Neurology Imaging and EEG Quiz

WS - Neurology 1

• CT angiography of cerebral blood vessels is indicated in cases of subarachnoid bleeding, ischemic stroke, transient ischemic attacks, and cerebral parenchymal hemorrhage.
• CT angiography is contraindicated in pregnancy, patients with large intracranial aneurysms/stenosis, allergy to gadolinium (iodine is used instead), and intracerebral bleeding.
• Digital subtraction angiography (DSA) is an invasive imaging method using contrast agent directly administered into arterial blood vessels.
• DSA is not a non-invasive method, it does use radiation during the examination.
• CT angiography is used in the diagnosis of subarachnoid bleeding, cerebral aneurysms, and carotid artery stenosis.
• MR angiography (MRA) is faster than CT angiography, and does not use radiation.
• Gadolinium contrast is not contraindicated in pregnant women.
• MRA is often a cheaper method compared to CT angiography.

Additional Notes (Page 2)

• EEG - Electroencephalogram
• Findings like spike-wave complexes are indicative of epileptic origin of the loss of consciousness
• EMG (electromyography): NCS (nerve conduction studies) shows slowing of conduction velocity and decreased amplitude of action potentials in axonal lesions.
• D. In the case of a demyelinating-axonal lesion, a slowing down of the conduction velocity through a given part of the nerve and a decrease in the amplitude of the action potential.

Additional Notes (Page 3)

• EMG (electromyography) measures action potentials.
• Used to locate lesions in peripheral nerves, spinal cord parts, spinal roots, plexus, and peripheral nerves.
• Needle EMG is used to locate lesions within muscles or spinal cord.
• Needle is inserted into the muscle and then spontaneous resting and voluntary activity are observed.
• Conductivity of the spinal cord is not measured.

Additional Notes (Page 4)

• Needle EMG reveals if pathological spontaneous activity is detected.
• Pathological increment of action potentials are seen in denervation potentials.
• Pathological decrement of action potentials are also denervation related.
• Myopathic pattern is characterized by reduced action potential durations, an increased number of fibers and shorter duration of these action potentials.
• Myopathy is characterized by abnormal spontaneous activity.
• Spinal cord lesion is manifested by homolateral hemiparesis.
• Brainstem lesion is manifested by homolateral hemiparesis.
• Evoked potentials are used for detection of conduction disturbances.

Additional Notes (Page 5)

• Evoked potentials are used to investigate auditory and vestibular pathways at brainstem level
• Evoked potentials (SEP) use stimulation of median and tibial nerves for evaluation.
• Evoked potentials (VEP) are used for visual pathway, specifically optic nerve disorders.

Additional Notes (Page 6)

• Spectrophotometric analysis of cerebrospinal fluid detects the presence of blood in cerebrospinal fluid from subarachnoid hemorrhaging.
• Spectrophotometric analysis of cerebrospinal fluid measures increased levels of glucose in patients with suspected Alzheimer disease or acute ischemic stroke.
• CSF analysis is indicated for diagnosis of various conditions from brain tumors to autoimmune encephalitis.

Additional Notes (Page 7)

• Positive oligoclonal bands in cerebrospinal fluid can indicate multiple sclerosis.
• CSF examination is indicated for demyelinating disorders.
• MRI is contraindicated in patients with cardio-stimulators, in pregnancy (due to the use of contrast agents) and in patients with iodire allergies.
• MRI is more sensitive than CT in depicting soft tissue pathology.

Additional Notes (Page 8)

• Magnetic resonance imaging (MRI) is indicated in acute cerebral hemorrhage and diagnosis of CNS demyelinating diseases.
• MRI uses gadolinium contrast medium.
• The cerebrospinal fluid appears as hyperintense on T2 and FLAIR weighted MRI images.
• Sonography of extracranial vessels is useful to depict atherosclerotic plaques and to assess the nature. Non invasive and no radiation used.

Additional Notes (Page 9)

• Transcranial sonography of cerebral arteries: The examination is carried out through the so-called acoustic bone windows.
• Duplex USG is used for control exams after carotid stenting.
• Duplex USG is not commonly used for patients with hemorrhagic stroke and is contraindicated for patients undergoing thyroid surgery and in those with allergy to iodine contrast media
• Doppler mode is used to display speed of blood flow in vessels.
• Doppler ultrasound measures the speed of blood flow in vessels.

