Now let's talk about some additional diagnostic
tests of someone's under neuro assessment,
these are ones where you have to
go somewhere for a test, okay.
First one is a non-contrast CAT scan or MRI
So a non-contrast means we don't use
contrast, so we don't inject any kind of dye,
That's why we call it non-contrast
CAT scan or MRI, remember MRI is the
one magnetic resonance imaging,
and that is the one where you
can't take anything metal in.
I mean when MRIs first started and the
first time I took a patient to an MRI,
I had barrettes in my hair that are
clips, hairclips that have metal on them,
and that metals that magnet is so
strong, I could feel it pulling on my hair.
Now it didn't pull it out of my hair but when you go for an
MRI, you take all hemostats and scissors and anything metal
out of your pockets before you go in because there have been
times when metal things have flown out of people's pockets
and it shuts down the MRI.
Yeah, they're not real happy when that happens,
so you'd be really careful about metal things.
Your patient also can't have metal inside
their body as in a pacemaker or defibrillator
so those are important questions to ask
before your patient goes to an MRI
Now, why would we do a CAT scan or MRI
non-contrast for a neuro patient?
Well, these can tell us the
size and location of a lesion
and they can help us differentiate between
an ischemic stroke and a hemorrhagic stroke.
An ischemic stroke is one where blood supply has been
cut off, oxygenated blood has been cut off to the brain.
Hemorrhagic stroke is one where we've got a similar
problem except it was caused by excessive bleeding.
So ischemic is a blocked blood supply, hemorrhagic
is woah, we've got bleeding in the head.
Okay, so we would take somebody for
a non-contrast CAT scan or MRI,
because we wanna see do they
have a lesion in their brain?
Have they had an ischemic stroke or
have they had a hemorrhagic stroke?
So this would happen more than likely in the ER
if the patient presented with some odd symptoms.
People can develop a stroke or a neuro problem
while they're in a hospital for something else.
So you may also do that as the first step for
somebody who's already been admitted to the hospital.
Now cerebral angiography, okay this is an
angiography, helps you see the cerebral blood vessel.
So this helps the physician estimate the perfusion and look
if there's any filling defects in the cerebral arteries.
I still have the friend who had postpartum
preeclampsia and they thought she was having strokes,
but when they did her cerebral angiography, they found out
that it wasn't stroke, even though it looked like that,
but the cerebral angiography helped them
visualize the blood vessels so well.
what they figured out was it
was just cerebral vasopasms.
So the great news was, she wasn't
a 32-year old having strokes,
she just was having cerebral vasopasms as we knew we
got her past this period of postpartum preeclampsia,
it would resolve and it did.
But please be aware, if your patient
is having cerebral vasopasms,
I can't even give you a word to explain
how excruciating the headaches are.
They are just unbelievably intense and
very difficult to relieve their pain,
makes them super sensitive to light and excruciating
pain that you just can't get away from.
So be very patient with those patients
that you are careful with them
that you really work with them on pain
management because it's difficult.
Okay, so let's go back and
review just really quick.
Non-contrast CAT scan or MRI
let us look at the lesion,
helps us differentiate between
ischemic and hemorrhagic stroke
Cerebral angiography is gonna let us know
about the blood vessels in the brain
and it helps give us an estimate of how well it's perfusing and
look if there's any filling defects in the cerebral arteries.
The third test I wanted tell you about
is the transcranial doppler or a TCD
Now that's an ultrasonography - it's a
non-invasive study, that's really good.
Cerebral angiography is a very invasive study but
a transcranial doppler ultrasonography is not.
So it's a non-invasive study and it just measures the
velocity of the blood flow in the major cerebral arteries.
So it's a little bit faster than the other one, it
can also give us some really helpful information
Now, why is cardiac imaging up there
because we're talking about neuro stuff?
Well, think about how close
your heart is to your brain.
So cardiac imaging is usually also recommended because many
strokes are caused by blood clots that come through the heart
So that's why they may order cardiac imaging.
Now a CTA or an MRA can also see
vascular lesions or blockages.
An MRA can be really similar to a CTA.
Now the last one is kind of a mouthful
- digital subtraction angiograpy.
Okay this is intraarterial meaning any artery,
digital subtraction angiography or DSA
It reduces the dose of contrast material
that we need that uses smaller catheters
and it shortens the length of the procedure.
So that's why they might also do a DSA.
Now lastly, we've got the EEG
Now that looks like something from almost
like an Edward Scissorhands movie because
they come in and they glue and it is a
nasty smelling glue, it's really strong
but they'll come in and they will glue
multiple electrodes to the patient's head
and then they'll monitor the electroencephalogram,
they'll monitor the brain waves over a period of time.
This can be really helpful if the patient is
having seizure activity or different problems.
I know that my brother in law after he
had an aortic valve replacement surgery
started to have some
real mentation problems.
He forgot that he had surgery after he was discharged
home and so he had to be admitted back into the hospital
and he had to wear this get up, we were sure to
take a picture of him and posted it on facebook
just because it was fun but he had to
wear this get up for an overnight period
so they can observe and see what was going on and
what these episodes might be connected to with an EEG
So there you have seven possible
additional diagnostic test
that might be ordered for a patient
who's having a neurology problem
So again I would recommend, pause the video, go back and are
there any details you want to listen to this section again
just to kinda get a feel for what these
test are then join back up with us.