Additional Diagnostic Tests in Neurology (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 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.

    00:09 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.

    00:31 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.

    00:46 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.

    01:01 Yeah, they're not real happy when that happens, so you'd be really careful about metal things.

    01:07 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.

    01:32 An ischemic stroke is one where blood supply has been cut off, oxygenated blood has been cut off to the brain.

    01:40 Hemorrhagic stroke is one where we've got a similar problem except it was caused by excessive bleeding.

    01:46 So ischemic is a blocked blood supply, hemorrhagic is woah, we've got bleeding in the head.

    01:53 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.

    02:09 People can develop a stroke or a neuro problem while they're in a hospital for something else.

    02:14 So you may also do that as the first step for somebody who's already been admitted to the hospital.

    02:18 Now cerebral angiography, okay this is an angiography, helps you see the cerebral blood vessel.

    02:26 So this helps the physician estimate the perfusion and look if there's any filling defects in the cerebral arteries.

    02:33 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.

    02:50 what they figured out was it was just cerebral vasopasms.

    02:53 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.

    03:07 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.

    03:16 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.

    03:27 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.

    03:35 Okay, so let's go back and review just really quick.

    03:37 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.

    03:57 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.

    04:07 Cerebral angiography is a very invasive study but a transcranial doppler ultrasonography is not.

    04:13 So it's a non-invasive study and it just measures the velocity of the blood flow in the major cerebral arteries.

    04:19 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.

    04:33 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.

    04:42 Now a CTA or an MRA can also see vascular lesions or blockages.

    04:48 An MRA can be really similar to a CTA.

    04:52 Now the last one is kind of a mouthful - digital subtraction angiograpy.

    04:57 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.

    05:10 So that's why they might also do a DSA.

    05:14 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.

    05:36 This can be really helpful if the patient is having seizure activity or different problems.

    05:41 I know that my brother in law after he had an aortic valve replacement surgery started to have some real mentation problems.

    05:47 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.

    About the Lecture

    The lecture Additional Diagnostic Tests in Neurology (Nursing) by Rhonda Lawes, PhD, RN is from the course Neurological Assessment (Nursing) .

    Included Quiz Questions

    1. MRI
    2. CT scan
    3. Cerebral angiography
    4. Transcranial Doppler ultrasonography
    1. CT scan or MRI
    2. EEG
    3. Cerebral angiography
    4. Transcranial Doppler
    1. The cardiovascular system perfuses the brain.
    2. Many strokes are caused by clots from the heart.
    3. Some heart rhythms place clients at a greater risk for strokes.
    4. Myocardial infarct should first be ruled out.
    5. It must be ensured that the blood is sufficiently oxygenated.
    1. EEG
    2. Digital subtraction angiography
    3. Cerebral angiography
    4. MRI

    Author of lecture Additional Diagnostic Tests in Neurology (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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