Psych II Flashcards
CTA vs MRA: CTA ?
Often used after questionable MRA findings
Also used in acute settings
CTA vs MRA: own notes ?
facial droop , slurred speak, not orientated in time - stroke! CT brian is neg. and this is NL with acute stroke ( esp. hemorrhagic cause it is to early to see the blood light up)
BP is to high so not a TPA candidate
MRI and MRA or carotid and circle of willis
What is better at detecting blood within 24-48 hours , CT or MRI ?
CT
EEG results ?
Collection of fluid in an area will cause activity to be damped in that lead
Lesions in cerebral cortex will cause high-voltage abnormal waves
Generalized seizures- widespread electrical activity
Absence seizures- characteristic spike and wave pattern
What is a EMG ?
Electrode is placed in the skin to measure electrical activity if the skeletal muscle
EMG results: Polymyositis ?
Small, spontaneous wave forms caused by hyperirritability of the muscle
- *muscle that is hyper-irritable
- *
Mitochondrial Tests are for ?
Mitochondrial Myopathies
When is ENG used ?
Differentiate between organic versus psychogenic vertigo
Differentiate between peripheral and central vertigo
What is NL about pineal gland and coccoid plexus ?
calcified pineal gland and coccoid plexus - this is NL
When is EMG used ?
Can differentiate between primary muscular disorders and neurologic muscular weakness
Used in patients with muscle weakness
EEG Brain Waves: Alpha waves abnormal with ?
alpha coma caused by destructive process in the pons, seen in pts with hypoxic brain injury (unresponsive)
Abnormal to see these in patients that are awake
General Guidelines: dementia ?
Non-con MR ( extend of dementia)
EEG Brain Waves own notes ?
coma with prominent with T and D waves = again someone in a coma who has wakeful periods and stay in these waves ( eyes opening and we still see these waves then this is a worse prognosis cause the brains till thinks it is asleep )
Spindle coma!?
but if i get headache alot ___________ then do a MRI - more chronic
over months
EMG results: ALS ?
Reduced muscle activity with spontaneous contractions; NL with stimulation
** ALS - problem with lateral nerve and they dont worse anymore , the muscle is fine just the signal is not getting to the muscle **
What is better for acute problem, CT or MRI ?
CT evaluate for acute facial trauma , acute neurologic dysfunction, suspected subarachnoid hemorrhage
it is quick and easy and give you alot of info better then MRI ( superior to MRI in wrist 24 hours if blood is suspected)
make sure to do a Cr/ BUN before a CT
What is better for trauma CT or MRI ?
CT, rapid acquisition
General Guidelines: Headache, acute ?
non-con CT
EMG results: Muscle injury ?
Decreased electrical activity and amplitude
Imaging the Head/Brain: midline ?
Middle of the brain should be in the middle of the head
Indications for Head CT ?
Trauma Acute Stroke Suspected SAH or ICH Headache Sensory or motor loss Sinuses
EEG Brain Waves: Alpha waves prominent with ?
Prominent with relaxation, disappear with attention ( this is normal)
General Guidelines: Headache, chronic ?
MR
What is the Tilt-table Test ?
Provokes vasopressor syncope
Induces orthostatic hypotension
CT brain is normally at wha angle ?
oblique
**not straight across it is more of an oblique angle **
**slicing head at oblique angle and patient i standing **
When is a Tilt-table Test used to evaluate for ?
Tachyarrhythmias
Overmedication for heart disease or HTN
Hyper-reactive vagal activity
Vasomotor instability
-POTS (postural orthostatic tachycardia syndrome )
**list headed alot or head racing when standing up **
CT contrindications and risks ?
pregnancy
radiation to fetus
When is EEG used ?
Evaluating for epilepsy
After trauma - see if there is brian activity
Determine cerebral death in comatose pt
Cerebral lesions localization
**below a voltage for a certain amount of time then they can said that there is brain death **
What is the big star fish ?
suprasellar cistern and 4th ventricle
Imaging the Brain: what are you evaluating for ?
Evaluate the suprasellar cistern and the quadrigeminal plate cistern
Evaluate the ventricles.
Are they midline and symmetric?
Can fill with blood or pus
Can you see the “smile” and the pentagon?
**expect to find the pineal gland and the coccoid plexus here in their view
big one - starfish - super cellar cistern and 4th ventricle **
Evoked Potential Studies Results: Sensory ?
