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Neurology Chapter 20
Diagnostic Techniques and Neurologic Concepts
| Term | Definition |
|---|---|
| Static Brain Imaging | -imaging that allows the identification brain structures ( -i.e. CT |
| Dynamic | -Identify function of brain -PET or fMRI |
| Cerebral Angiography | -Identifies arterial disease, aneurysms and AV malformations -Radiopaque substance released into bloodstream and followed through system |
| CT | -Imaging technique that relies on X-rays -Widely available -Most (if not all) hospitals and many clinics also have them because of relatively low cost -Shows body structures (bone and soft tissue) – does not show function (metabolism) |
| What is CT used for? | -Mainly used for bone scans, chest x-rays, and stroke imaging -Takes 1-5 mins & is optimal for detection of cerebral hemorrhage -Usually does not detect acute ischemic stroke -Patients who receive tPA always get CT before to rule out hemorrhage |
| Advantages of CT | -Very quick compared to other imaging techniques -Gives good spatial resolution compared to metabolic imaging (PET) -New CT applications can scan perfusion -Is widely available -Cheap compared to MRI. CT 100-200k, MRI 3mil |
| Disadvantages of CT | -Uses X-rays (radiation!) -Cannot detect acute ischemic stroke -Poor spatial resolution compared to MRI -Good for ruling out a hemorrhage, but not good for detecting an acute systemic stroke |
| How to read a CT Scan | -Right is right and left is left (NOT flipped) -Ischemic stroke: Dark -Bleed: Bright -Tumor: Dark -MS Plaque: Dark |
| Magnetic Resonance Imaging | -Not radiographic, analyzes response to radiofrequency signal -Visualizes structures -Does use radiation so no increase cancer risk |
| How to read MRI | -right is left and left is right -T1-MRI: ischemia/infarct- dark, bleed- bright, tumor - dark, MS plaque- dark -T2-MRI: ischemia/infarct- bright, bleed- bright(hard to see), tumor - bright, MS plaque- bright |
| Positron Emission Tomography (PET) | -Measures glucose tagged with radioactive substances to determine which tissues have highest energy use during activity -Doesn't emit radio activity, but measures what you inject into person (or person drinks). |
| What is PET used for? | -Mostly used in cardiac and cancer management -Can distinguish b/w Alzheimer's, blood flow shortages, depression, or other reason for dementia -Can localize site of seizures Can detect: Small tumors, Viable cardiac tissue, Decreased brain metabolism |
| PET Disadvanatges | Takes a long time. Therefore: -Not optimal for persons with acute condition needing immediate medical management -Not for persons who have difficulty laying still for extended period of time |
| fMRI | -Person lies in scanner & completes a specific task -Used to determine which parts of the brain are activated by different types of physical sensation or activity, such as: Sight, Sound, Language, Finger tapping |
| Electroenceph- alography (EEG) | -Measuring electrical potentials from electrodes placed on the scalp -Can make comparisons of activity in various parts of the brain -Creates Topographical mapping of brain’s electrical potentials -Compares diff wave patterns and function over time |
| Electro- myography | -Measure electrical activity at the level of the muscle -Can determine if muscle is receiving electrical stimulation -Helpful in spinal injury cases and myoneural problems |
| Dichotic Listening | -Assesses cerebral dominance for language -speech understood better with right ear as fibers cross to left hemisphere which is dominant for speech -Two words presented simultaneously - one to each ear - Person reports which word was processed |
| Lumbar Puncture | -aka Spinal Tap to determine the presence of infections in cerebrospinal fluid -Fluid removed from lumbar subarachnoid space and is subjected to lab test to look for blood or infections |
| Cortical mapping through craniotomy | -Done before craniotomy surgery to prevent cutting into language, memory or motor function. -Can also be done through TMS (trans magnetic stimulation) |
| Stereotactic Surgery | -subcortical mapping -Done when surgeon wanst to put a lesion in sub cortical areas (i.e. basil ganglia) to try to reduce abnormal movement. |
| Carotid Endarterectomy | -Removal of sclerotic plaque from the common carotid artery to increase blood flow |
| Aneurysm Clipping | -Metal clip is used to obliterate the bulge to reduce possibility of rupture -Can also do embolizing by using a catharater with metal at end to get platelets to block blood from coming into aneurysm area. |
