What is a neurological exam?
What are some of the most common screening tests?
What diagnostic tests are used to diagnose neurological disorders?
What comes next?
Where can I get more information?
Diagnostic tests and procedures are important tools that help doctors confirm or rule out a neurological disorder or other medical condition. A century ago, the only way to definitively diagnose many neurological disorders was to perform an autopsy after someone's death. Today, new tools and techniques allow scientists to assess the living brain and monitor nervous system activity as it occurs. Physicians now have powerful and accurate tools to better diagnose diseases and test the performance of a given therapy.
Perhaps the most significant changes over the past 10 years have occurred in genetic testing and diagnostic imaging. Much has been learned from sequencing the human genome (a person's complete set of genes) and from the development of new technologies to detect genetic mutations. Improved imaging techniques provide high-resolution images that allow doctors to see the structure of the brain. Special imaging tests can show changes in brain activity or levels of certain brain chemicals. Scientists are continually improving these methods to provide more detailed diagnostic information.
Researchers and clinicians use a variety of imaging modalities, as well as chemical and metabolic tests, to detect, treat, and manage neurological disorders. Many tests can be performed in a doctor's office or outpatient clinic with little or no risk to the person. Some procedures are performed in specialized settings to determine specific disorders or anomalies. Depending on the type of test, results may be immediate or may take some time to process.
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What is a neurological exam?
ANneurological examassesses motor and sensory skills, hearing and speech, vision, coordination and balance. It can also test mental state, mood and behavior. The exam uses tools such as a tuning fork, a flashlight, a reflex hammer, and an eye exam tool. The results of the neurological exam and the patient's medical history are used to create a list of possibilities, called the differential diagnosis, and help determine what additional diagnostic tests and procedures are needed.
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What are some of the most common screening tests?
Job screening testsBlood, urine, or other body fluids can help doctors diagnose disease, understand disease severity, and monitor levels of therapeutic drugs. Certain tests, ordered by a doctor as part of a regular checkup, provide general information, while others are used to identify specific health problems. Blood tests can, for example, provide evidence of infections, toxins, clotting disorders, or antibodies that indicate the presence of an autoimmune disease. Genetic testing of DNA extracted from cells in blood or saliva can be used to diagnose hereditary diseases. Analysis of the fluid surrounding the brain and spinal cord can detect meningitis, encephalitis, acute and chronic inflammation, viral infections, multiple sclerosis, and certain neurodegenerative diseases. Chemical and metabolic blood tests can indicate some muscle diseases, protein- or fat-related disorders that affect the brain, and inborn errors of metabolism. Blood tests can monitor levels of therapeutic drugs used to treat epilepsy and other neurological disorders. Analysis of urine samples may reveal toxins, abnormal metabolic substances, disease-causing proteins, or signs of certain infections.
Retestarof people with a family history of a neurological disorder can determine whether they carry any of the genes known to cause the disorder. Genetic counseling may be recommended for patients or parents of children tested to help them understand the purpose of the tests and the meaning of the results. Genetic tests used for diagnosis or treatment must be performed in a laboratory certified for clinical testing. Clinical tests can look for mutations in specific genes or in specific regions of multiple genes. This test can use a gene panel for a specific type of disease (such as epilepsy in infants) or a test known as whole exome sequencing. Exomes are the parts of the genome formed by exons that encode proteins. Exome sequencing analysis can take several months. Doctors and researchers also sequence entire exomes, or entire genomes, to discover new genes that cause neurological disorders. These genes could eventually be used for clinical trials in more focused panels.
Prenatal genetic testing can identify many neurological disorders and genetic abnormalities in utero (while the child is in the womb).
- The mother's blood may be tested for abnormalities that indicate her risk for a genetic disorder. Cell-free DNA from the mother's blood can also be used to screen for Down syndrome and some chromosomal disorders.
- Doctors may also use what is called a triple screening blood test to identify some genetic disorders, including trisomies (conditions such as Down syndrome, in which the fetus has an extra chromosome) in an unborn baby. A blood sample is taken from a pregnant woman and tested for three substances: alpha-fetoprotein, human chorionic gonadotropin, and estriol. The test is carried out between the 15th and 20th week of pregnancy. It usually takes several days to get results from a triple screen. Abnormal triple screening results may indicate a possible problem such as spina bifida (incomplete development of the brain, spinal cord, or protective covering of the spinal cord) or a chromosomal abnormality. However, the test has many false positives, requiring additional testing to confirm if there is a problem.
