Chapter 2: Review Medical Record for Diagnostic Procedures and Results

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dmshaw9
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Chapter 2: Review Medical Record for Diagnostic Procedures and Results
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2015-03-09 23:58:58
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Diagnostic Procedures Results
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NPTE: Chapter 2
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  1. Radiological Procedures
    • Skull x-rays
    • Delineates lesions of bone
    • Tomograms (tomography) are layered x-ray exposures -- either vertical or horizontal
  2. Ventriculography
    • X-rays of skull after injection of air into lateral ventricles
    • Delineates ventricles
    • Helps localize tumors
    • Useful with increased intracranial pressures
  3. Myelography
    • X-rays of spine after injection of air or dye into spinal subarachnoid space
    • Delineates abnormalities impinging on subarachnoid space
    • Complications = dye may result in meningeal irritation
  4. Cerebral Angiography
    • X-rays of skull after injection of dye into carotid or vertebral arteries or both
    • Has largely been replaced by magnetic resonance angiography
    • Complications: invasive technique; may cause meningeal irritation, hemorrhage, vasospasm, or anaphylactic reaction to dye
  5. Computed Tomography (CT)
    • Neuroimaging technique
    • Narrow x-ray beams are transmitted through tissues of varying densities 
    • Allows cross-sections of brain to be visualized with 3D localization 
    • Contrast agents (intravenous iodinated agents) used to increase diagnostic sensitivity to detect brain abnormalities
    • Useful for showing abnormal changes in tissue density (acute bleeding (hemorrhage in developing stroke), edema (within 3 days post stroke), infarction (within 3-5 days post stroke)) 
    • Allows administration of TPA (clot busting drug) in absence of evidence of hemorrhage within 3 hours of thromboembolic stroke
  6. Magnetic Resonance Imaging (MRI)
    • Nuclear particles (protons and neurons) are depicted in strong external magnetic field 
    • No radiation used 
    • Superior imaging of brain, provides greater resolution of tissues and flow of blood 
    • Bone poorly imaged 
    • More sensitive in diagnosis of acute strokes (allows detection of cerebral edema within 30 min after vascular occlusion and infarct within 2-6 hours)
    • Primary method of examination of tumors, demyelination, and vascular abnormalities
  7. Magnetic Resonance Angiography (MRA)
    • Uses special software to create image of arteries in brain
    • Identifies vascular abnormalities similar to angiography (x-ray of brain) with increased sensitivity and lowered risks
  8. MRI Contraindications
    • Metal implants
    • Pacemakers
  9. Positron Emission Tomography (PET)
    • Radioisotopes inhaled or injected 
    • Emissions measured with gamma ray detector
    • Allows physiological mapping (imaging cerebral blood flow, brain metabolism)
    • Lacks detailed resolution of CT or MRI
  10. Electroencephalography (EEG)
    • Ongoing electrical activity of brain recorded, appears as periodic waves
    • Provides useful info about structural disease of brain, especially when seizures are present or likely
    • Can assist in localization of intracranial lesions in brain
  11. Evoked Potentials/Evoked Responses
    • External visual, auditory, or somatosensory stimuli are used to evoke potentials in brain
    • VEP: visual evoked potential
    • BAEP: brainstem auditory evoked potential
    • SEP: somatosensory evoked potential 
    • Delineates conduction times along sensory pathways
    • Detects lesions if responses are delayed or absent
  12. Echoencephalogram (Ultrasound/Doppler Techniques)
    • Reflected ultrasonic waves recorded and analyzed
    • Imaging lumen of carotid artery and analyzing flow
    • Detection of plaques in carotid 
    • Measures position and shifts of medicine structures (i.e. tumors or hematomas)
  13. Lumbar Puncture (LP): Definition
    Insertion of spinal needle below L1-2
  14. Lumbar Puncture: Purposes
    • Withdraw CSF for chemical analysis and cytological exam - measurement of protein, glucose, immunoglobulin content, cell count
    • Measure intracranial pressures and spinal fluid dynamics 
    • Injection of contrast medium for radiological exam
    • Injection of therapeutic agents (treatment of cancer, meningitis)
  15. Lumbar Puncture: Complications
    • Severe headache caused by CSF leakage (relieved by lying down)
    • Infection
    • EPidural hematoma
    • Uncal herniation
  16. Normal CSF
    • Appearance: crystal clear and colorless
    • Volume: 90-150 mL (adult); 60-100 mL (child)
    • Pressure: 90-180 mm H20 (adult); 10-100 mm H20 (child)
    • Normal protein: 15-45 mg/dL (adult); 15-100 mg/dL (neonates)
  17. Pathological CSF Findings
    • Increased pressure occurs with intracranial tumors, abscesses, meningitis, inflammatory processes, subarachnoid hemorrhage, cerebral edema, and thrombosis of venous sinuses
    • Decreased pressure occurs with leaking CSF, subarachnoid block circulatory collapse, severe dehydration
    • Changes in color or appearance occur with inflammatory diseases, hemorrhage, tumors
    • RBCs indicate hemorrhage or traumatic tap
    • Elevated WBCs indicate significant inflammation and infection
    • Elevated proteins may indicate tumors or inflammation
  18. Neuromuscular Diagnostic Procedures
    • Electromyography (EMG)
    • Nerve Conduction Velocity (NCV)
  19. Electromyography
    • Detects electrical activity arising from muscles, both resting state and active contraction
    • Diagnose LMN disease or primary muscle disease, defects in transmutation of NM junction 
    • Insertional activity (burst of AP's when EMG needle is inserted into normal muscle) is increased in denervated muscle and many muscle diseases
    • Number of motor unit potentials (MUPs) is decreased in LMN injury (denervated muscles), overall configurations remain normal
    • Alterations in MUP configurations (increased in size and duration, polyphasic shape) occur with reinnervation of previously enervated muscles
  20. Fibrillation
    • Spontaneous independent contractions of individual muscle fibers
    • Evident with enervation for 1-3 weeks after losing nerve
  21. Fasciculations
    • Spontaneous contractions of all or most of the fibers in a motor unit
    • Muscle twitches that can be observed or palpated
    • Present with LMN disorders and denervation
  22. Complete LMN Lesions
    • Show only fibrillation potentials
    • Partial LMN lesions show fibrillation and fasciculation potentials
  23. Nerve Conduction Velocity (NCV)
    • Stimulate peripheral nerves through skin and record muscle and sensory nerve APs 
    • Distance between 2 points (conduction distance) is divided by difference between corresponding latencies (conduction time)
    • Decreased conduction velocities = peripheral neuropathies characterized by demyelination (Guillain-Barre syndrome, chronic dymyelinating polyneuropathy, Charcot-Marie-Tooth Disease)
    • Slowed conduction velocities seen with focal compression of peripheral nerve

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