Spinal cord injury
Peripheral nerve injury
CVA
CT Angiogram (CTA) what is it ?
Problem solving technique, NOT a screening method EXCEPT for dissection or acute CVA where CT is negative.
Acetylcholine Receptor Antibody (AChR Ab) what is it ?
Antibody test
Binding vs. Blocking ABS
Modulating ABS
What are Evoked Potential Studies ?
Similar to EEG
Focus on changes that occur when brain is stimulated
Doesn’t require any pt participation
Blood in the subdural space ? own notes ?
under the dura then it just seeps into the brain - diffuse bleeding that seeps out if it is not big enough to shift midline
What is ENG ?
Evaluate for nystagmus by measuring electrical changes around the eye
Makes a recording of eye movement at rest, with head movement, and with stimuli
The direction, velocity, and degree can be recorded
Mosby’s pg. 584
**measure electrical changes around they eye to see of there is nystagmus ( hard to tell if it is horizontal or vertical ) but this can tell you what type og nystagmus the patient is having
organic versus psychogenic vertigo **
Imaging the Head/Brain: midline - any shift represents ?
mass effect
Gomori stain uses ?
Muscle bx
General Guidelines: cancer ?
MR
CS#3
An 80 year old female is brought in by daughter for dizziness. She states that she feels completely off balance and cannot walk. On exam you note she has an abnormal finger-to-nose test (ataxia).
What do you do?
CT scan
is an old brain cause it is aptly and it is symmetrical
all dark spaces get larger
CT normal then call nureo, check Cr and order a CTA ( make sure vasculartur is okay with Cr)
EEG Brain Waves: Theta waves ?
Seen in sleep, slow waves
Abnormal in awake adult
CS #2
A 12 year old boy was playing soccer and was struck in the side of the head by another boy’s knee. There was a brief LOC initially. Now is complaining of headache, nausea, and light sensitivity.
What do you do?
get a non con CT - cause LOC, and sxs, photosensitive and N and he has pain
lenticular shape - epidural - soft tissue swelling as well
this is a brain window
Evoked Potential Studies Results: Auditory ?
Acoustic neuroma
Auditory nerve damage
Deafness
When do you want to pick CT ?
Best for sizing coils and treatment plans for AVMs
No contrast in an acute setting unless looking for brain abscess or tumor
Acute (within 48 hours)
The septum between the lateral ventricles should NOT deviate more than _ mm from midline
5
**lateral ventricle are a good place to start
draw line down an they should be symmetric **
CS #1
A 2 year old fell off of the couch and hit his forehead on the hardwood floor. He has a small bruise there. Mother is concerned because he cried then he fell asleep.
What do you ask?
no V and no LOC, fell off cough onto hardwood floor,
no V and cried is good and no LOC is all good - injury is in the forehead ( best place, better thn back of head)
2 yo this is better
REASSURE!! do not radiate this little kid!
Imaging the Head/Brain windows ?
different window
C - bone window
A and B - brain windows
bone window is a better view of the bone
“soft tissue edema outside the tissue”
slide 29
CTA vs MRA: MRA ?
Easier to read
Better contrast between tissues
Intracranial vascular stenosis
Aneurysms
PTs who are NOT acutely ill
if not emergent ( takes alot of time and requires patient coorporation)
Diverse group of disorders that result from abnl mitochondrial DNA
?
Mitochondrial Myopathies
General Guidelines: seizure ?
Non-con CT ( make sure no big area of edema or bleed causing the siezure)) THEN CT or MR with
more for new onset siezure contrast
Caloric Study: Normal results ?
Cold water: nystagmus away from ear being irrigated
Warm water: nystagmus toward the ear being irrigated
**fast and a slow part of the nystagmus **
Electromyography aka ?
EMG
ABS MS own notes ?
Each is ther but the receptor are gone so the AP does not get generated
less receptors to pick up Each and at first it works fine but with repetitive movement ( development of weakness occurs cause not enough receptor)
talking and face starts to droop
early they are fine but it gets worse
thigh weakness - walking around fine and then all the sudden thigh weakness
What is a Penumbra ? own notes.
black area where the vessel has been occluded
dead tissue is dead - never get it back
penumbra - will potential die as well if you do not reverse the ischemic event ( catch it early enough)
pic rt - ischemia to long and the brain died in that penumbraa area
TIME IS BRAIN!!