- Amniocentesisit is usually performed in the 14th to 16th week of pregnancy. It involves examining a sample of amniotic fluid in utero to look for genetic defects (cells in the amniotic fluid and the fetus have the same DNA). Under local anesthesia, a thin needle is inserted through the woman's abdomen into the uterus. About 20 milliliters of liquid (about 4 teaspoons) is withdrawn and sent to a laboratory for evaluation. Test results usually take 1 to 2 weeks.
- chorionzote biopsyIt is performed by removing and testing a very small sample of the placenta during early pregnancy. The sample, which contains the same DNA as the fetus, is taken by a catheter or thin needle inserted into the cervix or by a thin needle inserted into the abdomen. Results are usually available within 2 weeks.
brain scansinclude different types of imaging tests used to diagnose tumors, blood vessel malformations, stroke, injuries, abnormal brain development, and bleeding in the brain. Types of brain scans include computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and single proton emission (SPECT) scans.
- Computed tomography (computed tomography)uses X-rays to create two-dimensional images of organs, bones and tissues. A CT scan can help in the correct diagnosis by showing the affected area of the brain. CT scans can be used to quickly detect bleeding in the brain and determine whether someone who has had a stroke can safely receive intravenous treatment to break up blood clots. Computed tomography can also be used to detect bone and vascular irregularities, brain tumors and cysts, brain damage caused by head trauma, hydrocephalus, brain damage that causes epilepsy and encephalitis, among others. A contrast medium can be injected into the bloodstream to highlight different tissues in the brain. A CT scan of the spine may show herniated discs, spinal fractures, or spinal stenosis (narrowing of the spinal canal).
A CT scan takes about 20 minutes and is usually done in an outpatient imaging center or hospital. The person lies down on a special table that slides into a narrow, donut-shaped chamber. A sound system built into the chamber allows the person to communicate with the doctor or technician. X-rays (ionizing radiation) pass through the body at various angles and are captured by a computerized scanner. The data is processed and displayed as cross-sectional images or "slices" of the internal structure of the body or organ. Occasionally, a mild sedative may be given if the person is unable to sit still, and pillows may be used to support and stabilize the head and body.
When a contrast medium is injected into a vein, the person being examined may feel a warm or cold sensation as the contrast medium circulates through the bloodstream, or they may experience a slight metallic taste. CT scans are especially helpful in people who cannot have an MRI. Because CT uses X-rays, pregnant women should avoid the test because of possible harm to the fetus.
- Magnetic resonance imaging (MRI)uses computer-generated radio waves and a powerful magnetic field to create detailed images of body tissues. Using different sequences of magnetic pulses, MRI can show anatomical images of the brain or spinal cord, measure blood flow or reveal deposits of minerals such as iron. MRI is used to diagnose stroke, traumatic brain injury, brain and spinal cord tumors, inflammation, infection, vascular irregularities, brain damage associated with epilepsy, abnormally developed brain regions, and some neurodegenerative diseases. MRI is also used to diagnose and monitor conditions such as multiple sclerosis. A contrast medium may be injected into the vein to improve the visibility of specific areas or tissues.
An MRI scanner consists of a tube surrounded by a very large cylindrical magnet. These scanners create a magnetic field around the body strong enough to temporarily realign water molecules in tissue. Radio waves are then passed through the body to detect the molecules shifting back into a random orientation. A computer then reconstructs a three-dimensional image, or two-dimensional “slice” of the scanned tissue. MRI can distinguish between bone, soft tissue, and fluid-filled spaces due to differences in water content and tissue properties. The person lies on a special table that slides into the tube and is asked to remove jewelry, eyeglasses, removable dentures, clothing containing metal and other items that might interfere with the magnetic image. The person may hear squeaks or knocks when the direction of the magnetic field is reversed. Headphones or ear plugs can help block out the noise. For MRI scans of the brain, a detector is placed over the head.
Due to the incredibly strong magnetic field generated by an MRI, people with implanted medical devices, such as pacemakers or intravenous equipment, generally should not have MRIs. In certain circumstances, facilities may have equipment to temporarily interrupt and reset implanted device programming to allow for an MRI.
