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Neuroscience Diagnostics

The key to success in treating neurological disorders and diseases is accurate diagnosis of the problem.  McLaren’s Neurodiagnostics department is a sophisticated diagnostic resource for all of mid-Michigan.

Skilled physicians and technologists perform diagnostic testing in a professional, caring environment.

Diagnostic Procedures

Ambulatory EEG

If you have seizures or other suspected events that have not been detected by a routine EEG, your doctor may request that you have an ambulatory EEG. An ambulatory EEG is a continuous recording of your brain's function. You will wear the EEG monitor 24-72 hours while you go about your usual daily activities.

To prepare for this test, wash and dry your hair and wear a shirt that opens in the front. Bring a hood or scarf to wear home.

During the ambulatory EEG, the technologist will measure and scrub your scalp, and electrodes will be placed as was done during your routine EEG. A small receiver will also be placed on your scalp and your head will be wrapped to hold everything securely in place. You will also wear a light-weight monitor around your waist or over your shoulder. You will be asked to keep a diary of any symptoms that occur during the test and to return to have the monitor removed after the prescribed period of time. Your ambulatory EEG will be scanned onsite by a registered technologist and a neurologist will generate a report, which will be sent to your physician.

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Electroencephalogram (EEG)

The EEG is a safe and painless test that evaluates the function of your brain. If you have experienced seizures, fainting, memory loss, headaches, dizziness, stroke or head injury, your doctor may request that you have an EEG. These studies evaluate brain wave and electrical function.  Physicians refer patients for evaluation of seizures, epilepsy, attention deficit disorders, headaches, dizziness, fainting, and memory disorders. All studies are performed by trained technologists and reviewed by the Center’s neuologists.  Results are sent to the referring physician.

In preparation of the test you will be asked to sleep less than five hours the night before the test. You should also wash and dry your hair prior to your test.

During the EEG, you will sit in a  comfortable reclining chair in a quiet room. The technologist will measure your head and scrub the areas where electrodes will be placed. The electrodes will be dipped in cool cream and placed on your scalp. The lights will be dimmed and you will be allowed to lie back in the chair. The technologist will monitor the activity of your brain as you rest with your eyes closed. During the test, a strobe light will flash for about two minutes and you will be asked to open and close your eyes. You may also be asked to breathe rapidly and deeply for a few minutes. Many people fall asleep during this relaxing procedure. 

The test lasts about one hour and you will be able to resume your normal daily activities after it is completed.

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Electromyography

Conducted by physicians with specialty training, this is a needle examination of selected muscles of the arms, legs and small muscles along the spinal regions of the neck and back.  This test is primarily used to evaluate cervical or lumbar (neck or back) nerve root compression.  The needle examination is also used for diagnosis of ALS and other motor neuron disorders (polio, for example).

The needle is inserted just under the skin into the underlying muscle.  Specific waveforms, indicating the presence or absence of nerve injury and its effect on muscle function, are observed on a computer screen. 

For patients with specific pain concerns, referring physicians may prescribe pre-test pain or anti-anxiety medications.

The test is usually well tolerated by patients, who are advised by the examining physician about each step of the procedure.

Preliminary test results are reviewed with patients.  A follow-up appointment with your referring physician is suggested to discuss treatment recommendations.

Please plan on 2 hours for your EMG appointment.

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Evoked Potentials (EP)

This test evaluates how long it takes for a stimulus to reach the brain from a point of stimulation.  Stimulation points may be on the arms and legs.  Visual and auditory impulses are also used.  Your surgeon may request this test prior to surgery to establish baseline information that will be available to your surgeon during your surgical procedure.

Specialized EP tests also evaluate Multiple Sclerosis and other conditions affecting brain or spinal cord function.

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Interoperative Monitoring

Intraoperative monitoring during surgery evaluates peripheral and central nervous system function at the surgical site.  This is particularly helpful during back and spinal cord surgery.  This service is provided upon the request of your surgeon.

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Nerve Conduction Studies

This study is used to diagnose common conditions such as carpal tunnel syndrome, ulnar neuropathy, and peripheral neuropathy.

Small electrical impulses are used to evaluate nerve integrity.  Nerves in the arm and leg have both sensory and motor function.  This study will evaluate whether conduction pathways are transmitting information appropriately.

