto-immune labyrinthitis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Viral Labyrinthitis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Autoimmune Labyrinthitis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Susac’s Syndrome
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Sudden SNHL / Tinnitus Labyrinthine hemorrhage IAC/CPA tumor Intracranial hypotension Vestibulocochlear migraine
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Sudden SNHL / Tinnitus Labyrinthine hemorrhage IAC/CPA tumor Intracranial hypotension Vestibulocochlear migraine
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Sudden SNHL / Tinnitus Labyrinthine hemorrhage IAC/CPA tumor Intracranial hypotension Vestibulocochlear migraine
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
CPA/IAC Mengioma
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Foreign Body Granuloma
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Sudden SNHL / Tinnitus Labyrinthine hemorrhage IAC/CPA tumor Intracranial hypotension Vestibulocochlear migraine
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Intracranial Hypotension
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Superficial Siderosis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Sudden SNHL / Tinnitus Labyrinthine hemorrhage IAC/CPA tumor Intracranial hypotension Vestibulocochlear migraine
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Intracranial Hypotension
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Infection
•
Acute vertigo
•
Sudden hearing loss
•
Facial paralysis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone CN VII: Differentiating central from peripheral weakness
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone House – Brackman Scale • • • • • •
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
Normal Slightly weak Obviously weak Disfiguringly weak Minimal movement No movement
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Facial paralysis Bell’s Palsy Ramsey Hunt (H. Zoster Oticus)
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Bell’s Palsy Bell’s Palsy
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Acute Labyrinthitis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Tuberculous Meningitis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Neurosarcoidosis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Mastoiditis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Hemangioma Benoit M, Otolaryngol Head Neck Surg. 2010 Jan;142(1):108-14. Facial nerve hemangiomas: vascular tumors or malformations?
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
Longitudinal Fx: CN 7 Palsy
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone Non-traumatic Otologic Emergencies •
Infection
•
Acute vertigo
•
Sudden hearing loss
•
Facial paralysis
Non-traumatic Emergency Head and Neck Imaging:
The Temporal Bone
John I. Lane, MD Mayo Clinic ASNR 2016
Acute Orbit Abnormalities 2016
May 21
Red eye Acute vision loss Ophthalmoplegia
Eye and Orbit
The Red Eye Infection vs. Pseudotumor
? Proptosis
“Dirty fat” Dr. John S. Kennerdell
Infection Inflammation (NSOI) Hemorrhage Venous congestion Lymphoid lesion
Ali Sepahdari
Preseptal Postseptal
Preseptal Skin involved spared?
Eye and Orbit
Post septal Infection vs. Pseudotumor
? Proptosis
Is it infection? Where from? Sinuses Teeth Skin Lacrimal sac
Sinus?
Periorbital collection (abscess)
“Dirty Fat”
Orbital cellulitis
Source ?
Teeth
Periodontal membrane Lamina dura
Caries
Lacrimal sac
Shunts and implants
Ahmed shunt Scleral band
Other complications
Nonspecific Orbital Inflammation (NSOI) (Idiopathic orbital inflammation, Orbital inflammatory syndrome, Orbital pseudotumor) Diagnosis of exclusion
Eye Muscles Nerve Lacrimal Fat
Periscleritis Myositis Perineuritis (not optic neuritis) Dacryoadenitis Diffuse
Periscleritis/ Perineuritis
Perineuritis
Myositis
Dacroadenitis
Diffuse Ali Sepahdari Pakdaman MN, Sepahdari AR, Elkhamary SM. Orbital inflammatory disease: Pictorial review and differential diagnosis. World journal of radiology 2014; 6:106-115
Are we done yet??? Exclude: endophthalmitis fungus fistula cav sinus thrombosis vasc malf hemorrhage
Endophthalmitis
s
Invasive fungal disease
“Dirty fat” / proptosis Exclude: 1. Carotid cavernous fistula 2. Cavernous sinus thrombosis
“Dirty fat” / proptosis Exclude: 1. Carotid cavernous fistula 2. Cavernous sinus thrombosis
Acute Vision loss optic neuritis vs meningioma compression ischemic AAION NAION Retinal artery occlusion
Optic neuritis
Meningioma
Ischemic optic neuropathy (ION) Anterior AION Posterior PION Arteritic Non arteritic Retinal artery
Mod from Dragos Catalin Jianu and Silviana Nina Jianu (2013). Giant Cell Arteritis and Arteritic Anterior Ischemic Optic Neuropathies, Updates in the Diagnosis and Treatment of Vasculitis, Prof. Lazaros Sakkas (Ed.), InTech, http://www.intechopen.com/books/updates-in-the-diagnosis-andtreatment-of-vasculitis/giant-cell-arteritis-and-arteritic-anterior-ischemic-optic-neuropathies
Diffusion ?