Unlike CT scans, MRIs do not use ionizing radiation to create images. The test is painless and risk-free, although it may be uncomfortable for someone who is overweight or claustrophobic. Depending on the parts of the body to be scanned, the MRI can take up to an hour. Some centers use open MRI machines, which don't completely envelop the person being tested and are less confining. However, open MRI does not currently offer the same image quality as standard MRI and some tests may not be available with this device.
Because people must remain still during MRI scans, children may need to be sedated to be scanned. If an intravenous contrast agent is needed, a blood test to check kidney function may be needed first, because the contrast agent called gadolinium can increase the risk of a rare condition in people with advanced kidney disease.
A fetal MRI may be ordered if the prenatal ultrasound shows a possible problem with the fetus. Fetal MRI is considered safe for the baby because it does not require radiation or contrast media.
functional magnetic resonance imaging (fMRI)uses the magnetic properties of blood to create real-time images of blood flow to specific areas of the brain. fMRI can identify areas of the brain that are becoming active and show how long they remain active. This imaging process can be used to localize brain regions for language, motor function or sensation prior to epilepsy surgery. Researchers use fMRI to study head injuries and degenerative diseases like Alzheimer's disease.
- Positron Emission Tomography (PET)The scans provide two-dimensional and three-dimensional images of brain activity by measuring radioactive isotopes that are injected into the bloodstream. PET scans of the brain are used to identify or highlight tumors and diseased tissue, show blood flow, and measure cellular and/or tissue metabolism. PET scans can be used to examine people with epilepsy or certain memory disorders and to show changes in the brain after an injury. PET may be ordered as a follow-up after a CT scan or MRI to give the doctor a better understanding of specific areas of the brain that may be involved in problems. PET scans are performed by experienced technicians in state-of-the-art medical facilities in a hospital or outpatient testing center. A low-level radioactive isotope, also called a tracer, is injected into the bloodstream and the uptake of the tracer in the brain is measured. The person lies still while airborne sensors detect gamma rays in body tissues. A computer processes the information and displays it on a video or film monitor. With different connections, more than one brain function can be tracked at the same time. PET is painless and uses small amounts of radioactivity. The duration of the test time depends on the body part to be scanned.
- Single Photon Emission Computed Tomography (SPECT)is a nuclear imaging test that can be used to assess certain brain functions. As with a PET scan, a radioactive isotope, or tracer, is injected intravenously into the body. A SPECT scan may be ordered as an accompaniment to an MRI to diagnose tumors, infections, brain regions involved in seizures, degenerative spinal disease, and stress fractures. Dopamine transporter imaging with single photon emission computed tomography (DaT-SPECT) can be used to diagnose Parkinson's disease. During a SPECT scan, you lie on a table while a gamma camera rotates around your head and records where the radioisotope went. This information is converted by the computer into cross-sectional slices that are stacked to create a detailed three-dimensional image of the tracker in the brain. The test is done at an outpatient imaging center or in a hospital.
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What additional tests are used to diagnose neurological disorders?
The following list of procedures - in alphabetical order - describes some of the other tests used to diagnose a neurological disorder.
Angiographyis a test in which a dye is injected into the arteries or veins to check for blockage or narrowing. A cerebral angiogram can show a narrowing or blockage of an artery or blood vessel in the brain, head, or neck. It can determine the location and size of an aneurysm or vascular malformation. Angiograms are used in certain strokes where there is an opportunity to clear the artery using a clot retriever. Angiograms can also show the blood supply to a tumor before surgery or embolectomy (surgical removal of a blood clot or other material that blocks a blood vessel).
Angiograms are usually performed in an outpatient or hospital setting and can take up to 3 hours, followed by a 6- to 8-hour rest period. The person, wearing a hospital gown or imaging gown, lies down on a table that is brought into the imaging area. A doctor numbs a small area of the leg near the groin and then inserts a catheter into a large artery located there. The catheter is inserted through the body and into a carotid artery. The dye is injected and travels through the bloodstream to the head and neck. A series of X-rays are taken. The person may feel a warm to hot sensation or mild discomfort as the dye is released. In many situations, cerebral angiograms have been replaced by specialized MRI scans called MR angiograms (MRA) or CT angiograms. A spinal angiogram is used to detect arterial blockages or blood vessel malformations in the vessels leading to the spinal cord.
