Neuro

ANGIOGRAPHY

BY:-Sita Pandey

Angiography is a test that uses an injection of a liquid dye to make the arteries easily visible on X-rays.

When to use?

1)An angiogram is commonly used to check the condition of Blood vessels.

2)It is used if Dr is considering surgery (it shows the clear picture of blood vessels.

3)It revels aneurysm(Bulge on a artey)

4)It is used to look the artey of neck,head,heart,kidney,liver,legs etc.

5)It is used to localise different tumours in different organs.

How you prepare? Usually you go to the hospital the morning of the procedure.

Your health care team will give you specific instructions and talk to you about any medications you take. General guidelines include:

-Don't eat or drink anything after midnight the day before your angiogram.

-Take all your medications to the hospital with you — in their original bottles.

-If you have diabetes, ask your doctor if you should take insulin or other oral medications before your angiogram.

-Before your angiogram procedure starts, your health care team should review your medical history, including allergies and medications you take. The team may perform a physical exam and check your vital signs — blood pressure and pulse. You empty your bladder and change into a hospital gown. You may have to remove contact lenses, eyeglasses, jewelry and hairpins

How to perform?1)You may be sedated through the IV to help you

relax,Under all aseptic condition.2)A liquid die is inserted into the blood vessels3)Depending on the test die is inserted with the help of

catheter in the groin or most commonly the arm.4)Thin wire with a rounded tip is then carefully inserted

into the artery using a needle.5)When catheter is in the correct position,the wire is

pulled out and dye is inserted through the catheter.6)Now blood vessels can be checked in the screen.

Angiography set

Is angiography dangerous?

1)Small minority of patients are allergic to the liquid dye.

2)Pregnant women should enquire about the risks of the fluoroscopy

(X-ray screening)harming their baby4)It is possible that the angiogram can

provoke a stroke,heart attack either of which occasionally lead to death6)There is a small risk of the catheter

damaging the blood vessels that it was inserted through.

Glasgow Coma Scale (GCS)

GCS:- The Glasgow Coma Scale is based on a

15 point scale for estimating and categorizing the outcomes of brain injury.

GCS measures the motor response, verbal response and

eye opening response with these values: I. Motor Response6 - Obeys commands fully 5 - Localizes to noxious stimuli 4 - Withdraws from noxious stimuli 3 - Abnormal flexion2 - Extensor response 1 - No response

II. Verbal Response 5 - Alert and Oriented 4 - Confused, yet coherent, speech 3 - Inappropriate words and jumbled phrases consisting of words 2 - Incomprehensible sounds 1 - No sounds

III. Eye Opening 4 - Spontaneous eye opening 3 - Eyes open to speech 2 - Eyes open to pain 1 - No eye opening

The final score is determined by adding the values of I+II+III.

This number helps medical practioners categorize the four possible levels for survival, with a lower number indicating a more severe injury and a poorer prognosis:

Mild (13-15)

Moderate Disability (9-12)

Severe Disability (3-8)

Vegetative State (Less Than 3)

Persistent Vegetative StateBrain Death

Mild (13-15):Markely drowsy but well oriented to time place and person.

Moderate Disability (9-12):1) Loss of consciousness greater than 30 minutes2) Physical or cognitive impairments which may or may resolve 3) Benefit from Rehabilitation

Severe Disability (3-8):

Coma: unconscious state. No meaningful response, no voluntary activities

Vegetative State (Less Than 3):

Sleep wake cycles, Aruosal,but no interaction with environment No localized response to pain

Persistent Vegetative State:

Vegetative state lasting longer than one month

Brain Death:

No brain functionSpecific criteria needed for making this diagnosis

Electroencephalography

Electroencephalography:- EEG refers to the recording of the brain's

spontaneous electrical activity over a short period of time, usually 20–40 minutes, as recorded from multiple electrodes placed on the scalp.

The main diagnostic application of EEG is in the case of epilepsy, as epileptic activity can create clear abnormalities on a standard EEG study.

