Neuro Lecture 1 Flashcards

1
Q

EEG measure the spontaneous electrical activity of the what?

A

Superficial cortex

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2
Q

How many electrodes are placed on a person for an EEG?

A

20+

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3
Q

Who reads EEGs?

A

Neurologist who has fellowship training in neurophysiology

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4
Q

How many people will have an abnormal EEG?

A

8% of people. Must be clinically correlated for diagnosis

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5
Q

How many % of patients with epilepsy have a normal EEG?

A

20% (not sensitive, not specific)

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6
Q

Can an EEG measure activity deeper in the brain?

A

No

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7
Q

How long is a routine EEG for?

A

20-120 minutes

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8
Q

What can cause significant artifact on the EEG?

A

movement of muscles

ex- blinking eyes, moving arm, etc

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9
Q

Someone with a primary _________ epilepsy is unlikely to have a normal EEG.

A

generalized

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10
Q

What is an EEG where leads are kept on for 6+ hours (usually 8).

A

extended EEG

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11
Q

What is where the patient is discharged to go home with EEG recording, somewhat like a Holter monitor.

A

Ambulatory EEG

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12
Q

Leads are left on for 24-72+ hour, inpatient.

A

Video EEG (usually take off of all meds, usually for pre-op)

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13
Q

Are all EEGs done with video?

A

Yes

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14
Q

Subdural or stereotactic depth electrodes. Leads are used for stimulation and recording.

A

Implanted EEG

Done right before surgery (make sure you aren’t taking out the right area)

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15
Q

Benefits of implanted EEG

A

Incredible detail

can transmit information

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16
Q

What 2 things is a CT of the head excellent for showing?

A

Bone and blood

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17
Q

CT shows the ventricles reasonably well in adults and children > ___ years old. Grey-white matter contract is visible.

A

2 years old

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18
Q

Test where an area of the brain is turned off, then wake patient up and put then through a battery of tests.

A

Wada test

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19
Q

what type contrast is used for CT?

A

Iodine

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20
Q

why can’t you see the different in white and grey matter in infant CTs?

A

Don’t get myelin until about 18 months old

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21
Q

What type stroke will show up on CT?

A

hemorrhagic

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22
Q

What is the natural exposure from air, food, etc. in the USA?

A

3.1 mSv/year (about 4 in ABQ)

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23
Q

how much radiation is a CT of the head?

A

2.0 mSv

24
Q

for the heart stress test, which has higher radiation exposure?

A

Thallium

25
Q

How much radiation from a PET scan?

A

14.1 mSv

26
Q

What 3 conditions is a head CT good for?

A

Traumatic injury to the head
Stroke (hemorrhagic)
suspected increased ICP

27
Q

What is a MRI good at showing?

A

brain tissue

28
Q

Can a head MRI be done with many implanted metal devices in the patient?

A

Yes, it is a different machine used with a “send-receive coil”

29
Q

What type contrast is used with MRI?

A

Gadolinium

30
Q

Does a MRI cause radiation?

A

Nope

31
Q

2 reasons for brain MRI with contrast.

A

Infection or neoplasm

32
Q

Do 3 tesla and 1.5 tesla cost the same?

A

Yes (3 tesla MRI has better imaging)

33
Q

Why doesn’t MRI show bone well?

A

Bone doesn’t have much water

34
Q

How long does a MRI usually take?

A

30-45 minutes but can do fast MRI with thicker sections (only about 5 minutes)

35
Q

What detects pairs of gamma rays emitted indirectly by a tracer (usually fludeoxyglucose)?

A

PET scan

36
Q

What is a PET scan good at showing?

A

Areas of increased metabolic activity (glucose uptake)

37
Q

What 2 things in the brain are more metabolically active?

A

Tumor

Epileptogenic

38
Q

What are some limitations of PET scans?

A

Images aren’t sharp
Must be compared w/ normal brain images
High radiation exposure (14 mSv)
Scan done within 2 hours of giving fludeoxyglucose

39
Q

What is similar to PET but directly measure emitted gamma radiation?

A

Single Photon Emission CT (SPECT)

40
Q

How is a SPECT different than a PET?

A

Directly measure emitted gamma radiation
Not as sensitive as PET, longer 1/2 life of tracers
Bigger window to do scan

41
Q

When may you get a medication level way more than prescribed?

A

After a patient has had a seizure then are given lots of their seizure meds.

42
Q

What is a PET scan good at showing?

A

Areas of increased metabolic activity (glucose uptake)

43
Q

What drugs can cause seizures?

A

Cocaine
Ecstasy
Meth
any stimulant drugs

44
Q

Level to see how much medication is in a patient’s blood. Don’t know when they last took their medicine, if they took their medicine, etc.

A

random medication level

45
Q

What are 2 rules of thumb for drug levels.

A
  1. If they are still having seizures- drug is too low

2. If they are having side effects- drugs is too high

46
Q

Why do you get a random drug level.

A

To see if a patient has really been taking their meds.

47
Q

What is the biggest reason for a breakthrough seizure in someone with epilepsy?

A

Skipping their medication

48
Q

What is a medication level taken right before their morning dose?

A

Trough level

49
Q

What is the peak level a measure of?

A

Absorption of the medication

50
Q

If you want to see if a person is given enough of their drug, what level do you want to get?

A

Trough level

51
Q

Are there separate orders for random or troughs?

A

No, only you will known

52
Q

What should you order when a person presents with a seizure?

A

Toxin screen (a lot of street drugs cause seizures)

53
Q

When do you order LFTs and ammonia levels?

A

When someone is on an anti-epileptic med that affects P450

54
Q

What 2 drugs most commonly cause liver problems?

A

Valproic acid, carbamazepine

55
Q

Why do you want to order a CBC with differential and a Chem 7?

A

Some meds can cause anemia, changes in sodium, etc.

56
Q

Do you worry more about levels in the system or CBC with differential?

A

CBC with differential (and history)