Biopsyinvolves removing and examining a small piece of tissue from the body. Muscle or nerve biopsies are used to diagnose neuromuscular disorders. A small sample of muscle or nerve is taken under local anesthesia (pain-relieving medication) and examined under a microscope. The muscle sample can be obtained surgically, by cutting the skin, or by needle biopsy, in which a thin, hollow needle is inserted through the skin and into the muscle. A piece of the nerve can be removed through a small surgical incision near the ankle or, occasionally, near the wrist. Muscle and nerve biopsies are usually done at an outpatient testing center. A skin biopsy can be used to measure small nerve fibers or to test for certain metabolic disorders. A small piece of skin is removed under local anesthesia, usually in an office setting. A brain biopsy, used to determine the type of tumor or certain infections, requires surgery to remove a small piece of the brain or tumor. A brain biopsy is an invasive procedure that comes with its own set of risks.
Analysis of the cerebrospinal fluidinvolves removing a small amount of the fluid that surrounds the brain and spinal cord. The procedure is commonly called a spinal tap or spinal tap. The fluid is tested for evidence of brain hemorrhage, infection, multiple sclerosis, metabolic disease, or other neurological disorders. Pressure inside the skull can be measured to detect conditions like a false brain tumor. Lumbar puncture can be performed in an inpatient or outpatient setting. During a lumbar puncture, the person lies on their side with their knees close to their chest or leans forward while sitting on a massage table, bed, or chair. The person's back is cleaned and injected with a local anesthetic. The injection may cause a slight burning sensation. After the anesthetic takes effect, a special needle is inserted into the spinal sac between the vertebrae and a small amount of fluid (usually about three teaspoons) is collected for testing. Most people will only feel pressure when the needle is inserted. Patients are usually asked to lie down for an hour or two to reduce the side effects of a headache. There is a small risk of nerve root injury or infection from a lumbar puncture. The operation takes about 45 minutes.
Electroencephalography, or EEG, monitors the electrical activity of the brain through the skull. EEG is used to diagnose seizure disorders and metabolic, infectious, or inflammatory diseases that affect brain activity. EEGs are also used to assess sleep disturbances, monitor brain activity when a person is fully anesthetized or loses consciousness, and can be used to confirm brain death.
This painless, risk-free test can be performed in a doctor's office or at a hospital or testing center. A person being tested usually reclines in a chair or bed during the test. A series of cup-shaped electrodes are attached to the scalp with a special conductive paste. The electrodes are connected to wires (also called conductors) that transmit the brain's electrical signals to a machine. A variety of external stimuli can be administered during an EEG recording session, including bright or flashing lights, sounds, or certain medications.
People may be asked to open and close their eyes or change their breathing patterns. Changes in brain wave patterns are transmitted to an EEG machine or computer. An EEG test usually takes about an hour. Testing for certain disorders requires taking an EEG while sleeping, which takes at least 3 hours.
For people undergoing epilepsy surgery, electrodes can be inserted through a surgical opening in the skull to reduce signal interference. This is called an intracranial EEG. People typically remain in a hospital's epilepsy monitoring unit while the implanted electrodes are in place. During this time, the brain is monitored for seizures to determine the source of the seizures. Patients may also be asked to perform specific types of tasks (such as reading, speaking, or certain limited motor activities) so that the EEG can be used to identify brain regions important for normal functioning.
electromyography, or EMG, is used to diagnose nerve and muscle disorders, spinal nerve root compression, and motor neuron disorders such as amyotrophic lateral sclerosis. EMG records electrical activity in muscles. Muscles develop abnormal electrical signals when nerves or muscles are damaged. During an EMG, very fine needles or wires are inserted into a muscle to assess changes in electrical signals at rest and during movement. The needles are connected to an EMG machine by wires. The test can be performed in a doctor's office or clinic and takes an hour or more, depending on the number of muscles and nerves tested. Due to the low risk of bruising or bleeding, patients are asked whether they are taking aspirin or blood thinners. Most people find this test rather uncomfortable.
