Comprehensive Neurological Examination and Diagnostic Tests

Comprehensive Neurological Examinations

Imaging studies

These tests primarily focus on visualizing structures in the brain, blood vessels, and other parts of the body.

• Magnetic Resonance Imaging (MRI):  Magnetic resonance imaging (MRI), with the help of computer-generated radio waves and a strong magnetic field, creates precise images of body tissues. Using various sequences of magnetic pulses, the MRI can measure blood flow, display anatomical pictures of the brain or spinal cord, or locate iron (mineral) depositions. MRI is indicated to diagnose stroke, inflammation, brain and spinal cord tumours, traumatic brain injury infection, improperly formed brain regions, vascular irregularities, multiple sclerosis, epilepsy-related brain damage and various neurodegenerative disorders. The radiologist inserts a contrast dye that may be injected into a vein to make certain tissues or organs more visible. The real-time pictures of blood flow to specific brain regions can be done with functional MRI (fMRI) with the help of blood magnetic properties. Prior to epilepsy surgery, this imaging procedure may be utilised to identify the brain regions responsible for language, motor function, or sensation.
  
• Magnetic Resonance Angiography (MRA): MRA is a non-invasive imaging technique used to visualize the blood vessels in the brain and other parts of the body. It uses magnetic resonance imaging (MRI) to create detailed images of arteries and veins. MRA is useful in diagnosing conditions like aneurysms, stenosis, arteriovenous malformations, and other vascular abnormalities in the brain. It can also help assess blood flow in the brain, detect blockages, and guide treatment for conditions such as stroke or brain tumors.
  
• Magnetic Resonance Venography (MRV): MRV is a specialized form of MRI that focuses on imaging the veins in the brain. It is used to evaluate venous sinus thrombosis, which can lead to increased intracranial pressure, headaches, and other symptoms. This test helps to identify vascular disorders like venous malformations or blockages and is important for diagnosing conditions related to poor venous drainage.
  
• Computed Tomography (CT) Scan :  Computed tomography (CT), with the help of X-rays, provides two-dimensional pictures of organs, bones, and tissues. A CT scan can diagnose the patient’s condition by displaying the damaged area of the brain. CT scans can be used to detect brain haemorrhage. An interventional radiologist will inject a contrast dye into the bloodstream to highlight the various brain tissues. Herniated discs, spine fractures, and spinal stenosis (spinal canal narrowing) can be diagnosed and can all be seen on a CT scan of the spine.
• Positron Emission Tomography (PET) Scan : The Positron emission tomography (PET) scan provides pictures of brain activity (two- and three-dimensional) by measuring the injected blood radioactive isotopes. This test is used to detect tumours, damaged tissue, and blood flow and measures cellular and/or tissue metabolism. A PET scan is indicated to diagnose epilepsy, memory disorders and injury-induced brain changes. Single photon emission computed tomography (SPECT) is a nuclear imaging test to evaluate brain functions. SPECT scan may be prescribed as a follow-up to an MRI to diagnose degenerative spine disease, infections, seizures, tumors, and stress fractures.
• Cerebral Angiography : Cerebral angiography is a diagnostic procedure used to detect brain aneurysms or any other blood vessel abnormalities in the head and neck with the help of X-ray imaging. A vascular surgeon performs this procedure by injecting a dye into the patient's arteries/veins to detect any blockage or narrowing. The X-ray creates an image known as a cerebral angiogram, which a vascular surgeon can use to identify blockages or other anomalies in the brain, head and neck that include arteriosclerosis, brain tumours, arteriovenous malformation, aneurysm, tears in the lining of an artery, blood clots and blood vessels inflammation. It can also identify the location and size of an aneurysm or vascular malformation. Angiograms are helpful, especially in strokes.
• Dopamine Transporter Imaging (DaT-SPECT) : It can help detect various conditions, especially Parkinson's disease. This imaging technique can help differentiate between the neurodegenerative symptoms of Parkinson's disorders and a dopaminergic deficit from other causes of Parkinsonism, such as drug-induced Parkinsonism, etc.

Electrophysiological and Functional Tests

These tests measure electrical activity in the brain or muscles to evaluate function and abnormalities.

• Electromyography (EMG): Electromyography (EMG) measures a muscle's reaction or electrical activity when a nerve stimulates a muscle. The test is used to identify abnormalities of neuromuscular functions. This procedure is done by inserting one or more tiny needles, commonly known as electrodes, which are introduced through the skin and into the muscle during the test. An oscilloscope, a monitor that shows electrical activity as waves, displays the electrical activity detected by the electrodes. In order to hear the activity, an audio amplifier is employed. The muscle's electrical activity during the rest and contraction (light and strong) are measured by EMG. At rest, muscle tissue doesn't typically create any electrical signals.
• Electroencephalogram (EEG) : Electroencephalogram (EEG) test is a non-invasive procedure used to estimate the electrical activity of a patient's brain, with the help of small metal discs or electrodes placed on the patient's scalp, which is further observed by the neurophysiologist to analyse the patient's brain functions. It helps diagnose and monitor several conditions affecting the brain, such as epilepsy, memory loss, Alzheimer's disease, encephalitis, narcolepsy, stroke, the presence of internal bleeding, brain tumors, etc. Routine EEG, Prolonged EEG, Ambulatory EEG, Video EEG, Sleep EEG, and Invasive EEG are the types of EEG tests.
• Transcranial Doppler (TCD): TCD is an ultrasound technique used to measure the velocity of blood flow in the brain’s major arteries. It is particularly useful in assessing conditions that affect cerebral circulation, such as stroke, vasospasm (narrowing of blood vessels), and sickle cell disease. TCD can detect abnormal blood flow patterns, including blockages or narrowing of arteries, and can also be utilised to monitor the effectiveness of treatments like carotid artery stenting or to evaluate the risk of stroke in patients with certain conditions.
  
