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Unit 3 Clin Med III > L15: Neurodiagnostics > Flashcards

L15: Neurodiagnostics Flashcards

1
Q

Safe, painless recording of the cortical electrical activity

8-16 pairs of electrodes applied to the scalp

A

EEG

Electroencephalogram

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2
Q

Alpha rhythm on EEG

A

8-12 Hz

Normal awake adult

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3
Q

Beta rhythm on EEG

A

> 12 Hz

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4
Q

Theta rhythm on EEG

A

4-8 Hz

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5
Q

Delta rhythm on EEG

A

0-4 Hz

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6
Q

Contraindications to EEG

A

None

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7
Q

Indications for EEG

A

Seizure disorders → may be normal; seizures are episodic events

Metabolic encephalopathy → distinguish focal
from generalized slowing

Cortical vs subcortical
• Cortical: see neglect, aphasia and hemianopia
• Sub cortical: see motor hemiparesis

Tumors → see focal slowing/spike discharges

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8
Q

Epileptiform activity on EEG

A

seizures

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9
Q

Focal discharges or spikes on EEG (consistent with a focal problem)

A

Tumor
Infarct
Scar tissue

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10
Q

Generalized changed on EEG

A

Slowing consistent with metabolic disorders:
Encephalopathy
Anoxia (no O2)

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11
Q

Psychogenic seizures

A

Normal EEG

Pt has seizures that don’t show up on EEG, aka its “all in their head” (psychological)

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12
Q

Clinical examination of the electrical activity of

muscle fibers/motor uni

A

EMG (electromyogram)

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13
Q

EMG can….

A

Define location of problems affecting peripheral
nerves
Differentiates primary muscle conditions from muscle
weakness caused by neurologic disorders

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14
Q

EMG evaluates electrical activity of the muscle during

A
  • Needle insertion
  • Spontaneous activity at rest
  • Slight muscle contraction
  • Full muscle contraction
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15
Q

Example of a LMN disease that can be seen on EMG

A

Amyotrophic lateral sclerosis (ALS)

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16
Q

Myasthenia Gravis on EMG

A

Fatiguability

A NMJ disease

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17
Q

Muscle diseases/myopathy shows _____ on EEG

A

EMG consistent with ↓ amplitude of motor

response

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18
Q

Examples of peripheral nerve disorders which can be seen on EMG

A

Carpel tunnel

Peripheral neuropathies

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19
Q

Assess rate of conduction and amplitude of response of peripheral nerves
Usually in conjunction with EMG

A

Nerve conduction studies

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20
Q

How is a nerve conduction study performed?

A

Electrical stimulation of peripheral nerve→ muscle contraction or a sensory response
Recording electrode and stimulating electrodes over
nerve or muscle

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21
Q

Nerve conduction studies are indicated for _____

A

•Differentiate between primary nerve and muscle disorders
•Differentiate lower motor neuron
diseases from peripheral neuropathy
•Detect abnormalities in sensory nerves
•Axonopathy (decreased amplitude)
•Demyelinating process (decreased conduction rate)
Carpal Tunnel Syndrome
• Can check integrity of sensory and motor pathways
• Determine when surgery is needed

22
Q

What information does a nerve conduction study give us?

A

The nerve conduction velocity

23
Q

Indications for plain films

A 
Degenerative disease
Osteophytes
Decreased disk space
Alignment
Kyphosis, scoliosis
Trauma
Fracture/dislocation
Malignancy

Plain skull films:
Trauma
Metabolic disease
Malignancy, Multiple Myeloma

24
Q

Spondylolisthesis requires _____ views to evaluate _____

A

flexion and extension views to evaluate for degree of instability
(L3-S1)

25
Q

First line imaging for spinal fractures with or without associated dislocations (compression fractures)

A

Plain films

Followed by CT or M

26
Q

Indications for CT

A 
Trauma
• Stroke→ Ischemic vs hemorrhagic
• Hydrocephalus
• Suspicious headaches
• Altered mental status
• For spine→ Trauma, Degenerative
Loss of consciousness
• Persistent neurologic dysfunction
• Persistent vomiting
• GCS < 8 or deteriorating
• Retrograde or anterograde amnesia
• Post-traumatic seizures
27
Q

What might a non-contrast CT of a gunshot wound show?

A

soft tissue swelling
hemorrhagic track across brain (bullet pathway)
blood in ventricles
air bubbles in ventricles. (Blood=white)

28
Q

CT: Lens shaped bleed between dura and skull

A

Epidural bleed

29
Q

CT: Crescent shaped bleed between dura and arachnoid

A

Subdural bleed

30
Q

How do you rule out a hemorrhagic stroke before administering thrombolytic medications?

A

Non-contrast head CT

31
Q

Hydrocephalus on CT

A

Dilated ventricles

32
Q

Indications for MRI

A 
Tumors
Vascular disease
Inflammation/ infection
Multiple sclerosis
Degenerative disease (spine)
33
Q

T1 MRI vs T2 MRI

A

T1: water/CSF dark
T2: water white
(T2 shows H20)

34
Q

Test of choice for brain tumors

A

MRI with gadolinium

Shows:
Mass effect, surrounding edema, pattern of enhancement

35
Q

On MRI, Multiple Sclerosis will show

A

Periventricular plaques

36
Q

Measures microscopic motion of water→ most sensitive for acute ischemic Stroke of the brain and/or spinal cord.
Encephalitis
Abscess

A

Diffusion MR

37
Q

Indications for imaging (CT/MRI) of a new deficit

A 
Acute onset of: 
•New vision loss
•Aphasia
•Mental Status changes
•Sensory abnormalities
•Motor paralysis
•Vertigo w/HA, diplopia, focal deficit, ataxia, dysarthria
38
Q

Indications for Imaging for a headache (CT/MRI)

A 
“Worst HA of my life” (SAH) 
New HA in patients with cancer or HIV
Papilledema
Neurologic deficit
Mental status changes
Worsens w/exertion, positionally related, awakens pt. from sleep, changes over tim
39
Q

On a CT, blood appears _____

A

Opaque

40
Q

A suspected TIA or CVA should get ___ imaging

A

CT

41
Q

A suspected brain tumor should get ___ imaging

A

MRI

42
Q

Recommended study for New onset symptoms

A

CT

43
Q

Do ____ if the CT (-) and the patient has new onset symptoms with a neurologic deficity

A

MRI

44
Q

Do an MRI for dizziness if _____

A

Brainstem or cerebellar CVA or mass suspected

45
Q

Indications for an MRI of the spine

A 
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
46
Q

Reflective sound waves determine velocity through vessel

Assess degree of stenosis by percentage

A

Carotid ultrasound

47
Q

Detect spinal cord pathology/ compression→ herniated disks, spinal stenosis
Radiopaque dye injected into thecal space
Patient tilted for imaging: X-ray or CT

A

Myelography

48
Q

Myelography was replaced by

A

MRI

49
Q

Lumbar puncture contraindications you should really know by now

A

Cannot be performed if papilledema or increased intracranial pressure

50
Q

IV injection of contrast medium→ traditional, CTA, or MRA

Vascular access via femoral vessels

A

Angiography

51
Q

Angiography indications

A

Indicated when definitive anatomy needed: pre-op CEA, aneurysm repair

Unit 3 Clin Med III (3 decks)

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