There are a number of otolaryngologic conditions which occur because of pathological states in the cerebrovascular system. These conditions may seem obscure until they are thought of in relation to cerebrovascular disease. For example, a middle-aged patient was referred by an internist to the department of otolaryngology for the evaluation of the symptom of hoarseness. This appeared suddenly and was associated with weakness, vertigo, and ataxia. Almost everyone is acquainted with the association of hoarseness and mediastinal conditions. This had already been excluded. Examination revealed a cord paralyzed on the left side. Because of the associated vertigo and ataxia, a brain lesion was considered a possibility, and the vestibular caloric test was applied. There was a marked reduction in the vestibular response on the left side.
The symptoms of vertigo, ataxia, hoarseness, and weakness struck a note which pointed to a possible vascular lesion in an area supplied by