Diagnostics in Neurology

Question 1

_____ is a useful tool for assessing the patency or
extent of carotid artery atherosclerotic disease

Answer 1

Carotid Duplex Ultrasound

Question 2

Advantage to Carotid Ultrasound

Answer 2

Advantage of being able to measure the
thickness of intimal-medial arterial wall.

Question 3

Angiography

Answer 3

Angiography provides the ability to visualize
the vasculature of the brain, which can be
helpful when diagnosing stenosis, full
blockage, aneurysms, etc

Question 4

Angiography options:

Answer 4

○ Cerebral Angiography
■ Historic gold standard that remains the
definitive pre-op tool for aneurysms
○ CT Angiogram (CTA)
○ MR Angiogram (MRA)

Question 6

______ involves accessing the arterial system with
a catheter and then injecting radiopaque dye while Fluoroscopy of the skull is obtained and recorded.

Answer 6

Cerebral angiogram

Question 7

____ also involves radiation, but can be obtained faster and with less vascular invasion

Answer 7

CT Angiogram

Question 8

______ uses the same technology as a regular MRI, but intravascular MR contrast is pushed through a catheter during the MR machine spin

Answer 8

MR Angiogram (MRA)

Question 9

Administering contrast for CT and MR angiograms

Answer 9

● Contrast administration for both CT and MR Angiograms is
administered to the patient through a simple intravenous line.

Question 10

Administering contrast for angiography using fluoroscopy

Answer 10

● For traditional Angiography using fluoroscopy, the contrast is
administered only at the area being imaged, which requires a long
catheter be inserted and fed through a vessel in the groin or wrist

Question 11

For all angiography studies, ensuring the patient has ____ prior to the imaging study is important, especially if the patient is elderly, diabetic, or other significant comorbid conditions.

Answer 11

adequate kidney function

Question 12

Angiography of the carotids and
vertebral arteries is generally
performed for definitive
assessment of ______

Answer 12

carotid artery
stenosis, especially before surgical
intervention

Question 13

_____ are the two most commonly used imaging procedures in Neurologic medicine

Answer 13

MRI and CT

Question 14

Nerve Conduction Studies

Answer 14

● Nerve Conduction Studies comprise a combination of measurements as a type of electrodiagnostic study.
○ Usually (but not always) performed in combination with electromyography (EMG)

Question 15

Nerve Conduction Studies can help diagnose _____

Answer 15

peripheral neuropathies, entrapment syndromes (like Carpal Tunnel Syndrome), and radiculopathies- Conditions of the peripheral nerves

Question 16

Nerve Conduction Studies process

Answer 16

● For this test, surface electrodes are placed at different locations along
specific peripheral nerves.
● The nerve is then stimulated with an
electrical impulse at one site and
recorded at the electrode.
○ Measures whether or not the nerve
is conducting normally

Question 17

Electromyography (EMG)

Answer 17

● Usually in addition to the Nerve Conduction Studies, the needle EMG specifically measures the response of the muscle to lower motor
neuron innervation and stimulation (can help diagnose myopathies).

Question 18

Electroencephalography (EEG) process

Answer 18

● Several sensitive electrodes are placed over the scalp and the tracing received during the EEG depicts the electrical activity occurring along
the surface of the brain

Question 19

What does wafeform information tell us on an EEG?

Answer 19

● This information about waveform frequency and shape is combined with the age of the patient, state of alertness or sleep, and scalp location to determine pathologic or diagnostic significance

Question 20

The ____ is the key characteristic that defines normal versus abnormal EEG rhythms

Answer 20

frequency of the wave

Question 21

Most waves of _____ are normal EEG findings in the awake adult

Answer 21

8 Hz or higher

Question 22

____ is the essential
component in the evaluation
of seizure disorders

Answer 22

EEG

Question 23

Evoked Potential Testing

Answer 23

● Evoked Potentials (EPs), also known as Evoked Responses, measure the electrophysiologic responses of the nervous system (using EEG) to a certain type of environmental stimulus

Question 24

Types of Evoked Potential Testing

Answer 24

○ Visual Evoked Potentials
○ Short-latency Somatosensory EPs
○ Short-latency Brainstem Auditory EPs

Question 25

Visual Evoked Potentials are used to evaluate the ability of the brain to _____

Answer 25

pass visual information from the retina to the occipital lobe

Question 26

_____ measure EEG waves while other electrodes on the skin of the face and lateral femoral cutaneous dermatome activate afferent sensory fibers

Answer 26

Somatosensory EPs

Question 27

Brainstem Auditory EPs measure the functionality of the _____

Answer 27

auditory nerve and auditory pathways in the brainstem

Question 28

Essentially a “super duper mental status exam”

Answer 28

Neuropsychological Testing

Question 29

Neuropsychological Testing

Answer 29

Neuropsychological evaluation is a testing method through which a neuropsychologist can acquire large amounts of data about a subject’s cognitive, motor, behavioral, linguistic, and executive functioning

Question 30

These evaluations provide quantifiable data about reasoning and problem-solving abilities, language comprehension, memory and attention abilities, processing speed, visual-spatial organization, planning, etc

Answer 30

Neuropsychological Testing

Question 31

The indications for a lumbar puncture are:

Answer 31

○ Suspicion of Meningitis ○ Suspicion of Subarachnoid Hemorrhage ○ Suspicion of neurologic diseases like Guillain-Barre syndrome and MS ○ Therapeutic relief of idiopathic intracranial hypertension

Question 32

Lumbar Puncture practice

Answer 32

● If performed at the correct level (L3-4 or L4-5), the risk of neural tissue damage is minimal, although some experience “jolts of pain” for a split second. ● Using the manometer that is provided in the LP tray, you may choose to measure the “Opening Pressure,” which correlates with intracranial pressure (high with high ICP). ● Four vials are then passively filled with CSF as it drips slowly out of the needle

Question 33

Conditions associated with abnormal CSF analysis include (but are not limited to) the following:

Answer 33

○ Infectious diseases ○ Intracranial hemorrhage (SAH) ○ Inflammatory or autoimmune diseases (MS, GBS, etc) ○ Primary or metastatic CNS cancers

Question 34

CSF with a yellow tint indicates the likely presence of pus and raises immediate suspicion of _____

Answer 34

bacterial meningitis