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Neurology Chapter 20

Diagnostic Techniques and Neurologic Concepts

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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