The different procedures in Neurological Disorders
The introduction of sophisticated, noninvasive, but rather expensive diagnostic techniques in neurological disorders has revolutionalized the practice of medicine.
In this issue, let us review and acquaint ourselves with the following procedures whose yields have been quite accurate and have virtually replaced other procedures.
These are the following:
1. Computerized Tomography (CT) – this is the procedure of choice in neurology because it defines intracranial structures and pathological lesions quite distinctly- the amount of radiation is less- the amount of contrast material used is far less than angiography
2. Magnetic Resonance Imaging (MRI) – this is a more sensitive imaging technique than the CT scan. However, it is twice as expensive as a Ct scan. Its greatest advantage over the ct scan is that radiation is not involved. MRI gives an excellent delineation of the brain, spinal cord and of the intra and extra parenchymal lesions
3. Cranial Ultrasound (CUS) – this has become the first -line procedure in infants with open fontanels. It has the advantage of being portable, thereby, giving a prompt and quite accurate information of the intracranial contents
4. Skull Roentgenography – These are plain films of the skull and are rarely done since the advent of CT scans. But they still help in demonstrating congenital anomalies of the bone, fractures, sutural fusion or spread and enlargements of various foramina.
5. Roentgenography of the Spine – This is useful in congenital anomalies such as spina bifida and scoliosis, in tuberculosis, trauma and in certain metabolic disorders, the mucopolysaccharidoses.
6. Myelography – This is rarely done in pediatrics. It is useful and indicated in delineating suspected lesions within the spinal canal such as tumors, herniated discs, hematomas and abscesses
7. Lumbar Puncture (LP) – in pediatrics, the only absolute indication of performing an LP is the suspicion of a central nervous system infection. The only absolute contraindication of an LP is the presence of an infection over the site of the puncture. Some relative contraindications include: increased intracranial pressure, bleeding tendencies and spinal cord tumors
8. Subdural Tap – this is indicated in patients suspected or diagnosed to have subdural hematomas and effusions
9. Electroencephalography (EEG) – this records electrical activity of the brain and is particularly useful in the evaluation of seizure disorders, sleep disorders and in the diagnosis of brain death