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X Clin Med III Exam 3 > Neuro Diagnostics > Flashcards

Neuro Diagnostics Flashcards

1
Q

What is an electroencephalogram (EEG)?

A

Safe, painless recording of cortical electrical activity

8-16 electrodes applied to scalp

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2
Q

Stressors of EEG

A

Sleep deprivation

Hyperventilation

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3
Q

Indications for EEG

A 
Seizure disorders (may be normal, they are episodic)
Metabolic encephalopathy (distinguish focal from generalized slowing)
Distinguish b/w cortical and subcortical
Tumors (see focal slowing or spike discharges)
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4
Q

How to distinguish b/w cortical and subcortical on EEG

A

Cortical: see neglect, aphasia, hemianopia
Subcortical: see motor hemiparesis

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5
Q

Rhythms seen on EEG

A

Alpha: 8-12 Hz (normal awake adult)
Beta: >12 Hz
Theta: 4-8 Hz
Delta: 0-4 Hz

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6
Q

What does this EEG finding suggest: epileptiform activity

A

Seizures

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7
Q

What does this EEG finding suggest: focal discharges/spikes c/w focal problem

A

Tumor, infarct, scar tissue

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8
Q

What does this EEG finding suggest: generalized changes/slowing c/w metabolic disorders

A

Encephalopathy, anoxia

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9
Q

What does this EEG finding suggest: normal EEG with presence of seizure activity

A

Psychogenic seizures (inpt monitoring is helpful)

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10
Q

Contraindications to EEG

A

No major ones

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11
Q

What is an electromyogram (EMG)?

A

Clinical examination of the electrical activity of muscle fibers/ motor unit
Define location of problems affecting peripheral nerves

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12
Q

What can an EMG do?

A

Differentiate primary muscle conditions from muscle weakness caused by neurologic disorders

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13
Q

Technique for EMG

A

Needle electrodes inserted into skeletal muscle to record electrical potentials and look for abnormals (electrode on the needle detects electrical activity given off by muscles)
Makes graphs, sounds or numerical values

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14
Q

When to measure electrical activity with EMG

A

Needle insertion
Spontaneous activity at rest
Slight muscle contraction
Full muscle contraction

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15
Q

Indications for EMG

A

Lower motor neuron diseases (ALS)
NMJ disease (myasthenia gravis)
Muscle disease (myopathy)
Peripheral nerve disorders (carpal tunnel, peripheral neuropathies)
(alcohol neuropathy, brachial plexopathy, cervical spondylosis, denervation, guillain barre, nerve dysfunction, polymyositis)

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16
Q

What does an EMG show for myasthenia gravis (NMJ disease)?

A

Fatigability

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17
Q

What does EMG show for myopathy?

A

Decreased amplitude of motor response

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18
Q

What are nerve conduction studies used for?

A

Assess rate of conduction and amplitude of response of peripheral nerves (usually with an EMG!)
Electrical stimulation of peripheral nerve will produce muscle contraction or a sensory response
Recording electrode and stimulating electrodes over nerve or muscle

19
Q

Indications for nerve conduction studies

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)

20
Q

NCV and carpal tunnel syndrome

A

Used to check integrity of sensory and motor pathways

Can help determine when surgery is needed

21
Q

Types of neuroimaging

A 
Plain films
CT scan
MRI
U/s
Angiograph/MRA
Myelography
22
Q

Indications for plain films

A

Degenerative disease (osteophyte, decreased disk space, alignment-kyphosis/scoliosis)
Trauma (fracture, dislocation)
Malignancy

23
Q

Lumbar spine films for spondylolisthesis

A

Flexion and extension views indicated to evaluate degree of instabiity

24
Q

First line to look for spinal fractures with or without associated dislocations

A

Plain films (compression fractures)

25
Q

What must be done after plain films to define presence of soft tissue injuries

A

CT or MRI

26
Q

Indications for plain skull films

A

Trauma
Metabolic disease
Malignancy

27
Q

Indications for CT

A 
Trauma
Stroke (ischemia or hemorrhagic)
Hydrocephalus
Suspicious HAs
AMS
For spine (trauma, degenerative)
Loss of consciousness
Persistent neuro dysfunction
Persistent vomiting
GCS <8 or deteriorating
Retrograde or antegrade amnesia
Post traumatic seizures
28
Q

Epidural vs subdural hematoma on CT scan

A

Epidural: lens shaped
Subdural: crescent shaped

29
Q

What is mandatory to rule out hemorrhagic stroke before administering thrombolytic meds?

A

Non contrast head CT

30
Q

Indications for MRI

A 
Tumors
Vascular disease
Inflammation/infection
Multiple sclerosis
Degenerative disease (spine)
31
Q

T1 vs T2 MRI

A

T1: reflects uptake of magnetic energy better for normal anatomy
T2: reflects release of magnetic energy better for pathology
CSF/water is dark on T1 and white on T2

32
Q

Diagnostic study of choice for tumors

A

MRI with gadolinium (look for mass effect, surrounding edema and pattern of enhancement)

33
Q

What is a diffusion MR?

A

Measures microscopic motion of water

34
Q

Most sensitive test when suspect acute ischemic stroke or brain or spinal cord

A

Diffusion MR (also good for encephalitis or abscess)

35
Q

What is seen on MRI in multiple sclerosis?

A

Periventricular plaques

36
Q

CT/MRI indications for new deficit

A 
Acute onset of:
New vision loss
Aphasia
Mental status changes
Sensory abnormalities
Motor paralysis
Vertigo with HA, diplopia, focal deficit, ataxia or dysarthria
37
Q

CT/MRI indications for headache

A

Worst HA of life
New HA in pts with cancer of HIV
HA with papilledema, neuro deficit, mental status changes
Worsens with exertion, positionally related, awaken pts from sleep or changes over time

38
Q

Recommended study for head trauma

A

CT

39
Q

Recommended study for new onset sxs

A

CT (do MRI if CT is negative and pt has neuro deficit)

40
Q

Indications for 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 pt with cancer
41
Q

Carotid ultrasound

A

Reflective sound waves can determine velocity through blood vessel
Assess degree of stenosis

42
Q

When is angiography indicated?

A

When definitive anatomy needed (pre-op like CEA or aneurysm repair)

43
Q

What is myelography used for?

A

Detects spinal cord pathology/compression (herniated disks or spinal stenosis)
Radiopaque dye injected into thecal space
Has been replaced by MRI

44
Q

When can LP not be performed?

A

If papilledema or increased ICP

X Clin Med III Exam 3 (7 decks)

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