Neurological imaging and diagnostic testing

Focal sensory examination evaluates 3 things

light touch, 2 point discrimination, sharp/dull

The more distal, the more _____ sensory capabilities you have

focal

what does AVPU stand for

Alert, Voice (responds to), Pain (responds to), Unresponsive

What is the best score for GCS

15

What is the GCS of a totally unresponsive person

3

EVMS

Eye, Verbal, Motor, Score

"Dry" CT

CT w/o IV contrast

CT w/o contrast can help identify

intracranial bleeding, stroke (ischemic or hemorrhagic), brain/spine tumors, fractures, spinal stenosis

epidural hematoma

lemon shaped

normal mental status to completely unconscious

subdural hematoma

Crescent-shaped intracranial bleeding after head injury in the elderly; can be acute on chronic

subarachnoid hemorrhage

more diffuse presentation

intracerebral hemorrhage

typically not trauma related; can often come from a ruptured AVM from uncontrolled HTN

ischemic brain injury

are epidural or subdural hematomas more common?

subdural

Dark (on CT) means

old blood

White means

new blood or CSF

Can you have a subdural hematoma that is acute on chronic?

yes

CT w/ IV contrast head can help identify

stroke (ischemic), brain/spine tumors & vascularity, AVM, fractures/spinal stenosis

if you wanted both a CT w/ and w/o contrast, which would you do first?

Without contrast ("dry")

MRI head is most helpful in evaluating __________

soft tissue disturbances (tumors, brain infections, dementia, inflammation)

Before having an MRI, you must make sure the patient doesn't have

metal in the body

head MRA evaluates

magnetic resonance angiography

head PET Scans use ____ bound to glucose to show where the brain is _____

radioactive substance bound to glucose to see where the brain is working

PET Scans are used to identify brain

function

PET Scans are useful in evaluation of

alzheimer's disease, epilepsy, parkinson's disease, mets

EEG measures the pattern of

electrical activity in the brain

EEG can find brain wave patterns a/w

epilepsy, seizure, tumors, alzheimer disease, psychoses, sleep disorders, brain injury/death

brain death on EEG

normal EEG

in CSF analysis what do tubes 1,2,3,4 represent

1: CBC w/ dif

2: gram stain

3: C&S

4: Cell count

Positive cell count on LP could indicate

traumatic tap or intracranial hemorrhage

do you have to draw tubes 1,2,3,4 in consecutive order?

YES

what is a major contraindication for performing an LP

space occupying lesion in the brain (this could cause the brain to herniate because you are quickly decreasing the intracranial pressure)

what are some signs and symptoms that would make you concerned about a space occupying lesion

progressively worsening HA, ne HA w/ focal neuro symptoms, unexplained HA in pt with cancer or HIV, new onset seizure

doppler US of the head can help identify

blood clots, arterial stenosis, vascular vasospasm

EMG can be used to evaluate _____ nerves

peripheral

EMG evaluates the ___ and ____ of electrical nerve impulses

speed and strength

what are some conditions that EMG is used for

peripheral nerve compression syndromes, peripheral neuropathy, diabetic neuropathy, carpal tunnel syndrome

what is some lab testing that you can order to evaluate peripheral nerve testing

vit deficiencies (vit b12, e, b6) , diabetes (glucose and HgbA1c) , immune function abnormalities, chronic renal failure (uremia), exposure to heavy metals (lead)

CT myelography can be used to evaluate the ____ and _____

spinal cord and canal

CT myelography is a good alternative to MRI to identify

spinal stenosis, disc herniation, spondylosis, arthritis

plain radiography of the head/neck is good to determine

flexion and extension of the spine (evals stability)

herniated disc disease

pain related to a herniated disc will most oftentimes occur ____ to the injury

distal

spinal compression fracture

cervical burst fracture

clay shoveler's fracture

Fracture of C6 or C7 spinous process, relatively innocuous.

spondylosis

arthritic degeneration of the spine

spondylosis is generally accompanied by ____ formation and disc ______

osteophyte formation and disc thinning/collapse

_____ is a common cause of low back pain but can occur anywhere

spondylosis

spondylolisthesis

forward slipping of one vertebra over another (caused by vertebral fracture at the pars interarticularis)

spondylolithesis can be caused by ____ or ______

degenerative or traumatic etiology

spondylolisthesis s/s can range from none to _______

severe low back pain with radiculopathy

spinal stenosis

Narrowing of the spinal canal that causes pressure on the spinal cord (nerves)

spinal stenosis etiology

osteophytes, disc herniation, tumors, trauma

what are the s/s of spinal stenosis

mild-severe pain, paresthesia, and muscle weakness

cauda equina syndrome is a form of _____ where all nerves in the lower spine are compressed

spinal stenosis

s/s of cauda equina syndrome

low back pain, radiculopathy, lower extremity weakness, reduced, incontinence of bowel/bladder

rank arthritis, cauda equina, spondylolithesis, and spinal stenosis from best to worst

Normal

arthritis/spondylosis

spondylolithesis

spinal stenosis

cauda equina syndrome

hangman's fracture is a fracture of the

bilateral pars interarticularis of C2

hangman's fracture is traumatic _____ of the atlas/axis

spondylolisthesis of the axis (C2)

what are the most common causes of a hangman's fracture

MVA, diving injuries, sports injuries, face first fall from standing position

Jefferson's fracture is a ___ fracture of the atlas/axis caused by axial loading of the cervical spine

burst fracture of the atlas (C1)

are jefferson's fractures usually accompanied by c-spine injuries?

yes, 1/3 have c2 fracture

Jefferson's fracture also usually causes a blunt ____ injury

cerebrovascular (ICA, CCA, vertebra artery)

chance "seatbelt" fracture

An unstable traumatic flexion-distraction fracture in the area of the thoracolumbar junction

there is a high chance of severe ____ injury with chance fractures

abdominal

odontoid fracture is a common fracture of the ____ dens caused by low-energy falls in geriatric patients and high energy trauma in younger patients

C2 dens

odontoid fractures are typically related to

hyperextension or hyperflexion

what are the 2 m/c primary spinal tumors

multiple myeloma and osteosarcoma

what are the m/c secondary spinal tumors

breast, lungs, prostate

multiple myeloma

Most common form of plasma cell cancer that develops in the bone and metastasizes throughout the body

"moth eaten appearance" of bones indicates

multiple myeloma

what are the s/s of multiple myeloma

bone pain, weakness, weight loss

what is the m/c form of bone cancer that begins in the bone

osteosarcoma

what is the gold standard imaging for osteosarcoma

MRI (must confirm w/ bx)

secondary spinal tumors often present with nighttime _____ that wakes the patient up from sleep

neck or back pain