• Magnetoencephalography (MEG): This is a non-invasive technique that measures the magnetic fields produced by neuronal activity in the brain. This test provides real-time mapping of brain function, which is helpful for diagnosing disorders such as epilepsy, brain tumors, and neurodegenerative diseases. MEG is particularly valuable in locating the origin of epileptic seizures, planning brain surgery, and understanding brain networks involved in sensory and motor processing. 
• Sensory Evoked Potentials : Sensory evoked potentials measure the brain’s electrical activity in response to stimulation by touch, sound, or sight. Signals move through the nerves to the brain when the brain is stimulated by sound, touch or sight. These signals are further detected by the electrodes and displayed for neurological interpretation. Visual evoked response (VER), Brainstem auditory evoked response (BAER) and Somatosensory evoked response (SSER) are the tests used to measure response to visual, auditory, and electrical stimuli. VER test is used to diagnose optic nerve problems that affect sight. BAER test is used to detect hearing ability in addition to diagnosing potential brainstem tumours or multiple sclerosis. SSER test is used to diagnose problems related to the spinal cord that cause leg and arm numbness.
• Neuropsychological Testing: This consists of a set of standardised tasks and examinations designed to examine cognitive skills such as memory, attention, language, and problem-solving ability. These tests are used to diagnose and assess the effects of neurological conditions like Alzheimer’s disease, traumatic brain injury (TBI), strokes, and other cognitive disorders. The results help in identifying areas of cognitive dysfunction and can guide treatment plans, as well as assess the progression of the disease.

Cerebrospinal Fluid (CSF) and Genetic Testing

Tests for fluid analysis and genetic information related to neurological conditions.

• Lumbar Puncture (Spinal Tap): A lumbar puncture is a diagnostic and treatment procedure used to diagnose various disorders by collecting a small amount of Cerebrospinal fluid (CSF) for testing in patients with overproduction or decreased absorption of CSF. A neurosurgeon will carry out this procedure by inserting a hollow needle into the subarachnoid area (space surrounding the spinal column) in the lower back. The fluid is tested for the presence of proteins, red and white blood cells, glucose, bacteria, viruses, and abnormal cells. Lumbar puncture is used to diagnose Meningitis, Brian and spinal cord cancers, Encephalitis, Subarachnoid space bleeding, Reye syndrome, Myelitis, Neurosyphilis, Guillain-Barré syndrome, Demyelinating diseases, Headaches of unknown cause, Pseudotumor cerebri and Normal pressure hydrocephalus.
• Genetic Testing : It is done to comprehend the family history of neurological disease in patients. Prenatal genetic testing (done in utero) can identify congenital abnormalities and neurological disorders. Genetic counselling can help understand its necessity and the meaning of its results. An individual's blood, skin, hair, or other body tissue may be subjected to genetic testing to examine the DNA, chromosomes, or proteins for mutation or any change that is linked to a genetic disorder. A gene's function may be altered due to a mutation, which may impact a gene's entire structure or only a portion of it. Newborn screening, Carrier testing, Prenatal diagnostic testing, Predictive or predisposition genetic testing and Forensic testing are the types of genetic testing.

Sleep and Temperature Monitoring

Tests for assessing brain and body functions during sleep or temperature-related abnormalities.

• Polysomnogram (PSG) : This diagnostic procedure calculates the activity of the brain and body during sleep by recording the brain waves, eye movement, sleep/wake cycles, breathing, blood pressure, leg and skeletal muscle activity, and heart rate. A polysomnogram is the gold standard for diagnosing obstructive sleep apnoea (OSA), central sleep apnoea, and sleep-related hypoventilation/hypoxia. In addition, it can be used to test for narcolepsy, periodic limb movement disorder, rapid eye movement sleep behaviour disorder, and nocturnal seizures. A polysomnogram (PSG) is a procedure that assesses underlying causes of sleep problems by using an electroencephalogram, electrocardiogram, electrooculogram, electromyogram, pulse oximetry, airflow, and respiratory effort.
• Thermography (Digital Infrared Thermal Imaging): This non-invasive diagnostic procedure uses an infrared camera to capture heat map images of the target surface, which aids in the detection of cancer. The heatmap infrared sensing devices measure the slight temperature changes and abnormalities between the two sides of the system or within a specific organ, thus evaluating the complex regional and certain peripheral nerve disorders apart from nerve root compression.
  

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