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Clin Med III Unit 3 > Neurologic Diagnostic Studies > Flashcards

Neurologic Diagnostic Studies Flashcards

1
Q

Safe, painless recording of the cortical electrical activity

A

Electroencephalogram (EEG)

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2
Q

EEG involves _____ paired of electrodes applied to the scalp

A

8-16

Readings taken awake and/or asleep

Temporary vs. continuous monitoring

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3
Q

Indications for EEG

A

Seizure disorders**

Metabolic encephalopathy

Distinguish between cortical and subcortical

Tumors

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4
Q

Why might an EEG be normal in a seizure patient?

A

B/c seizures are EPISODIC events - unless you’re monitoring at the moment the seizure occurs, you may not see EEG changes

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5
Q

Why use EEG in metabolic encephalopathy?

A

To distinguish focal from generalized slowing

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6
Q

What is the difference between cortical and sub-cortical injury?

A

Cortical: See neglect, aphasia, and hemianopia

Sub cortical: See motor hemiparesis

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7
Q

What are the different types of rhythms in EEG?

A

Alpha = 8-12 Hz

Beta = >12 Hz

Theta = 4-8 Hz

Delta = 0-4 Hz

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8
Q

What type of EEG rhythm do you normally see in awake adults?

A

Alpha (8-12 Hz)

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9
Q

EEG findings:

Epileptiform activity

A

Seizures

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10
Q

EEG findings:

Focal discharges/spikes c/w focal problem

A

Tumor, infarct, scar tissue

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11
Q

EEG findings:

Generalized changes/slowing c/w metabolic disorders

A

Encephalopathy, anoxia

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12
Q

EEG findings:

Psychogenic seizures —> normal EEG w/ presence of “seizure” activity

A

Get them on inpatient monitoring unit

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13
Q

What are the contraindications for EEG?

A

NONE (YAAAAY!)

Should be interpreted by neurologist who specializes in EEG

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14
Q

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

A

Electromyogram (EMG)

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15
Q

EMGs differentiate ________ conditions form ___________

A

Primary muscle conditions

Muscle weakness caused by neurologic disorders

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16
Q

How is an EMG performed?

A

Needle electrode(s) inserted into skeletal muscle to record electrical potentials —> look for abnormal activity

Electrical activity of the muscle is evaluated during:
• Needle insertion
• Spontaneous activity at rest
• Slight muscle contraction
• Full muscle contraction
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17
Q

The ________ provides information about the muscle’s ability to respond when the nerves are stimulated during an EMG

A

Presence, size, and shape of the wave form (the action potentials)

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18
Q

EMG indications

A

Lower motor neuron disease (ie ALS)

NMJ disease (ie Myasthenia gravis)

Muscle disease (myopathy)

Peripheral nerve disorders (ie carpal tunnel, peripheral neuropathy)

Others: alcoholic neuropathy, brachial plexopathy, cervical spondylitis, denervation, Guillain-Barre, muscular dystrophy, nerve dysfunction, polymyositis

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19
Q

What will EMG show in NMJ disease such as Myathenia gravis?

A

Fatigability

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20
Q

What will EMG show in muscle disease (myopathy)?

A

Decreased amplitude of motor response

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21
Q

Study used to assess the rate of conduction and the amplitude of response of peripheral nerves

A

Nerve conduction studies

Tests how well and how fast the nerves can send electrical signals

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22
Q

Nerve conduction studies are usually performed in conjunction with …

A

EMG

23
Q

How do nerve conduction studies work?

A

Electrical stimulation of peripheral nerve will produce muscle contraction or a sensory response

Recording electrode and stimulating electrodes are placed over nerve or muscle

24
Q

Indications for Nerve Conduction Studies

A

To differentiate between primary nerve and muscle disorders

To differentiate lower motor neuron diseases from peripheral neuropathy

Detect abnormalities in sensory nerves

Axonopathy

Demyelination process

25
Q

What nerve conduction study finding suggests axonopathy?

A

Decreased amplitude

26
Q

What nerve conduction study finding suggests demyelination process?

A

Decreased conduction rate

27
Q

How is NCV utilized for carpal tunnel syndrome?