Very specialized studies may be used to evaluate diseases, such as Myasthenia Gravis, which affects the junction where nerves connect with muscle fibers.

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Neurology

Neurological Disorders: Diagnostic Puzzles requiring extensive exam, tests to find healing pieces

Patients are referred to neurologists by their physicians, neurosurgeons or other specialists. Neurologists diagnose, treat and manage disorders of the brain and nervous system for children and adults. Many neurological disorders can be treated with medication. Other interventions can include sleep studies, cognitive-behavioral therapy, physical therapy, relaxation techniques, biofeedback training, and implantable neuro-stimulators.

The inner workings of the brain and nervous system differ with each individual and his or her condition. For each patient, the 'healing pieces' for their neurological puzzle may require long-term intervention and therapy. Neurologists do not perform surgery but can refer patients to neurosurgeons or other specialists.

Common neurological conditions include:

  • ALS (Lou Gehrig's disease)
  • Alzheimer's disease
  • Autism
  • Bell's Palsy
  • Brain and Nerve Tremors
  • Brain tumors
  • Epilepsy
  • Migraine headaches
  • Multiple sclerosis
  • Parkinson's disease
  • Peripheral nerve disorders
  • Sleep Disorders
  • Some learning disabilities
  • Stroke
  • Tourette Syndrome

Click here to learn more about a neurological exam....

The Neurological Puzzle: Finding the Locking Pieces

"As more of the gene code is unraveled, and we do more stem cell research, we will find the basis for many autoimmune diseases. Our treatments will be more effective, and in some cases, we may be able to cure some neurological conditions. New medications and treatments allow us to extend quality of life for patients far beyond what would have been true even two or three years ago.

"I think patients and physicians finally understand that health is best achieved when the patient takes note of changes in their body and mind, and seeks appropriate medical attention as needed. Early diagnosis and treatment is key. And quite frankly, good nutrition, daily exercise, and adequate sleep, a positive attitude, and stress reduction have a significant impact on healing."

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Neurology Exam

The Seven Stages of a Neurological Exam

The neurological exam is a critical evaluation of different aspects of the brain and central nervous system. When completed, the neurologist compares the patient's medical history with results from the neurological exam to arrive at a diagnosis. The seven stages include:

1. Mental Status

    • How aware and responsive is the patient to the environment and his/her senses?
    • Evaluation of appearance and general behavior
    • Evaluation of mood
    • How does the individual process information?
    • Is the patient oriented to time, place and person?
    • Can they pay attention?
    • Can they remember objects after a period of time?
    • Can they repeat sentences?
    • Can they copy a three-dimensional drawing?
    • Tests for speech and language function.
    • Can they think abstractly, make correct judgments, and reveal their thoughts when asked a question?

2. Cranial Nerves (Set of 12 nerves that relay messages between the brain, head and neck, and control motor and sensory functions, including vision, smell, and movement of the tongue and vocal cords). Evaluation of:

    • Eyelid strength and function
    • Visual function
    • Peripheral vision
    • Pupil's response to light
    • Ability for the eye muscle to move
    • Strength of face muscles
    • Gag reflex
    • Tongue and lip movements
    • Ability to smell, taste and hear
    • Sensations in the face, head, and neck

3. Motor System (brain and spinal cord motor pathways)

    • Examination of muscles for atrophy, twitching, abnormal movements
    • Strength evaluation in all major muscle groups
    • Scratch heel to toe. Normally, patients' toes curl downward.

4. Sensory System (Tests sensation by stimulating receptors in the skin, muscles and tendons)

    • Evaluate sensations for pain, temperature, pressure, position, with eyes open and eyes closed.

5. Deep Tendon Reflexes (tests involuntary actions in response to stimuli sent to the central nervous system)

    • Specific muscle tendons tapped with soft rubber hammer to see if muscle fibers contract.

6. Brain coordination for voluntary movement, coordination and posture

    • Patient will be asked to move fingers from nose to neurologist's finger, going back and forth
    • Tap fingers together quickly in coordination, or move hands one on top of the other, back and forth.
    • Patient is asked to rub one heel up and down smoothly over opposite shinbone.

7. Gait

    • Orientation to posture
    • Ability to walk heel to toe, turn quickly
    • Ability to walk on toes, heels, run

Source: www.neurologychannel.com

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