CT Angiogram (CTA) own notes ?
carotid dissection, dissection of arterial aneurysm or posterior circulation stroke , - start with regular w/o CT brain to not miss something else and this is fine ( still vomitting) then check Cr and then run CTA
problem solving technique
dizzy, V and ataxia, no trauma, woke up 68 yo and feeling fine and then sudden got dizzy and things are spinning and now vomitting, not ficial drop, little unstable gait, little nystagmus horizontal - think stroke in the posterior ( vertigo and ataxia usually posterior issue)
Evoked Potential Studies: response and potentials ?
Visual-evoked responses
Auditory brainstem-evoked potentials
Somatosensory-evoked responses
**i cant hear out of my left ear , nothing wrong physically and there is no tumor and they still can’t tear
so this test does not lie - they can tell if brain is responding to it or not
used in babies to tell them if they can smell or hear or see
good test cause no participation from the patient **
When are Evoked Potential Studies used ?
Evaluate specific areas of the brain cortex that are stimulated by the eyes, ears or sensory nerves
Identify histrionic or malingering patients who complain of sensory deficits
sudden acute worse head ache of my life - sub arachnoid hemorrhage - first do a ?
non contract CT
General Guidelines: coma ?
Non-con CT
When is AChR Ab used ?
To diagnose MG
EEG Brain Waves: Delta waves ?
Slowest, largest amplitude
Generated in deep meditation and dreamless sleep
EEG during the test ?
Supine position
Allow pt to move every 5 minutes ( if they are awake - not continuously though)
+/- photostimulation
can trigger seizures or abnormal brain activity
+/- hyperventilation
can trigger seizures or abnormal brain activity
+/- sleep
Takes 45 min- 2 hrs
EEG Brain Waves: Beta waves ?
Small, observed in all age groups
Irregular, occur with attention
Evoked Potential Studies Results, what is abnormal ?
Prolonged latency is abnormal
General Guidelines: Acute trauma ?
Non-con CT
ABS: MS - ____________________ cause myasthenia fatigue
Repeated movements
Acetylcholine Receptor Antibody (AChR Ab) resources ?
Harrison’s Ch. 386
Mosby’s pg.22
ENG results ?
Different patterns of nystagmus correspond to various pathologies
Will allow differentiation between central or peripheral cause.
Antibody tests: Myasthenia gravis - ___ combines with ____ at the NM junction
ACh
AChRs ( receptors)
Mitochondrial Myopathies can mimic __ pr present with ___ dysfunction
Can mimic MG or present with CNS dysfunction
- *this is a fuzzy area that mimic things like MS ( mitochondrial myopathies mimic disorders and they cause neurologic or muscular dysfunction)
- *
What is a Caloric study ?
Irrigation of the EAC with hot or cold water induces nystagmus
ABS: MS - Antibodies destroy receptor sites for the ___
ACh
Blood in the epidural space ? own notes ?
blood in epidural space - dura is pushed down but the dura is attached still where the suture lines are but the blood pushed down the cerebrum in a symmetrical way
nice lenticular space
Electronystagmography aka ?
ENG
EMG results: other ?
MD Guillan-Barre MG Nerve injury MS Diabetic neuropathy
Electroencephalography aka ?
EEG
what is an EEG ?
Graphic recording of the electrical activity of the brain
When do you want to pick MRI ?
Chronic or subacute
Best for seeing AVMs
Better for cancer
more chronic problems
Caloric Study: Abnormal results ?
Labyrinth is diseased or CN VIII is not functioning then there will be no nystagmus induced
General Guidelines: stroke ?
Non-con CT ( make sure its not hemorrhagic)
F/U MRA or CTA
Imaging the Brain :Symmetry ?
Compare left and right side
Do they look alike?
**the right side is smaller - in a accident and atrophy of the brian on one side **
Evoked Potential Studies Results: Visual ?
Demyelinating disease
Optic nerve damage
Occipital lobe tumor or CVA
Mitochondrial Myopathies Gomori stain shows ?
characteristic “ragged red fibers” - if you are looking for a mitochondrial myopothay
EEG pre-test ?
+/- medications
Sometimes sleep time should be shortened
No sedatives before the test
No fasting
No caffeine
