Symptoms of Brain and Nervous System Diseases
Our brain is the most perplexing and fascinating organ. It orchestrates several crucial function of various other organs throughout our body and controls consciousness, locomotion, memory, thought and cognition. Any disorders of our brain require urgent intervention to prevent further damage leading to disabilities. Urgent and correct diagnosis followed by timely treatment can prevent any further long-term damage.
Symptoms or effects of brain and nervous system disease or injury include:
- Dizziness;
- Headaches, facial pain, chronic pain;
- Stroke;
- Epilepsy;
- Cognition and behavioral disorders;
- Movement disorders;
- Neuromuscular disorders;
- Sleep apnea & sleep disorders;
- Brain & spinal cord tumor;
- Spasticity;
- Neurometabolic & neurogenetic disorders;
- Nausea, vomiting, diarrhea, constipation, urinary incontinence, impotence, dizziness or faintness , increased or decreased sweating; and
- Tingling, pain, numbness, or weakness in your feet and hands.
Neurological Assessment | Examination | Testing
Some of the other neurological assessment, examination, testing and rehabilitation services The Neuroscience Center offers include:
- Routine ambulatory electroencephalogram & long-term video EEG;
- Sleep laboratories;
- Nerve conduction studies & electromyograms (NCS/EMG);
- Quantitative sensory testing (QST);
- Evoked potentials (EPs);
- Autonomic nervous system studies;
- Nerve & muscle biopsies;
- Histochemical & immunohistochemistry;
- Treatment of muscular dystrophy, dystrophinopathy, dysferinopathy, sarcoglycanopathy, merosin deficiency, inflammatory myopathy & mithochondrial myopathy;
- DNA-based diagnosis;
- FSHD gene therapy, distal myopathy, X-linked recessive centronuclear myopathy, mitochondrial myopathy spinal muscular atrophy, mitochondrial myopathy, Kennedy disease, CMT myotonic dystrophy;
- Chromosomal analysis;
- Fluorescence in situ hybridization (FISH) for microdeletion syndrome;
- Cell line establishment - fibroblast, lymphoblast, storage, culture;
- Acylcarnitine profiles; and
- Lysosomal enzyme assays.
Sleep Laboratories
The Neuroscience Center offers several types of sleep studies:
- Routine Overnight Polysomnographic Diagnostic Study (PSG);
- Continuous Positive Airway Pressure (CPAP) Titration Study;
- Split-Night Study; and
- Multiple Sleep Latency Test (MSLT) or Nap Study.
A sleep study, also called a polysomnogram (PSG), is a test to record how well you sleep. Most of them require you to sleep in the controlled environment of the Neuroscience Center.
The test will monitor your sleep stages, body position, blood oxygen levels, respiratory events, muscle tone, heart rate, amount of snoring and general sleep behavior during the night. A sleep technician will connect you to various instruments and also be in attendance in a nearby room while you sleep. In some situations, the study can be done without the presence of sleep technician.
A routine diagnostic study takes about 6-8 hours per night. Based on the results of your first study, you might need to return for a second study.
In the case of sleep apnea, on the second night we will use a treatment called Continuous Positive Airway Pressure or CPAP. A CPAP Titration Study uses a device that gently blows air into your nasal passages to keep the airway open while you to find the optimal pressure for you.
If necessary, costs can be minimized by participating in a "split-night" test, in which half the night will be used to diagnose your sleep problem and the other half will be used to treat the problem using CPAP.
A Multiple Sleep Latency Test (MSLT) or Nap test can be done the day following a routine diagnostic study. The patient will take five naps during the day and the study can tell how sleepy you are.
Routine EEG, Ambulatory EEG & Long-Term Video EEG Monitoring
An electroencephalogram (EEG) is a test to detect the brain's electrical activities or brain waves. The test is painless and non-invasive. It is so safe that it can be performed even on a newborn baby.
An EEG is used to evaluate altered consciousness and to diagnose seizure disorders, confusion, sleep problems, dementia, and any other disturbances of brain functions. It is also used to confirm brain death.
A routine EEG lasts about 45-60 minutes. The test is performed by an EEG technician and you can do it as an in-patient or an out-patient in “ambulatory” mode. The test can be extended as long as 24 hours.
The EEG brain signal can also be recorded with video capture. Long-Term Video EEG Monitoring or “VDO EEG monitoring” can be done for a period of days or even weeks.
Nerve Conduction Studies (NCS) & Electromyography (EMG)
Muscular weakness may be caused by either disorders of the muscles and/or nerves — or neither of them. Nerve conduction studies (NCS) and Electromyography (EMG) are used to diagnose disorders of nerves and muscles. They help neurologists determine the exact causes of problems that outwardly can appear very similar but actually occur for a wide variety of reasons.