An EMG is usually done in conjunction with aNerve Conduction Study (NCS). An NCS measures the nerve's ability to send a signal, as well as the velocity (velocity of nerve conduction) and magnitude of the nerve signal. A set of recording electrodes is taped to the skin over the muscles or skin. Wires connect the electrodes to an EMG machine. A small electrical pulse (similar to the sensation of static electricity) is applied to the skin over a short distance to stimulate the nerve to the muscle or skin. The electrical signal is displayed on the EMG machine. The doctor then checks the response to determine whether there is nerve damage or muscle disease. This test involves minimal discomfort and no risk.
Elektronystagmographie (ENG)describes a group of tests used to diagnose involuntary eye movements, dizziness, and balance disorders. The test is done at a clinic or imaging center. Small electrodes are placed on the skin around the eyes to record eye movements. If infrared photography is used instead of electrodes, the test person wears special glasses that help record the information. Both test variants are painless and risk-free.
Evoked Potentials, also called the evoked response, measure the electrical signals to the brain produced by hearing, touching, or seeing. Evoked potentials are used to test vision and hearing (especially in infants and young children) and can help diagnose neurological disorders such as multiple sclerosis, spinal cord injury, and acoustic neuroma (small tumors of the auditory nerve). Evoked potentials are also used to monitor brain activity in comatose patients and to confirm brain death.
The test can be done in a doctor's office or in a hospital. A set of electrodes is attached to the person's scalp with conductive paste. The electrodes measure the brain's electrical response to stimuli. A machine records how long it takes for impulses generated by stimuli to reach the brain.
- Auditory Evoked Potentials(also called brainstem auditory evoked response) can assess hearing loss and damage to the auditory nerve and auditory pathways in the brainstem and detect acoustic neuromas. The person to be tested sits in a soundproofed room and wears headphones. Clicks are delivered to one ear individually, while a masking sound is sent to the other ear. Each ear is usually tested twice and the entire procedure takes about 45 minutes.
- visually evoked potentialsRecognize vision loss due to optic nerve damage (for example, due to multiple sclerosis). The subject sits near a screen and is asked to focus on the center of a moving checkerboard pattern. One eye is tested at a time. Each eye is usually tested twice. The test lasts 30-45 minutes.
- Somatosensory Evoked Potentials (SSEPs)Measure responses to electrical stimuli in nerves. In addition to scalp electrodes, electrodes are placed on the arms, legs and back to measure the signal as it travels from the peripheral nerves to the brain. Small electrical shocks are delivered by electrodes taped to the skin over a nerve in an arm or leg. SSEPs can be used to help diagnose multiple sclerosis, spinal cord compression or injury, and certain metabolic or degenerative diseases. SSEP tests typically take over an hour.
myelographyinvolves injecting contrast material into the spinal canal to enhance the image of the spine by CT scan or X-ray. Myelograms have largely been replaced by MRI, but they can be used in special situations. For example, myelograms can be used to diagnose tumors of the spine or spinal cord, or spinal cord compression from herniated discs or fractures. The procedure takes about 60 minutes and can be performed on an outpatient basis. After an anesthetic is injected into a site between two vertebrae in the lower back, a small amount of cerebrospinal fluid is removed by lumbar puncture (see Analysis of Cerebrospinal Fluid above). Contrast dye is injected into the spinal canal and a CT scan or X-ray series is taken. People may experience pain during spinal taps and headaches after spinal taps. There is a small risk of spillage or an allergic reaction to the dye.
ANpolysomnographymeasures brain and body activity during sleep. It is performed over one or more nights in a sleep center. The electrodes are taped or taped to the person's scalp, eyelids, and/or chin. During the night and during various sleep/wake cycles, the electrodes record brain waves, eye movements, breathing, skeletal and leg muscle activity, blood pressure and heart rate. The person can be filmed to observe any movement during sleep. The results are used to identify characteristic patterns of sleep disorders, including restless legs syndrome, periodic limb movement disorders, insomnia and breathing disorders such as sleep apnea. Polysomnograms are non-invasive, painless, and risk-free.
