- define locations of problems in peripheral nerves - differentiate primary muscle conditions from muscle weakness caused by neurologic disorders

Neuro Diagnostics Flashcards by Alexandra Mull

EEG

painless recording of cortical electrical activity;

8-16 electrodes applied to scalp and readings are taken

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Stressors for EEG

sleep deprivation

hyperventilation

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Indications for EEG

Seizure disorders (may be normal since seizures are episodic)
Metabolic encephalopathy (focal vs. generalized slowing)
Cortical vs. subcortical
Tumors

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Cortical issues

neglect
aphasia
hemianopia

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Sub cortical issue

motor hemiparesis

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Tumors on EEG

focal slowing/spike discharges

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EEG rhythms for normal awake adult

Alpha= 8-12 Hz
Beta = >12 Hz
Theta = 4-8 Hz
Delta = 0-4 Hz

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Focal changes on EEG

tumor, infarct, scar tissue

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generalized EEG changes

encephalopathy anoxia

metabolic disorders

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EMG

exam of electrical activity of muscle fibers/motor unit

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Goal of EMG

define locations of problems in peripheral nerves

- differentiate primary muscle conditions from muscle weakness caused by neurologic disorders

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Technique for EMG

needle electrodes inserted into skeletal muscle – look for abnormal activity

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When is activity evaluated for EMG

during need insertion
spontaneous activity at rest
slight muscle contraction
full muscle contraction

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Indications for EMG

LMN disease: ALS
NMJ disease: Myasthenia gravis (fatigability)
Muscle disease: Myopathy
Peripheral nerve disorders: carpal tunnel, peripheral neuropathies
• Alcoholic neuropathy 
• Amyotrophic lateral
sclerosis (ALS)
• Brachial plexopathy
• Carpal tunnel syndrome 
• Cervical spondylosis
• Denervation
• Guillain-Barre
• Muscular dystrophy
• Myasthenia gravis
• Myopathy
• Nerve dysfunction
• Peripheral neuropathy 
• Polymyositis

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EMG w/ myasthenia gravis

fatigability

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EMG w/ myopathy

decreased amplitude of motor response

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Nerve conduction study

used to assess rate of conduction & amplitude of response of peripheral nerves (how well and how fast nerves can transmit signal)

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Done together

EMG + nerve conduction study

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Indications for nerve conduction studies

differentiate b/w nerve and muscle disorder
differential LMN from peripheral neuropathy
Detect abnormalities in sensory nerves
Axonopathy (decreased amplitude)
Demyelinating process (decreased conduction rate)

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Decreased conduction rate on NCV

demyelinating process

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Decreased amplitude on NCV

axonopathy

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NCV for carpal tunnel syndrome

determine integrity of sensory/motor pathway

- help determine when surgery is needed

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Types of neuroimaging

Plain films
CT scan
MRI
Ultrasound
Angiography/MRA
Myelography

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Indication for plain films

Degenerative disease (osteophytes, decreased disk space, alignment- kypohsis, scoliosis)
Trauma (Fx/dislocation)
malignancy

Contraindications of EEG

None.

Spondylolithesis imaging and views

lumbar spine plain film; get flexion & extension views to show degree of instability

Dx of spinal fx

1st line: plain film! (compression fx) Follow w/ CT or MRI to define presence of associated soft tissue imaging

EMG measures what

ability of muscle to respond to stimulation

Indications for plain skull films

Trauma Metabolic disease Malignancy

CT scan indications

``` • Trauma • Stroke - Ischemic v. hemorrhagic • Hydrocephalus • Suspicious headaches • Altered mental status • For spine: - Trauma - Degenerative • LOC • Persistent neurologic dysfunction • Persistent vomiting • GCS < 8 or deteriorating • Retrograde or antegrade amnesia • Post-traumatic seizures ```

Epidural hematoma

between dura and skull | lens-shaped

Subdural hematoma

B/w dura and arachnoid | Crescent-shaped

Dx of stroke

Non-constrast head CT!!!!

Why do you need a non-contrast CT for stroke?

r/o hemorrhagic stroke prior to administration of thrombolytic meds

Indications for MRI

``` Tumors Vascular disease Inflammation/infection MS Degenerative disease (Spine) ```

Types of MRI

T1: fat lights up T2: water flights up

T1 MRI

reflects uptake of magnetic energy | better for normal anatomy

T2 MRI

reflects release of magnetic energy better for pathology

TOC for tumors

MRI w/ gadolinium

Diffusion MR

measures microscopic motion of water

Most sensitive test for suspected acute ischmic stroke of brain/spinal cord

Diffusion MR

MR use

ischemic stroke encephalitis abscess

Dx of MS

MRI showing periventricular plaques

Indications for new deficit (CT/MRI)

``` Acute onset of: •New vision loss • Aphasia •AMS •Sensory abnormalities •Motor paralysis •Vertigo w/HA, diplopia, focal deficit, ataxia, or dsyarthria ```

When to get imaging for HA

"worst HA of my life" - subarachnoid hemorrhage new h/a in pts w/ CA or HIV HA w/ papilledema HA w/ neuro deficit HA/ w/ AMS HA that worsens w/ exertion, positionally related, awakens from sleep, changes over tim

TOC for head trauma

TOC for onset sz

CT (MRI if CT neg and pt has neuro deficit)

TOC for brain tumor

MRI

TOC for hydrocephalus

Indications for MRI spine

* Radiculopathy – persistent/progressive * High impact trauma * New or progressive deficit * Suspected tumor or infection * Neurogenic claudication * New onset of back pain in a patient with cancer

Carotid US

used to determine degree of stenosis; measure velocity through blood vessel

Angiography: what is it?

IV injection of contrast; | Tradition vs CTA vs MRA

where is access for angiography

femoral vessels

Indications for angiography

pre-operative (CEA, aneurysm repair)

Goal of myelography

detect spinal cord pathology/compression (herniated discs, spinal stenosis)

MOA of myelography

radiopague dye injected into thecal space; patient tilted for images (XR or CT), Replaced by MRI

LP use

meningitis

Contraindication of LP