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Neuro > Lecture 4: Clinical Research Techniques > Flashcards

Lecture 4: Clinical Research Techniques Flashcards

1
Q

What are the clinical methods of investigation in neuroscience?

A
  • Clinical history and examination
  • Neuropathology
  • Imaging
  • Electrophysiology
  • Chemical studies
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2
Q

What information will be achieved with a Clinical History?

A

Information about whether it is a targeted or specific problem

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3
Q

What is a Clinical examination?

A

Systematic assessment from brain to muscle

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4
Q

Who pioneered the standardized neurological examination?

A

Charcot

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5
Q

What did Charcot standardize?

A

The order that tests are done and the order in terms of problems in the brain, spinal cord

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6
Q

What is impairment in the brain or spinal cord usually due to?

A

Upper Motor Neurons

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7
Q

Where do UMNs have their cell bodies and axons?

A

UMNs usually have their cell bodies in the cortex and have long axons that go down to different spinal levels to connect with LMNs

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8
Q

What six things does a neurological exam assess?

A
  • Mental status
  • Cranial nerves
  • Motor examination
  • Sensory examination
  • Cerebellar function
  • Deep tendon reflexes
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9
Q

Which part of the NS is Mental Status a part of?

A

Central

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10
Q

Which part of the NS is Cranial Nerves a part of?

A

Central

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11
Q

Which part of the NS is Motor examination a part of?

A

Central and Peripheral

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12
Q

Which part of the NS is Sensory examination a part of?

A

Central and Peripheral

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13
Q

Which part of the NS is Cerebellar function a part of?

A

Central

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14
Q

Which part of the NS is Deep Tendon Reflexes a part of?

A

Central and Peripheral

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15
Q

Which scale assesses wakefulness?

A

The Glasgow coma scale

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16
Q

What assesses Cranial Nerves 2 and 3?

A

Shining a light in someones eye and seeing the pupil change

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17
Q

What is the direct response to testing cranial nerves 2 and 3?

A

When flashing the light in one eye the constriction of the pupil occurs in that eye

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18
Q

What is the consensual response to testing cranial nerves 2 and 3?

A

When flashing the light in the opposite eye the other pupil still constrics suggesting syncitimus activity

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19
Q

What does increased reflex suggest?

A

There is UMN lesions

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20
Q

What does decreased reflex suggest?

A

There is LMN lesions

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21
Q

What is Clonus?

A

Sustained contration

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22
Q

What does Clonus suggest?

A

UMN injury

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23
Q

What is normal in the Babinsky test?

A

There is flexion of the toes

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24
Q

What suggests an UMN injury with the babinski test?

A

Toes fanning out

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25
Q

What tests are used to test Deep Tendon reflexes?

A
  • Lower extremity reflexes

* Babinski test

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26
Q

After determining an UMN lesion, what is the next step?

A

To determine where the UMN is injured

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27
Q

What can help identify where an UMN lesion is?

A

A neurological examination

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28
Q

What can a history of the progression of the symptoms indicate?

A

What the disease is

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29
Q

What is damage to the left frontal cortex associated with?

A

Difficulty speaking

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30
Q

What did Broca’s area establish?

A

The lateralization of linguistic function to the left hemisphere

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31
Q

What can pathology do?

A

Help confirm the clinical diagnosis

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32
Q

Where can Tau proteins often be seen?

A

In the brains of people with chronic traumatic encephalopathy

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33
Q

Why is imaging preferred over pathology?

A

Because pathology requires a sample which is more invasive and damaging

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34
Q

What is a CT Scan?

A

A series of X-ray slices

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35
Q

What are the advantages to CT?

A
  • Cheap and fast
  • Very common
  • Good at detecting blood
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36
Q

What are the disadvantages to CT?

A
  • Limited resolution

* Can miss acute stroke lesions

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37
Q

How does an MRI work?

A

Uses radio frequencies that excite tissues inside the brain and a magnet that records the picture

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38
Q

What are the advantages to MRIs?

A
  • Provides very fine details of anatomy

* Multiple sequences can be used to detect specific problems

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39
Q

What are the disadvantages to MRIs?

A
  • Takes an hour (vs 3 min for CT)
  • Children require sedation and special care
  • Expensive
  • Availability limited
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40
Q

What was one of the first applications of MRIs?