A

Can check integrity of sensory and motor pathways

Can help determine when surgery is needed

28
Q

What are the indications for plain film neuroimaging?

A

Degenerative disease (osteophytes, decreased disc space, alignment)

Trauma (fracture/dislocation)

Malignancy

29
Q

When are lumbar spine films used?

A

Spondylolisthesis - flexion and extension views are indicated to evaluate for degree of instability

30
Q

_______ are used as first line imaging to look for fractures with or without associated dislocations

A

Plain films

Will be followed by either CT or MRI to define presence of associated soft tissue injury

31
Q

Indications for plain SKULL films

A

Trauma
Metabolic disease
Malignancy

32
Q

CT scan indications

A 
Trauma
Stroke (ischemic v hemorrhagic)
Hydrocephalus
Suspicious headache
AMS
Trauma/degeneration of spine
LOC
Persistent neuro dysfunction
Persistent vomiting
GCS <8 or deteriorating
Retrograde/anterograde amnesia
Post-traumatic seizures
33
Q

How does CT appear for Epidural hematomas?

A

Blood between the dura and skill —> LENS SHAPED

34
Q

How does CT appear for Subdural hematomas?

A

Blood between the dura and the arachnoid

CRESCENT-SHAPED

35
Q

What is mandatory for suspected strokes?

A

Non-contrast head CT to r/o hemorrhagic stroke prior to administration of thrombolytic meds

36
Q

Indications for MRI

A 
Tumors
Vascular disease
Inflammation/infection 
Multiple sclerosis
Degenerative disease (spine)
37
Q

What are the two types of MRI?

A

T1 - reflects UPTAKE of magnetic energy (better for normal anatomy)

T2 - reflects RELEASE of magnetic energy (better for pathology)

38
Q

CSF/water is ______ on T2 and ______ on T2

A

Dark

White

39
Q

Fat is _____ on T1 and _____ on T2

A

White

Dark

40
Q

Diagnostic study of choice for brain tumors

A

MRI with gadolinium contrast

Look for mass effect, surrounding edema, and pattern of enhancement

41
Q

Test that measures the microscopic motion of water

A

Diffusion MR

42
Q

Diffusion MR is the most sensitive test when you suspect…

A

An acute ischemic stroke of the brain/spinal cord

Can also be used in the workup for encephalitis/abscess

43
Q

What will you see on MRI for MS?

A

Periventricular plaques

44
Q

How does a brain abscess look on MRI?

A

Well defined walled mass with central clearing

45
Q

Imaging indications for a new deficit (either CT/MRI)

A

New onset of vision loss, aphasia, AMS, sensory abnormalities, motor paralysis, vertigo w/HA, diploid, focal deficit, ataxia, or dysarthria

46
Q

Imaging indications for Headache (CT/MRI)

A

“Worst HA of my life”

New HA in patients with cancer or HIV

HA w/ papilledema

HA w/ neuro deficit

HA w/ AMS

HA that worsens w/ exertion, positionally related, awakens pt from sleep, changes over time

47
Q

Indications for MRI of the spine

A

Radiculopathy (persistent or progressive)

High impact trauma

New or progressive deficit

Suspected tumor or infection

Neurogenic claudication

New onset of back pain in a patient with cancer

48
Q

Reflective sound waves used to determine velocity of blood through carotid arteries

A

Carotid ultrasound

Assesses degree of stenosis

49
Q

IV injection of contrast medium used to assess patency of vessels

A

Angiography

Can be traditional, CTA, or MRA

50
Q

When is angiography indicated?

A

When definitive anatomy needed

Pre-operative (CEA, aneurysm repair)

51
Q

Radiopaque dye injected into thecal space and used to detect spinal cord pathology/compression (ie herniated disk, spinal stenosis)

A

Myelography

Patient is tilted for images (either xray or CT)

Being replaced by MRI so you won’t really see this

52
Q

Procedure used to obtain CSF sample for analysis

A

Lumbar puncture

Looking for WBC, glucose, protein, gram stain/culture

53
Q

LP is used to evaluate for …

A

Meningitis

54
Q

When should you NOT perform an LP?

A

If papilledema or other signs of increased ICP are present

Clin Med III Unit 3 (5 decks)

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