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Neuro-Diagnostics

@NeuroFOD@NeuroFOD
Neuro-Diagnostics Neuro-Diagnostics
Resting membrane potential -70 mV
Kinesin vs Dyenin Kinesin = anterograde, Dyenin = retrograde
Proteins to fuse vesicles to membrane SNARE, SNAP, SNAP-receptor
Apoptosis marker Ubiquitin
Structure that causes baseline oscillatory rhythm on EEG Thalamus and Reticular Activating System
Eye deflection on EEG Cornea = positive, retina = negative. Frontopolar discharges
Frequencies of alpha, beta, theta, delta Alpha = 8-12, Beta = >13, Theta = 4-7, Delta = <4
Lamda rhythm Occipital scanning while awake
Sharp and spike milliseconds Sharps = <70ms, Spike = <200ms
Electrographic definition of seizure Sharps >2.5Hz or sharp clusters >0.5Hz, for >10s, must evolve
Sensitivity and specificity of quantitative EEG 60% sensitive, 100% specific
Awake EEG rhythm 8-12Hz alpha + posterior dom (PDR) + muscle/eye artifact + reactive
Earliest EEG sign of sleep Drop of posterior dominant PDR
Stage of sleep for roving eyes N1
Stage of sleep for K-complex N2. Described as sharp -> slow -> fast
Stage of sleep for Vertex waves N2. Sharp waves, maximum at central Cz electrodes
Stage of sleep for spindle waves N2. 12-14Hz sharp waves, maximum at central Cz electrodes
POSTs Sharp, positive, bilateral, occipital, asymmetric
Stage of sleep for frontal delta N3
REM sleep EEG Sawtooth waves, silent EMG, non-reactive
Brain death EEG (1) >8 electrodes, (2) >10cm gap, (3) <2uV sensitivity, (4) >30 minutes
Wicket waves Normal for >60yo. Look like spindles or tosades, but in temporal leads
BETS Normal. Low amplitude spikes in sleep
14-6 spikes Normal. Often occipital in N2/N3 sleep
6Hz spike-and-wave Normal. Often in anterior or occipital leads
SREDA Normal. Subclinical rhythmic electrical discharges in adults
Neonatal EEG Delta brush, dysrhythmic
Sweat EEG Long low frequency >2s oscillations
Chewing EEG High voltage, cyclical
Breach rhythm High amplitude. Seen after crani d/t no bone in between
GIRDA/FIRDA Critically ill patients. No indication for treatment
TIRDA Temporal intermittent rhythmic discharges. Yes; treat this.
Alpha coma Alpha rhythm, but no posterior dom PDR and no reactivity. Poor progn.
Beta coma Beta rhtyhm. Often seen after benzos/barbs
Burst suppression Electrical silence with intermittent bursts. Cortex-Thalamus disconnect
Absence EEG 3 Hz
Lennox-Gastaut EEG 1.5-2 Hz
Triphasics Metabolic (hepatic encephalopathy or renal), often bilateral frontal
Hypsarrythmia Randomness. Seen in infantile spasms (Aicardi, West, TS)
GPDs / LPDs / BiPeDs General/Lateral/Bilateral periodic discharges. <2Hz. Try treatment trial.
Blink reflex cranial nerves CN5v1 -> CN7 -> orbicularis oculi
CMAP / SNAP definitions CMAP = motor amplitude, SNAP = sensory nerve amplitude
Conduction block >20% \/ in CMAP. Demyelinating disorders, can localize lesion
Temporal dispersion >30% /\ in CMAP duration. Demyelinating disorders
Distal latency /\ in 1st CMAP response after stimulation. Demyelinating disorders
Fibrillations vs fasciculations Fibril = on EMG, Fasc = clinical. Both seen >1-2wks after injury
Myotonic discharges on EMG Wax-waning, dive bomber. Myotonia congenita
Myokymic discharges on EMG Short bursts, gun fire, helicopter. Radiation injury, Isaac syndrome
NCS of motor neuron disease Motor: \/CMAP, /\CV, /\DL. Sensory: nL. +fibrillations
NCS of radiculopathy Motor: \/CMAP only. Sensory: nL. +fibrillations, +H-reflex, +paraspinal
NCS of plexopathy/mononeuropathy Motor: \/CMAP only. Sensory: \/SNAP. +fibrillations, +sharps
NCS of radiation injury Motor: \/CMAP only. Sensory: \/SNAP. +myokimia
NCS of axonal length-dependent peripheral neuropathy Motor: \/CMAP, /\CV, /\DL. Sensory: \/SNAP. +fibrillations
NCS of demyelinating disorder Motor: /\CV + /\DL only. Sensory: \/SNAP. +F-wave, +dispersion +block
NCS of neuromuscular disorder Motor: \/CMAP only. Sensory: nL.
NCS of myopathy Motor: nL. Sensory: nL.
What does cold temperature do to EMG? Cold = delayed Na inactivation. So /\CMAP + /\SNAP, but delayed peak.
H-reflex Ankle reflex, S1, tibial nerve. Sensory afferent -> interneuron -> motor
F-wave Motor neuron -> retrograde conduction -> ant. horn -> same motor nerve
Evoked action potentials SSEP = sensory DCML. BAEP = brainstem auditory CN8. VEP = visual
Total volume of CSF at any time 150 ml
Total volume of CSF produced per hour 20 ml
Xanthochromia Due to lysis of red blood cells. Occurs 4 hours post-hemorrhage
CSF values in normal person 15-45 protein, >40% of blood glucose, <5 wbc, <20 OP
CSF values in bacterial meningitis >100 protein, <40% of blood glucose, >500 PMNs
CSF values in viral meningitis High protein, normal glucose, 10-500 lymphocytes
CSF values in asceptic meningitis Mildly high protein, normal glucose, 100 PMNs
CSF values in granulomatous (TB) meningitis >100 protein, <40% of blood glucose, >500 lymphocytes
CSF values in demyelinating disorders nL protein, nL glucose, <20 lymphocytes. +bands, +IgG, +MBP
CSF values in AIDP (GBS) / CIDP >50 protein (albuminocytologic dissociation), nL glucose, nL cells
Hounsfeld unit Density of Xray/CT. Bone > blood > brain > CSF > fat > air
CT perfusion interpretation Pneumbra = high peak time, high transit time, nL volume, nL blood flow
Early stroke signs on CT Dense MCA, insular ribboning, loss of grey-white, cytotoxic edema
T1 MRI Highlights nL anatomy, blood, fat, protein, calcifications
T2 MRI Highlights pathology. Good of CSF flow
FLAIR T2 MRI minus CSF. Good of periventricular lesions, edema, tumor
DWI / ADC ADC = true image, DWI = inverted ADC. Stroke, mening/abcess, tumor
GRE Magnetic susceptibility. Iron (blood), calcium, amyloid, cavernomas
Ring enhancing lesions MAGIC-DR = mets, abcess, glioma, inflam, contusion, demyel, radiation
Periventricular lesions MS, small vessel disease, lymphoma, infection, PML, migraine
Bilateral basal ganglia lesions Metabolic (O2, Glucose, CO, toxins), CJD, TORCH, ADEM, NMDA
Grey-white junction lesions Mets, septic emboli, vasculitis
Created by: amitchaudharimd
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