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PATHOLOGICAL INVESTIGATIONS AND IMAGING TECHNIQUES IN NEUROMUSCULAR DISORDERS: A PHYSIOTHERAIST'S PERSPECTIVE
1.
2. COMMONLY USED IMAGING
TECHNIQUES AND PATHOLOGICAL
INVESTIGATIONS
PROCEDURES IN BRIEF
ROLE IN DIAGNOSIS OF VARIOUS
NEUROMUSCULAR CONDITIONS
3. • Imaging of the nervous system encompasses
a wide variety of modalities that have
undergone rapid evolution in the past few
decades.
• Commonly used neuroimaging techniques
are:
X-ray of skull and spine
Magnetic resonance imaging
Computerised tomography scan
Neuroangiography
Lumbar puncture
11. It is used to investigate intracranial
pathology and now routinely used for spine
and brain.
Indications:
Patients with implanted devices like
cardiac pacemakers, spinal stimulators, or
with other ferromagnetic foreign bodies,
which are not suitable for MRI.
12. Acute fracture of calvarium, skull base and
spine
Hydrocephalus- dilatation of ventricles
Appearance of tissues on CT-scan:
Air- Black
Fat- Black
CSF-Black
Brain tissue- Grey
Blood- White
Bone-White
14. A highly collimated pencil-like (1-10mm)
X-ray beam is directed through the patient.
The patient is placed in the CT-gantry and
the X-ray beam travels in a circular path
around the patient.
Detectors are arranged in a complete
circle around the beam and images are
reconstructed using a computer algorithm.
15.
16. Wider availability
Easier to perform in ventilated patients
Allows differentiation of solid organs from
each other
Extremely sensitive to the presence of
minute amounts of fat, calcium or contrast
material.
17. Use of ionizing radiations
Hazards of intravenous contrast
Lack of portable equipments
High cost
Large areas are poorly imaged by CT
Can’t be used for spine because it is
mostly limited to transverse plane.
18. Gorter is given credit for origin of the
concept of NMR, which is the basis of MRI.
19. T1 Film T2 Film
CSF Dark Lighter
Bone Dark Dark
White matter Light Dark
Fat Light Dark
20.
21. Improved soft tissue contrast resolution
Image can be obtained in axial , saggittal
or any plane
3D images can also be reconstructed
22. It is the study of CNS and related
cervicocerebral vasculature using
radiographs.
A catheter is inserted via the femoral artery
into the aortic arch. It is then manipulated
into the relevant cranial/neck artery. Then
a contrast medium is injected with
simultaneous radiographic filming of
appropriate vessels.
23.
24. Instead of femoral artery, axillary,
brachial/direct cervical approaches may be
used.
Common arteries to be examined:
Anterior cerebral, middle cerebral,
posterior cerebral arteries
Internal carotid , vertebral, basilar arteries
26. The pressure that is exerted on the brain
tissue by external forces,like CSF and
blood is k/a intracranial pressure. The
normal ICP is 5-10mmHg. If it rises above
20mmHg,it suggests impaired CSF
absorption and need for drainage
operation. It is an invasive technique, in
which a catheter is inserted into the lateral
ventricle and the pressure is measured.
29. Can be performed by a needle or as an
open procedure.
The former is less invasive and allows
multiple samples with better assessment of
tissue architecture.
Staining techniques allow seperation of
different fiber types like atrophied and
normal fibers. Commonly used stains are
methylene blue, H&E stain.
32. To diagnose and classify peripheral nerve
injuries. Sural nerve is commonly chosen
because it is commonly affected in
peripheral neuropathy.
The biopsy shows Nodes of Ranvier and
Schwann cells. The internodal length and
thickness of myelin sheath can be
calculated.
35. Used for:
Acquisition of CSF for analysis
CSF drainage and pressure reduction
Technique:
POSITIONING: Patient in side lying
position with hip-knee flexed.By doing this,
the intervertebral space gets opened up
and fluid can be obtained.
36. SITE: L3-L4 intervertebral space,at the
level of iliac crests. Clean the area,apply
local anesthesia. Insert the needle at a
slight angle towards the head so that it is
parallel to the spinous process. Withdraw
CSF.
Contraindications of lumbar puncture:
If there is raised intracranial pressure
If platelet count<40,000