| Seizures | -Instability of electrical activity in the brain -70-75% occur before age 20. -Some are not recurrent -Can be 2nddary to head injury, metabolic abnormalities, tumors, infarcts, infections, and physiological disturbances. |
| Partial-Focal seizures | -Type of seizure -Single area with a cortical or subcortical lesion -Seizure spreads from one body part action recruiting additional movement (could maybe start in leg than spread upwards) |
| Partial-Complex Seizures | -Lesions in temporal lobe structures -Automatic irrational behavior for which there is not memory -Can lead to interruptions in language. |
| Petit Mal Seizures | -Between ages 3 and 12 usually disappear after age 30 -Staring, chewing clinking, and myoclonic jerks, extenstion of extremities |
| Grand Mal (Tonic Clonic) Seizures | -Loss of consciousness with tonic convulsion |
| What to Do When a Person Has a Seizure? | -Do not hold the person down or try to stop movements -Keep objects away from area to prevent injury -Do not put anything in the mouth -Turn head to side to avoid choking on food Call for assistance and observe symptoms. Time the seizure if possible |
| What is a stroke | -occurs when normal blood flow to the area of a brain is cut off. When blood flow is cut off neurons begin to die. |
| Right Hemisphere strokes can cause | -Left side paralysis -Left side loss of vision -Neglect -Left side body sensation loss |
| Left Hemisphere strokes can cause | -Right side body paralysis -Inability to speak or understand speech -Right side vision loss -Right side body sensation loss |
| Brain Stem & Cerebellum strokes can cause: | -Difficulty swallowing -Double vision -Slurred speech -Loss of balance or dizziness -Paralysis -Unstable blood pressure -Impaired breathing -Coma |
| Amount of stroke survivors that suffer a 2nd stroke | -About 1/4 of stroke survivors have 2nd strokes. |
| Heart attacks and stroke | -Small percentage of stroke victims suffer heart attacks or irregular heart beats after stroke. |
| Dysphagia & aspiration Pneumonia | -some stroke victims have difficulty chewing and swallowing which causes food and liquids to go to lungs instead of stomach. Proper positioning and diet used to prevent this. |
| Cerebral Edema | Swelling of the brain. Time best healer. Meds only used in severe cases. |
| Pulmonary Embolism | -Blood clots forming in legs or pelvis may travel to lungs and get lodged there. Can lead to lung or heart damage and even death. -To prevent this complication meds maybe prescribed to reduce chances of blood clots forming. |
| Urinary Tract Complications | -Stroke survivors may have trouble with kidney and bladder functions due to dehydration, side effects to meds, loss of bladder sensation, or infection. |
| Percentage of stroke victims that suffer from depression | -occurs in 50% of stroke victims. -Families also experience emotional stress. |
| Recovery and Rehab after stroke | -Rehab starts within 2 days of stroke. -Some areas of brain that were injured may resume function. -Other areas may compensate for injured areas. -Brain maybe able to reorganize it’s own functioning. |
| Recovery percentages | -15% of people die shortly after the stoke -10% recover almost completely -25% recover with mild impairments -40% experience moderate to severe disabilities -10% need long term facility care. -There are 3 mil stroke survivors alive today in US |
| What happens to stroke survivors after hospital | -go to a rehab unit in or out of hospital -Can go home with care -Go to a long term care facility -Everyone in family must take up new roles. Join a support group. Schedule breaks in care giving -includes physical, occupational and speech therapy. |
| Goal of rehab is to... | -make person as independent as possible- |
| Ho can family help a family member who's suffered a stroke? | -Family can help by encouraging, supporting and giving love and allowing survivor to do things themselves. |
| Stroke stats in US | -3rd leading cause of death (behind heart disease and cancer) -leading cause of adult disability, impact 1 out 5 families in US. -Cost $25 billion each year |
| Transit Ischemic Attack | -temporary loss of blood flow to the brain. -Symptoms can include: -sudden inability to speak, -difficulty understanding speech, sudden weakness or numbness of arm or hand. -dizzy or black out. -most TIA patients will have a stroke |
| Preventing stroke | -Exercising -Diet change -Loose weight -Reduce blood pressure -Reduce cholesterol -Stop smoking -Drink alcohol only occasionally |
| Stroke warning signs | -Sudden impaired vision -Numbness, weakness or paralysis -Trouble speaking or understanding -Difficulty swallowing -Dizziness -loss of balance or unexplained fall |
Created by:
aramos139
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