Other Diagnostic Tests

Other diagnostic tests include lumbar puncture, which provides information about the CNS through
direct contact with the cerebrospinal fluid (CSF); a variety of tests that measure electrical impulses in
portions of the nervous system; and neuropsychological evaluation.

Lumbar Puncture

Description

1. A needle is inserted into the lumbar subarachnoid space, usually between the third and fourth
lumbar vertebrae, and CSF is withdrawn for diagnostic and therapeutic purposes.

2. Purposes include:

a. Obtaining CSF for examination (microbiologic, serologic, cytologic, or chemical analysis).

b. Measuring cerebrospinal pressure and assisting in detection of obstruction of CSF circulation.

c. Determining the presence or absence of blood in the spinal fluid.

d. Aiding in the diagnosis of viral or bacterial meningitis, subarachnoid or intracranial hemorrhage,

tumors, and brain abscesses.

e. Administering antibiotics and cancer chemotherapy intrathecally in certain cases.

f. Determining levels of tau protein and beta-amyloid in the CSF—a new test that may be used to assist
in the diagnosis of Alzheimer’s disease. Elevated levels of tau protein and decreased levels of beta-
amyloid are associated with Alzheimer’s disease.
Nursing Patient Considerations
Electroencephalography

Description

1. EEG measures electrical activity of brain cells. Electrodes are attached to multiple sites on the scalp
to provide a recording of electrical activity that is generated in the cerebral cortex. Electrical impulses
are transmitted to an electroencephalograph, which magnifies and records these impulses as brain
waves on a strip of paper. New devices allow for continuous EEG monitoring of selective areas of the
brain, thus limited data is collected. It is useful in the intensive care unit (ICU) setting for continuous
monitoring to evaluate for seizure activation.

2. Provides physiologic assessment of cerebral activity for diagnosis of epilepsy, alterations in brain
activity in coma, and organic brain syndrome and sleep disorders. Particularly helpful in the investigation
of patients with seizures.

3. Usually performed in a room designed to eliminate electrical interference; however, in the case of a
comatose patient, it may be performed at bedside using a portable unit.
4. Restlessness and fatigue can alter brain wave patterns.

5. For a baseline recording, the patient is instructed to lie still and relax with eyes closed. After a
baseline recording in a resting phase, the patient may be tested in various stress situations (eg, asked to
hyperventilate for 3 minutes, look at a f lashing strobe light) to elicit abnormal electrical patterns.

6. In patients with epilepsy, continuous monitoring is performed with video monitoring. This is useful
for interpretation and correlation of physiologic seizure activity and clinical seizures.

a. Grids or strips are placed intraoperatively for more accurate assessment of seizure foci.

b. Mapping of seizure activity is performed to determine precise location of seizure foci.

c. Once foci are located, the site is evaluated for possible surgical resection.

Nursing and Patient Care Considerations

1. For routine EEG, tranquilizers, anticonvulsants, sedatives, and stimulants should be held for 24 to 48
hours before the study.

2. Thoroughly wash and dry patient’s hair to remove hair sprays, creams, or oils.

3. Explain that the electrodes will be attached to patient’s skull with a special paste.