A

Volume measurement

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41
Q

What do the brains of people with Alzheimer’s look like under an MRI?

A

The brain is small in general and the hippocampus is quite small

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42
Q

What are two types of MRI sequences?

A
  • Diffusion weighted

* Perfusion weighted

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43
Q

What have Diffusion weighted and Perfusion weighted MRI sequences been tailored to identify?

A

Acutely ischemic stroke lesions that would not be visible otherwise

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44
Q

What doe DWI and PWI measure?

A

If parts of the brain are receiving enough blood

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45
Q

How can MRI be used to measure water in the brain?

A

It can be used to measure the movement (diffusion) of protons in water along fibre tracts. Movement is more in patients without brain tumors

46
Q

Aside from tumors, what can MRI tracking movement of protons do?

A

It can be uses in research of illness like depression of autism

47
Q

How can MRI be beneficial in mapping tumors?

A

In mapping proton diffusion we can superimpose it with the tumor and see which fibers are passing through and this can help with tumor resection

48
Q

What are the advantages to Magnetic Resonance Spectroscopy (MRS)?

A

Provides quantification of specific metabolites or neurotransmitters in a specific region of interest without having to go inside the brain

49
Q

What do MRI, MRS, and CT lack?

A

The don’t show the vascular aspect of the brain

50
Q

What is an angiogram?

A

Using a radiopaque substance, or dye, to make the blood vessels visible under X-ray

51
Q

What are the advantages of Angiograms?

A

There is very precise mapping of the blood vessels

52
Q

What are the disadvantages of angiograms?

A

Requires a catheter to put into the blood vessels and injection of dye which can lead to vessel eruption or allergic reaction

53
Q

What are the downside to some imaging techniques?

A

Sometimes a problem doesn’t affect the structure of the brain but instead the function of the brain cells

54
Q

What does an EEG record?

A

The difference in electrical potentials generated by the brain

55
Q

What are the advantages to the EEG?

A
  • High temporal resolution
  • Useful for monitoring state of arousal
  • Cheap and available
56
Q

What are the disadvantages to EEG?

A
  • Poor spatial resolution

* Restricted to mainly cortical activity

57
Q

What is the Alpha frequency range?

A

8-12 Hz

58
Q

What occurs in Alpha?

A

Resting, awake, eyes closed

59
Q

What is the Beta frequency range?

A

12 - 30 Hz

60
Q

What occurs in Beta?

A

Aroused and awake

61
Q

What is the Gamma frequency range?

A

30 - 100 Hz

62
Q

What occurs in Gamma?

A

Perception/Binding brain activity

63
Q

What is the Delta frequency range?

A

1 - 4 Hz

64
Q

What occurs is Delta waves?

A

Deep sleep

65
Q

What is the Theta range?

A

6 - 8 Hz

66
Q

What occurs during Theta?

A

Exploration/memory and learning

67
Q

What methods can be used when a finer location of epileptic activity than EEG is required?

A
  • Grids to map finer location

* Depth electrodes to look at deeper neurons

68
Q

What occurs in a Grid EEG?

A

Grids are put directly onto the brain for precise mapping

69
Q

What occurs in a depth electrode EEG?

A

Depth electrodes are implanted into the brain for deeper structure recording

70
Q

What neurons does Electromyogram (EMG) assess?

A

LMNs

71
Q

What occurs in EMG?

A

A patient muscle activity is recorded either at the surface or using a needle inserted within the muscle

72
Q

What are the advantages of EMG?

A
  • Measure precisely activity in the muscle
  • Can detect when the muscle in not getting enough nerve input
  • Can help define the type of muscle disease
73
Q

What are the disadvantages to EMG?

A

Can be painful with insertion of needle inside the muscle depending on location

74
Q

What occurs in a Nerve Conduction Study (NCS)?

A

The patient nerve activity is recorded by stimulating the nerve and recording the time for its connected muscle to be activated

75
Q

What are the advantages to NCS?

A
  • Can precisely measure the nerve activity

* Can narrow down type of nerve disease by pattern of injury

76
Q

What are the disadvantages of NCS?

A

Can be painful with the stimulation of the nerve

77
Q

What is a clinical method for both UMN and LMN?

A

Genetics

78
Q

What are the advantages to Comparative Genomic Hybridization?