An NCS is a standard test and a safe procedure to study nerve impulses. It's not painful but it is quite discomforting because it involves very low powered electrical shocks. The skin surface related to the nerve(s) to be studied is stimulated using electrical impulses while the responses (mostly muscle twitching) are recorded.
The stimulations can be performed over the nerve length (either near the stimulated muscle or further away). The nerve conduction velocity and amplitude of the response is obtained from the study and it clearly indicates the health of the nerve.
NCS is sensitive test but has some limitations. Only the large diameter nerve fibers such as vibration and touch sensation can be studied by NCS. Small nerve fibers such as those responsible for pain and temperature sensation requires Quantitative Sensory Testing (QST) because it is more sensitive.
EMG is a painful and lengthy procedure. It often follows NCS. No electrical stimulation is required but a special needle must be inserted into the muscles to be studied — much like acupuncture.
Electrical activity of the muscle is recorded through the special needle. The signal is recorded and analyzed by an advanced diagnostic machine. After the test, a patient may feel muscle pain at the puncture sites.
Quantitative Sensory Testing (QST)
QST is used to diagnose disorders of the small fiber nerves. It is a painless, well-developed, psychophysical methods to detect, characterize and quantitate sensory abnormalities. The patient’s sensitivity to warmth, cold and vibration will reflect the degree of nerve damage.
Nerve damage impairs sensory perceptions, such as pain and temperature. Quantitative Sensory Testing is a scientific way to quantify the degree and type of impairments. It uses a computer-aided sensory evaluator to study a patient's ability to detect these various sensations. The device is attached to the skin of the patient’s face, hand and foot. The patient then presses a button whenever he or she feels warm, cold or a vibration.
Doppler Neurovascular Laboratories
- Routine Transcranial Doppler (TCD);
- Bilateral Transcranial Doppler (TCD) Monitoring;
- Functional Test;
- CO2 Vasoreactivity Test;
- Emboli Detection; and
- High Intensity Transient Signals (HITS) Test (with/without IV microbubble injections).
Transcranial Doppler (TCD) Ultrasound is a safe, painless, reliable, and inexpensive way for measuring cerebrovascular blood velocities, which reflect the health of blood vessels, especially intracranial blood vessels. Patient’s cranial blood vessels will be studied by pulses of ultrasound, at frequencies around 2 MHz by using a handheld transducer towards the vascular formations in the base of the skull.
The frequency shift or the doppler effect of the reflected sound indicates the velocity of the reflecting matter and the results can be constructed into images. This test is useful for evaluating stroke patients. This test can be performed as a diagnostic test or during neurointensive care.
Test of Evoked Potentials (EPs)
- Somatosensory Evoked Potentials (SEPs)
- Auditory Evoked Potentials (AEPs)
- Visual Evoked Potentials (VEPs)
- Motor Evoked Potentials (MEPs)
Our sensory systems receive various sensory stimuli such as sounds, sensations and light though sensory organs such as the ear, skin and eyes, then convey the signals up to the corresponding areas in the brain. Evoked potentiasl (EPs) are the electrical signals generated by the nervous system along the way at the cortex, brainstem and spinal cord in response to those stimuli.
Motor and sensory systems can be studied by evoked potentials. All tests of evoked potentials, including AEPs VEPS, SEPs, and MEPs, are safe and painless studies. These tests help a neurologist to determine the precise location of a neurological problem and monitor a lesion ong term. Abnormalities found during these studies indicate an underlying pathology along either sensory or motor pathways within the nervous system.
During a test of SEPs, sensory nerves in arm (e.g.; median, ulnar nerves) or in the leg (e.g.; tibial, personal nerves) will be stimulated by weak electrical charges. The nervous system will respond to the stimuli and generate electrical signals that can be recorded at the arm, neck and scalp.
During tests of AEPs, the patient will hear "clicks" through a headphone while the electrical signals from the sensory system will be recorded from the scalp.
During tests of VEPs, a patient watches a television monitor while special images are flashed on the screen. The signals generated by the eyes in response to the stimuli are recorded from sensors attached to the visual area of the scalp.
When the brain orders an arm or leg muscle to move, the signal from the corresponding cortex travels down the brainstem, spinal cord and nerve to the muscle. In MEPs studies, we stimulate the corresponding cortex using a strong magnetic pulse generated by a transcranial magnetic stimulator (TMS). The cortical signal follows the same motor pathway as an order from the brain and causes the muscle to twitch, generating an electrical signal that can be recorded and studied.
