A compilation of important neuromuscular conditions and their investigation principles commonly dealt by a physical therapist.

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

4. Pathological tests:
Lumbar puncture: CSF study
Hematological tests
Nerve and muscle biopsy

5. Standard views used are:
Posteroanterior(PA)
Anteroposterior(AP)
Lateral
Towne’s (half-axial)
Base

7. X-ray skull showing lytic vault lesion

8. Skull radiographs are used to detect:
Bone erosion- Multiple myeloma
 Bone hyperostosis: Meningioma , Paget’s
disease,
Neoplasm: lymphoma
 Developmental abnormalities:
craniosynostosis (premature suture
closure)
 Trauma: facial fractures

9. Spinal disease:
 Lateral and AP views commonly used.
 Cervical spine fracture:
flexion/compression injury
 Degenerative diseases:AS,RA
 Metastatic tumours
 Congenital abnormalities:SPINA BIFIDA

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

13. Normal CT-Scan of brain Thalamic haemorrhage

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.

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

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.

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

25. To Detect:
Cerebral ischemia
Vessel occlusion/stenosis / plaque
formation
Aneurysm
AV Malformation
Vessel displacement/compression

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.

28. Hydrocephalus
Traumatic hematoma
Infections like meningitis
Cerebral edema
Neoplam/metastatic tumors

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.

31. Myopathy
Muscular dystrophy
Myasthenia gravis
Motor neuron disease

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.

34. Peripheral neuropathy
Vasculitis
Acute and chronic inflammatory
demyelinating polyneuropathies
Metabolic encephalopathies
Guillain Barre syndrome
Nerve disorders like
mononeuropathy,peripheral nerve
injury,etc.

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

37. pic

38. Appearance Clear and colourless
CSF Pressure 60-150 mm of water
Cells 0-4 Lymphocytes/ml
Proteins 15-45 mg/dl
Glucose 50-80 mg/dl
Bacteriology Sterile

39. Meningitis
Encephalitis
Malignacy
Tuberculous infection
Neurosyphillis
Multiple sclerosis
COMPLICATIONS:
Transient headache
Epidural haemorrhage

40. Erythrocyte count-4.5-5.5 million/cu.mm
ESR-0-20mm,
 Haemoglobin- 13-16g/dl
S. CPK- 0.5-5 microlts
Differential cell count:
Polymorphs-40-75%
Lymphocytes-20-50%
Monocytes-2-10%
Eosinophils-1-6%
Basophils-<1%

41. S.MCV( Mean corpuscular volume)- 77-
93fl
S.MCH( Mean corpuscular Hb)- 27-32 pg
Normal electrolytes:
Na-135-145 mmol/l
K-3.5-5.5 mmol/l
Cl-98-110 mmol/l
S.B12 level-200-900 pg/ml