Additional Notes (Page 10)

• Routine use of ultrasound examination for brain tumors, movement disorders, and cerebrovascular diseases.
• Carotid sonography cannot reveal the course of vertebral arteries in the neck area.
• Typical features of NREM sleep include K-complexes, vertex sharp waves and delta frequency band.
• Features of REM sleep include muscle atonia, saw-tooth waves.
• Absence of blood in the epidural space could show active bleeding or recent/past bleeding.
• Acute stage ischemia may not be visible, in acute stage brain density is like cerebrospinal fluid.
• Dysdiadochokinesis refers to a problem with rapid alternating movements and coordination .

Additional Notes (Page 11)

• Cerebellar dysfunction can present with gait abnormality (e.g "drunk man' gait").
• Neocerebellum includes the cerebellar hemispheres but not the vermis.
• Lesions of the vermis result in ataxia of standing, walking and ipsilateral limbs.
• Internal carotid artery branches from the brachiocephalic trunk.

Additional Notes (Page 12)

• Neuropathic pain is not presented in diabetic patients or trigeminal neuralgia, and does not respond to all pain medications.
• Meningeal syndrome is associated with various causes.
• For early treatment, neuropathic pain may respond better to pain medications.
• Isolated defects in deep sensation are seen in lesions of the posterior columns of the spinal cord.

Additional Notes (Page 13)

• Bradykinesia
• Essential tremor
• Positive or negative Chvostek sign
• Types of tremor
• Parkinsonian characteristics
• Pathological tremors
• Upper brainstem lesions and associated problems
• Differentiate between upper and lower brainstem lesions

Additional Notes (Page 14)

• Which of the following is a pathognomonic sign for functional tremor?
• Hyperkinetic movement disorders (myoclonus, chorea, tics, dystonia, etc.)
• Autoimmune chorea is typically seen in adolescence and young adulthood.

Additional Notes (Page 15)

• The oculomotor nerve, in case of palsy on the left side, will not have a consensual pupillary light reaction with the right eye, and direct pupillary response in the left eye.
• Brain stem lesions result in sensory deficits that follow contralateral or ipsilateral pathways, depending on the location.

Additional Notes (Page 16)

• The facial nerve (n.VII) innervates the anterior two-thirds of the tongue.
• The facial nerve (n.VII) controls muscles of facial expression for facial mimics and sensation for taste on the same side.

Additional Notes (Page 17)

• Peripheral facial nerve palsy is characterized by drooping of the eyelid and mouth.
• Taste abnormalities are usually present.

Additional Notes (Page 18)

• Lesion in Cranial nerve 12: leads to atrophy and fasciculation of the ipsilateral tongue.
• Peripheral palsy → hyporeflexia (or areflexia).
• Upper motor neuron lesion → spasticity, hyperreflexia, and clonus.

Additional Notes (Page 19)

• Paraparesis/paraplegia: weakness of lower limbs.
• Hemiparesis/hemiplegia: weakness of right or left limbs

Additional Notes (Page 20)

• Weber's syndrome is characterized by ipsilateral oculomotor nerve palsy and contralateral hemiparesis.
• Transtentorial herniation (temporal) presents with ipsilateral pupillary dilation and loss of consciousness.
• For Transtentorial herniation, the symptom is loss of consciousness and ipsilateral anisocoria.

Additional Notes (Page 21)

• Intracranial hypertension can result from many causes.
• A condition marked by increased intracranial pressure
• Signs include headache, vomiting and papilledema.
• Causes include brain tumours, infections, hemorrhages or haemorrhage and hydrocephalus.

Additional Notes (Page 22)

• Lesions in the spinal cord manifest with various motor and sensory deficits, depending on the location and extent of the lesion.
• Spastic and flaccid hemiparesis are possible outcomes of a lesion to the spinal cord.

Additional Notes (Page 23)

• Complete transversal spinal cord lesions at different levels have distinct symptoms.
• Brown Sequard syndrome presents with ipsilateral spastic paraparesis and contralateral loss of pain and temperature.
• Digital subtraction angiography is not used to diagnose intracranial bleed sources.
• Intracranial bleeding is diagnosed with CT angiography and other methods that use less radiation.

Additional Notes (Page 24)

• EMG, also called STEMG, assesses action potential amplitudes and velocities.
• Evoked potentials (BAEP) detect pathological delays or absence of neural response.

Additional Notes (Page 25)

• Noninvasive methods for cerebral artery imaging (like ultrasound) are available that are commonly used.
• Many non-specific findings might occur from a brain condition - including many neurological symptoms, such as sensory deficit, memory issues and pain.

