neuro investigations Flashcards
Botulism px and RF’s
Clinical?
Sudden muscle weakness, starts with the eye muscles, bulbar palsy
Rf- black tar heroin use, infected food
Myasthenia gravis clinical findings (not test results)
Clinical:
-bilateral facial weakness, squared off smile,
- extra-ocular weakness (double vision common)
- proximal limb weakness
- fatiguability
Diagnostic tests for mysathenia gravus
AChR antibodies (80-90% patients)
Ct for thymus hyperplasia/thymoma (75%)
How to differentite between MG and LEMs (lambort easton syndrome) investigation wise
EMG STUDIES
(electomyography)
(type of nerve conduction study)
LEMs- low amplitude wave which increase with excersize, vice versa for MG
what does diagnosis of ms require (1)
dissemination of lesions in time and space on MRI (with contrast!)
(looks like grey lesions on MRI this represents demyelination and varying shades of grey show that they have occurred at diff times)
Idiopathic raised intracranial pressure Ixs
include 1st line
1st line: MRI brain with MRV sequence- normal
Cerebro spinal fluid
-Elevated pressure
-Normal consitiuents
Visual fields
Trigeminal neuralgia ix
MRI brain
Giant cell arteritis ix
1st: Ultrasound temporal artery
Diagnostic: biopsy
Test to differentiate strokes
CT first line
MRI
what are the investigations to identify if large vessel occluded in stroke (1st and second line)
CT first line
mr angiogram
Most important investigation for epilepsy
ECG- rules out cardiac dysrythmia (long QT)
Who gets a ct scan for epilpesy
Only if u think there has been intracerebral damage/haemorrhage (if u think its an emergency situation)
eg.skull fracture, deteriorating GCS etc
or
new onset seizure- rule out tumour etc
What is eeg useful for regarding epilepsy
Classify epilepsy
Confirmation of non epileptic attacks
Surgical evaluation
Confirmation of non- convulsive status
(Don’t ever do it if u don’t know the cause)
Partial status epilepticus diagnostic ix
(Non convulsive status)
Eeg recording
what people with a head injury require a CT within ONE HOUR of being seen
head injury + …
- GCS <13 on initial assessment or <15 2 hours later
- suspected open or depressed skull fracture
- focal neurological deficit
- more than one episode of vomiting
-suspicion of NAI
what behaviours are checked in glasgow coma score , their scoring and main total scores to know
- eye opening response:
4. Spontaneous
3. To speech
2. To pain
1. None - best verbal response:
5. Orientated
4. Confused
3. Words
2. Sounds
1. None - Best motor response:
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate posture)
2. Extending to pain
1. None
total score= 15- best response, 8 or less- comatose client, 3- totally unresponsive
CT scan within eight hours after head injury if
- > 30 mins retrograde amnesia
or
-temporary LOC or amnesia
+ the following:
-65 or older
-coagulopathy
-dangerous mechanism of injury
general Ms: imaging of choice and what is seen on imaging
MRI
high signal T2 lesions
periventricular plaques
Dawson fingers: often seen on FLAIR images - hyperintense lesions perpendicular to the corpus callosum