Clinical use:-1)To distinguish epilepsy ,seizures from

other types of spells (ie syncope, fainting ,non-epileptic seizure)

2)To serve as a adjust test of brain death.

3)To measure ICP

4)To measure secondary brain damage(ie subarchonoid hemorrhage)

Echoencephalography

Echoencephalography

The use of ultrasound to examine and measure internal structures (as the ventricles) of the skull and to diagnose abnormalities and disease

Echoencephalography cont..

A diagnostic technique in which pulses of ultrasonic waves are beamed through the head from both sides, and echoes from the midline structures of the brain are recorded graphically; shifts from any midline may indicate a centrally placed mass.

Neurologic Assessment

Neurologic Assessment:- Assessment that controls cognitive and

voluntary behaviral process and sub- consious and involuntary bodily functions.

Components of a neurological Assessment:

1. Interview 2. Level of Consciousness 3. Pupillary Assessment 4. Cranial Nerve Testing 5. Vital signs 6. Motor Function 7. Sensory Function 8. Tone 9. Cerebral Function

Interview to identify presence of:-

• headache • difficulty with speech • inability to read or write • alteration in memory • altered consciousness • confusion or change in thinking • disorientation • decrease in sensation, tingling or pain • motor weakness or decreased strength • decreased sense of smell or taste • change in vision or diplopia • difficulty with swallowing • decreased hearing • altered gait or balance • dizziness • tremors, twitches or increased tone

Level of consciousness:-

***Consciousness is the most sensitive indicator of neurological change**

-Consciousness can be defined as a state of general awareness of oneself and the environment.

-Consciousness is difficult to measure directly but it is estimated by observing how patients respond to certain stimuli.

Alert: - awake, looks about - responds in a meaningful manner to

verbal instructions or gestures Drowsy:- oriented when awake but if left alone will

sleepConfused: - disoriented to time, place, or person - memory difficulty is common - has difficulty with commands - exhibits alteration in perception of

stimuli, may be agitated

Pupillary Assessment:--When assessing pupils (eyes) it is

important to assess the following:

- size - shape - reactivity to light - comparison of one pupil to the

other

Cranial nerve testing:-

Olfactory I Optic II Oculomotor III Trochlear IV Trigeminal V Abducens VI Facial VII Auditory (vestibulocochlear) VIII Glossopharyngeal IX Vagus X Spinal Accessory XI Hypoglossal XII

Vitals sign:- -Changes in vital signs are not consistent early

warning signals. Vitals are more useful in detecting progression to late symptom.

-Temperature -Pulse - Respiration -Blood pressure

Motor function:- When assessing motor function, from a

neurological perspective, the assessment should focus on arm and leg movement.

You should consider the following:

1. muscle size

2. muscle tone

3. muscle strength

4. involuntary movements

5. posture, gaitSymmetry is the most important consideration when identifying focal findings. Compare one side of the body to the other when performing your assessment.

Motor function testMotor function test

Sensory Function:- When assessing sensory function

remember that there are three main pathways for sensation and they should be compared bilaterally.

1. pain and temperature sensation 2. position sense 3. light touch

-Pain can be assessed using a sterile pin

-To test position sense,grasp the patient's index finger from the middle joint and move it side to side and up and down

-Light touch can be assessed with a cotton wisp

Tone:- Upper motor neuron problems (brain

and spinal cord) are associated with increased tone. Lower motor neuron problems are associated with decreased tone

Reflex responses: 0 no response 1+ diminished, low normal 2+ average, normal 3+ brisker than normal 4+ very brisk, hyperactiv

Cerebellar Function:- To test cerebellar function use the

following tests.

1)Finger to finger test:-Have patient touch index fingure with index fingure several times.2)Finger to nose test -Perform with eye open and eye closed.3)Tandem walking -Heel to toe on a straight line.4)Romberg test:-stand with feet together and arms at their sides. Have patient close his/her eyes and maintain this position for 10 seconds.If the patient begins to sway.have them open their eyes.If swaying continues,the test is positive or suggestive of cerebellum problems.

Finger to fingure test

Finger to nose test

Tandem walkingRomberg test

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