Additional Notes (Page 26)

• Cerebellar function is essential in coordinated movement.
• Disorders like ataxia and dysdiadochokinesia are possible results of cerebellar damage.

Additional Notes (Page 27)

• Parkinsonian tremor is a resting tremor and is often characteristic of the condition.
• Pathological tremors are often present in many neurological conditions.
• Thalamic syndrome involves sensory deficits on the contralateral side of the body.
• Signs and symptoms vary according to the affected areas.

Additional Notes (Page 28)

• Spasticity is a neurological condition in which the muscles are abnormally tense; increased tone.
• It responds differently to treatment.
• It is generally caused by lesions of upper motor neurons.
• Meningeal syndrome may indicate various conditions; meningitis or subarachnoid bleeding.

Additional Notes (Page 29)

• Vestibular nerve lesions are characterized by vestibular ataxia (e.g., gait problems), nystagmus, and other symptoms.
• Testing balance (Romberg test) helps determine if the symptoms are due to vestibular damage.
• Various eye movements may occur due to vestibular nerve damage.

Additional Notes (Page 30)

• Cranial nerve nuclei in the brainstem are associated with different functions.
• Bilateral damage shows bulbar paresis.
• In bulbar palsy, various cranial nerves (9-12) are affected.

Additional Notes (Page 31)

• Middle alternating hemiplegia is characterized by contralateral facial nerve lesion and ipsilateral third nerve palsy.
• CSF examination is indicated in various conditions (multiple sclerosis, ischemic stroke, Guillain Barré).
• CSF examination is used for diagnosing suspected bacterial CNS infection.

Additional Notes (Page 32)

• Hemisection of the spinal cord causes symptoms on the opposite (contralateral) side.
• Half spinal cord lesions cause different symptoms depending on the exact location.

Additional Notes (Page 33)

• Lesions in different parts of the spinal cord produce varied symptoms.
• A complete transversal spinal cord lesion typically causes spastic paraparesis or quadriparesis.

Additional Notes (Page 34)

• Lesions to various areas of the brain, such as the parietal lobe, affect particular functions.
• A particular area in the parietal lobe is needed for a person to discern objects with touch alone.
• Subacute onset of movement disorders is associated with autoimmune and paraneoplastic etiologies, vascular problems, toxic exposures, and neurodegenerative diseases.

Additional Notes (Page 35)

• MRI angiography shows brain arteries.
• Contrast medium is often used for better visualization.
• Various types of tests assess cranial nerve function.

Additional Notes (Page 36)

• Lesion in cranial nerve XII leads to atrophy and fasciculations of the ipsilateral tongue.
• Transversal complete spinal cord damage can result in various motor and sensory deficits.

Additional Notes (Page 37)

• MRI and CT scans are used to assess the brain.
• CT scanning shows brain structures with higher density than CSF in brighter shades.
• Meningitis has a characteristic symptom of headache.
• Strokes are associated with various symptoms.

Additional Notes (Page 38)

• There are different types of headaches that present with various symptoms.
• Meningitis is characterized by headaches, neck stiffness, as well as sensitivity to light and sound.
• Various diseases lead to intracranial hypertension.
• CSF analysis and MRI/CT scan are used in the diagnosis of potential intracranial conditions.

Additional Notes (Page 39)

• Dystonia, a neurological movement disorder, is marked by involuntary muscle contractions.
• Several conditions can cause dystonia and the most common presentation of these may include emotional instability.

Additional Notes (Page 40)

• EEG is utilized in diagnosing conditions involving the loss of consciousness, including coma.
• Evoked potentials are commonly used to detect pathological delays or absence of neural responses, aiding in the diagnosis of disorders.

Additional Notes (Page 41)

• The brain's structure and functions are complex and interconnected.
• Hyperkinetic movement disorders and chorea are two conditions that affect body movements.

Additional Notes (Page 42)

• Electrophysiological studies assess nerve conduction and action potentials.
• Disruptions to these processes may point to disorders.
• Various conditions can lead to lower action potential amplitudes.

Additional Notes (Page 43)

• Evoked potentials help in identifying potential issues.
• A cranial nerve lesion may result in specific impairments.

Additional Notes (Page 44)

• Different areas of the brain control different actions.
• Functions of the brain can include those related to sensation/perception.
• Dysdiadochokinesia: an inability to perform alternating movements
• Dissociation of sensation can be caused by damage the pathway of pain and temperature.