A

Allows to map changes in copy number for the entire genome so do not need to know which gene could be affected in the patients

79
Q

What are the disadvantages to CGH?

A

Is not table to tell if a patient has a single base pair change

80
Q

What kinds of defects won’t be seen in CGH?

A

Defects in single base pairs

81
Q

What kinds of defects won’t be seen in Karyotypes?

A

Defects in genes because of compaction

82
Q

How big are the fragments of DNA in next generation sequencing?

A

Sequences are shorter

83
Q

What are the advantages to next generation sequencing?

A

Multiple sequences at the time allow for faster and cheaper sequencing of exons or entire genome

84
Q

What are the disadvantages to NGS?

A
  • It is more error prone than one gene at a time traditional sequencing methods
  • Needs a reference genome
85
Q

Why might defects in genes not be seen in CGH?

A

Because they affect a single base pair in introns

86
Q

Which neurons can a Lumbar Puncture measure?

A

UMN and LMN

87
Q

What does a Lumbar puncture look at?

A

The level of RBCs, WBCs, glucose, and protein in cerebrospinal fluid

88
Q

What is a Lumbar puncture very useful to assess?

A

Blood and infections in the CSF (aneurysm bleed, meningitis)

89
Q

What are Lumbar Punctures used more for now?

A

Detecting auto-antibodies (ex. anti NMDA and others)

90
Q

What are the advantages to Lumbar Punctures?

A
  • Able to retrieve CSF which could help identify chemical, metabolic or immune differences
  • Less invasive than getting brain tissue
91
Q

What are the disadvantages of Lumbar Puntures?

A
  • Requires the patient to be collaborative

* Risk of pain and infection

92
Q

What are MRI based imaging methods based on?

A

The detection of changes in tissue and radiofrequency

93
Q

What are Nuclear medicine based methods based on?

A

Injection of radioactive dye

94
Q

What does a functional MRI (fMRI) measure?

A

The levels of oxyhemoglobin and deoxyhemoglobin in the brain and how they are modified by neuronal activity.

95
Q

What are the advantages to fMRI?

A

They can show localization of brain activity at rest or when performing a task

96
Q

What are the disadvantages of fMRI?

A

Requires a collaborative patient

97
Q

What occurs in a Positron Emission Tomography (PET) scan?

A

Radioactive compounds that emit positrons are injected and the positrons collide with electrons and produce photons (gamma rays)

98
Q

What are the advantages to PET scans?

A
  • Measures precisely localization of brain activity

* Used to map cancer cells because they have high uptake

99
Q

What are the disadvantages to PET scans?

A

Requires injection of radioactive tracer

100
Q

What is the difference between SPECT and PET?

A

They are similar except gamma ray emitting radioactive material is injected instead of positron like in PET. And SPECT is not as precise as PET

101
Q

What is reduced in patients with Parkinson’s disease?

A

[18F]dopa uptake in the putamen

102
Q

What are the advantages and disadvantages to Magneto-encephalogram?

A

+Fast temporal resolution

-Very expensive, limited spatial resolution

103
Q

What is Transcranial magnetic stimulation?

A

Using a coil to form a magnetic field which can then depolarize or inhibit the brain cells underlying it

104
Q

What are the advantages to TMS?

A

•Can be used to understand localization of brain network without direct electrical stimulation

105
Q

What are the disadvantages to TMS?

A
  • Requires cooperation from patients

* Risk of inducing seizure

106
Q

What two things is Single Pulse TMS used for?

A
  • Mapping changes in cortical excitability during behaviour

* Mapping changes in cortical motor maps after stroke and during rehab

107
Q

What is Repetitive pulse TMS used for?

A
  • Inhibiting activity of specific cortical regions
  • Enhancing functional recovery after stroke
  • Reduction of chronic pain
  • Treatment of depression, schizophrenia, addiction, anxiety
108
Q

What does DBS consist of?

A

Insertion of depth electrodes into a specific area that is then stimulated either by a stimulator or by the patient

109
Q

What diseases is DBS now used in?

A

Parkinsons, dystonia, severe depression, epilepsy

110
Q

What are the advantages to DBS?

A

Can be very effective in some disorders and limit the need for meds

111
Q

What are the disadvantages to DBS?

A

Risk of infection and invasive

Neuro (6 decks)

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