Thermography(also known as digital infrared thermal imaging) uses infrared sensors to measure small temperature changes and thermal abnormalities between the two sides of the body or within a specific organ. Some scientists question its use in diagnosing neurological disorders. It can be used to assess complex regional pain syndromes and certain peripheral nerve disorders and nerve root compression. It is performed in a specialized imaging center that uses infrared light recorders to take pictures of the body. The information is converted into a computer-generated two-dimensional image of unusually cold or hot areas, identified by color or black and white tones. Thermography uses no radiation and is safe, risk-free and non-invasive.
ultrasound, also called ultrasound, uses high-frequency sound waves to obtain images inside the body. During an ultrasound scan, the person lies on a table or in an examination chair. A gelatinous lubricant is applied to bare skin, and a transducer that transmits and receives high-frequency sound waves is passed over the body. The sound wave echoes are recorded and displayed as a real-time computer-generated visual image of the structure or tissue under investigation. Ultrasound is painless, non-invasive, and risk-free. The test is performed on an outpatient basis and takes between 15 and 30 minutes.
Ultrasound can be used to assess changes in soft tissue anatomy, including muscles and nerves. It is more effective than an X-ray for showing soft tissue changes such as torn ligaments or soft tissue masses. In pregnant women, ultrasound can suggest the diagnosis of disorders such as chromosomal abnormalities in the fetus. Ultrasound creates an image of the fetus and placenta. Ultrasound can also be used in newborns to diagnose hydrocephalus (a buildup of cerebrospinal fluid in the brain) or hemorrhage.
- Carotid Doppler Ultrasoundused to measure the flow in the arteries and blood vessels in the neck.
- Transcranial Doppler UltrasoundUsed to show blood flow in specific arteries and blood vessels within the skull. Carotid Doppler and Transcranial Doppler are used to assess stroke risk.
- Ultrassom Duplexrefers to ultrasound examinations combined with anatomical ultrasound.
X rayof a person's chest and skull can be done as part of a neurological examination. X-rays can be used to examine any part of the body, such as: B. a joint or major organ system. In a conventional X-ray, a concentrated burst of low-dose ionized radiation penetrates the body and strikes a photographic plate. Because calcium in bone absorbs X-rays more readily than soft tissue or muscle, bone structure appears white on film. Any vertebral misalignment or fracture can be seen within minutes. Tissue accumulations, such as torn ligaments or a bulging disc, are not visible on conventional x-rays. This quick, non-invasive, and painless procedure is usually performed in a doctor's office or clinic.
fluoroscopiais a type of X-ray that uses a continuous or pulsed beam of low-dose radiation to create continuous images of a moving body part. The fluoroscope (X-ray tube) is focused on the area of interest and the images are videotaped or sent to a monitor for viewing. Fluoroscopy is used to evaluate swallowing and may be used for other procedures such as B. a lumbar puncture, an angiogram to remove blood clots, or a myelogram.
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What comes next?
Scientists funded by the National Institute of Neurological Disorders and Stroke aim to develop additional and improved screening methods to more accurately and quickly confirm a specific diagnosis and examine other factors that may contribute to the condition. Technological advances in imaging will allow researchers to better see inside the body with less risk to the person. These diagnoses and procedures will continue to be important clinical research tools to confirm a neurological disorder, map disease progression, and monitor therapeutic efficacy.
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Where can I get more information?
For information about specific neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Information and Resource Network (BRAIN) no:
BRAIN
mailbox field 5801
Bethesda, MD20824
800-352-9424
The organization:
American Association of Neurological Surgeons
5550 Meadowbrook-Laufwerk
Rolling Meadows, IL 60008-3852
info@aans.org
Tel: 847-378-0500/888-566-AANS (2267)
Fax: 847-378-0600
American College of Radiology
1891 Preston White Drive
Reston, Virginia 20191–4397
info@acr.org
Tel: 800-227–5463 703-648-8900
Fax: 703-295-6773
Radiological Society of North America
820 Jorie Avenue
Oak Brook, IL 60523-2251
webmaster@rsna.org
Tel: 800-381-6660 630-571-2670
Fax: 630-571-7837
National Library of Medicine (NLM)
National Institutes of Health, DHHS
8600 Rockville Pike, Geb. 38, Rm. 2S10
Bethesda, MD20894
Tel: 301-496-6308; 888-346-3656
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"Neurological Diagnostic Tests and Procedures",NINDS. April 10, 2019.
NIHPublication No. 19-NS-5380
Prepared by: Office of Communication and Public Relations
National Institute of Neurological Disorders and Stroke
National Institute of Health
Bethesda, MD20892
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