Additional Notes (Page 45)

• Temporal lobe epilepsy often causes sensory and perceptual disturbances.
• Various conditions affect the brain, such as ischemia or hemorrhage
• Various pathological conditions affect cranial nerves.

Additional Notes (Page 46)

• Modifiable and non-modifiable risk factors for stroke are different.
• The symptoms of Parkinsonism may vary depending on the location and severity of the disease.
• Various conditions can cause strokes, and these cause distinct symptoms, including dysarthria, loss of coordination, and rigidity.

Additional Notes (Page 47)

• Brain tumors, including metastatic, affect the whole brain or a part of it.
• Many conditions are associated with headaches, and some are relatively common. Different types of headaches and their causes are examined here.

Additional Notes (Page 48)

• Evoked potentials and pathological findings help assess various conditions, from seizures to structural issues.
• Assessing a patient with neurological symptoms, including neurological disorders and loss of consciousness, uses different diagnostic techniques.
• There are various tests performed for conditions ranging from peripheral nerve damage to certain central nervous system (CNS) concerns and lesions.

Additional Notes (Page 49)

• Superior alternating hemiplegia is characterized by symptoms caused by a lesion in the area of the midbrain, including a specific pattern of muscle weakness.

Additional Notes (Page 50)

• Lesions in the brainstem affect both ipsilateral and contralateral body parts.
• Various etiologies are connected to disorders in the sensibility.

Additional Notes (Page 51)

• Tuberculosis meningitis is often seen in immunocompromised patients.
• Several signs and symptoms characterize meningitis.
• Viral meningitis has various possible triggers.

Additional Notes (Page 52)

• CT scans are beneficial for assessing acute stroke and intracranial hemorrhages.
• Pathological processes in the brain and spinal cord cause numerous symptoms.

Additional Notes (Page 53)

• Various conditions cause a wide range of symptoms.
• Differentiating between different neurological conditions is sometimes challenging due to overlap in symptoms.
• Symptoms (like gait and posture changes) are associated with Parkinson and related diseases.
• Several neurological conditions can cause various symptoms, including movement disorders, and those can be difficult to diagnose if they don't fit the classic patterns.

Additional Notes (Page 54)

• Huntington's disease is a genetic disorder characterized by motor dysfunction and psychological changes
• Vascular lesions, infections, and other issues are among the causes of various neurological issues.
• Various different causes are associated with different neurological symptoms, some that are more common, and some that are relatively rare

Additional Notes (Page 55)

• Meningitis and its complications are significant neurological concerns.
• Different infectious agents, such as bacteria, can trigger meningitis.
• Various tests assess the possibility of meningitis.
• Some symptoms are present in numerous conditions.

Additional Notes (Page 56)

• TIA: a transient ischemic attack, can cause the same issues as a cerebrovascular accident, except transient, short-lasting.
• Various conditions can lead to various neurological symptoms.
• Various conditions affect the brain and cause various neurological symptoms, some that are more common, and some relatively rare.

Additional Notes (Page 57)

• Lesions to different parts of the spinal cord cause a wide range of issues.
• Peripheral nerve lesions cause weakness of certain muscles and sometimes sensitivity abnormalities.
• Neurological conditions can affect different parts of the brain and cause varied symptoms.

Additional Notes (Page 58)

• Aphasia describes difficulties with language abilities which can be caused by diverse issues in the brain, including temporal lobe lesions
• There are different areas in the brain that are involved with language processing.
• Cerebellar ataxia is a condition associated with problems with coordination.
• Various conditions can cause symptoms similar to anosognosia or autopagnosia.

Additional Notes (Page 59)

• Hemisection of the spinal cord can result in distinct sensory and motor deficits.
• There are many potential causes of brain and spinal cord lesions.
• Various sensory and reflex testing are performed in patient clinics to locate or diagnose the particular area.

Additional Notes (Page 60)

• Brown-Sequard syndrome results from a lesion affecting half of the spinal cord.
• Various pathological conditions can affect the spinal cord producing many different clinical pictures.

Additional Notes (Page 61)

• The brain's ability to perceive and interpret sensory information is essential for functioning.
• Sensory deficits can result from lesions in various areas of the brain and the spinal cord.

Test your knowledge on CT angiography, MR angiography, and EEG findings related to neurological disorders. This quiz covers indications, contraindications, and specific findings associated with various imaging techniques, as well as symptoms of parkinsonian syndrome. Challenge yourself to identify the correct statements about these important concepts in neurology.