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DIAGNOSTIC PROCEDURES

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COMPUTERIZED TOMOGRAPHY (CT) SCAN
WHAT IS CT SCANNING OF THE HEAD? CT scanning—sometimes called CAT scanning—is a noninvasive medical test that helps physicians diagnose and treat medical conditions. CT scanning combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. These cross-sectional images of the area being studied can then be examined on a computer monitor, printed or transferred to a CD. CT scans of internal organs, bones, soft tissue and blood vessels provide greater clarity and reveal more details than regular x-ray exams. CT scanning provides more detailed information on head injuries, stroke, brain tumors and other brain diseases than regular radiographs (x-rays). WHAT ARE SOME COMMON USES OF THE PROCEDURE? CT scanning of the head is typically used to detect: • bleeding, brain injury and skull fractures in patients with head injuries. • bleeding caused by a ruptured or leaking aneurysm in a patient with a sudden severe headache. • a blood clot or bleeding within the brain shortly after a patient exhibits symptoms of a stroke. • a stroke, especially with a new technique called Perfusion CT. • brain tumors. • enlarged brain cavities (ventricles) in patients with hydrocephalus. • diseases or malformations of the skull. CT scanning is also performed to: • evaluate the extent of bone and soft tissue damage in patients with facial trauma, and planning surgical reconstruction. • diagnose diseases of the temporal bone on the side of the skull, which may be causing hearing problems. • determine whether inflammation or other changes are present in the paranasal sinuses. • plan radiation therapy for cancer of the brain or other tissues. • guide the passage of a needle used to obtain a tissue sample (biopsy) from the brain. • assess aneurysms or arteriovenous malformations through a technique called CT angiography.For more information, see the CT Angiography page .

NURSING RESPONSIBILITIES: Ask/Assist the client to wear prescribed gown Metal objects including jewelry, eyeglasses, dentures and hairpins may affect the CT images and should be left at home or removed prior t exam. ask to remove hearing aids and removable dental work. NPO hours before the exam, and ask the client if he/she has an allergy to contrast dye (iodine) substances. Women should always inform their physician or technologist if there is any possibility that they are pregnant.

MAGNETIC RESONANCE IMAGING (MRI)
WHAT IS MRI OF THE HEAD?

Magnetic resonance imaging (MRI) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. MRI uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. The images can then be examined on a computer monitor, transmitted electronically, printed or copied to a CD. MRI does not use ionizing radiation (x-rays). Detailed MR images allow physicians to better evaluate various parts of the body and determine the presence of certain diseases that may not be assessed adequately with other imaging methods such as x-ray, ultrasound or computed tomography (also called CT, MDCT or CAT scanning). Currently, MRI is the most sensitive imaging test of the head (particularly in the brain) in routine clinical practice. WHAT ARE SOME COMMON USES OF THE PROCEDURE? MR imaging of the head is performed to help diagnose: • tumors of the brain. • developmental anomalies of the brain. • vascular anomalies of the head (aneurysm for example). • disorders of the eyes and the inner ear. • stroke. • trauma patients (in selected patients).

• disease in the pituitary gland. • certain chronic disorders of the nervous system, such as multiple sclerosis. • causes of headache. Physicians also use the MR examination to document brain abnormalities in patients with dementia.

NURSING RESPONSIBILITIES: Patients cannot have halter monitors, telemetry units, nerve stimulation units or a IV pump in the magnet room Clothing Requirements No metal can enter the exam room, clothing with metal snaps or pins should not be worn. Jewelry, watches, rings etc should be left in a locker. Hairpins and dentures, should also be removed and left in a locker or outside the exam room Heavy facial makeup should not be worn as it may create artifacts on the image. Labs Labs are not required unless you have a history of impaired kidney function. However, allergy history records are necessary for contrast studies. Contraindication If you have a heart pacemaker or pacing wires, cerebal aneurysm or Swan Ganz catheter you cannot have an MRI under any circumstances! Pregnancy is a contraindication and will require patient consent for an MRI. All other history of metal fragments in the eye require orbit screening x-rays prior to your MRI. All other history of implants or surgery must be indicated to the technologist. The make and model of implants may be necessary (i.e. ear implants, heart valve replacements).

CEREBRAL ARTERIOGRAM
WHAT IS A CEREBRAL ARTERIOGRAM? An arteriogram, also called an angiogram, is an X-ray image of the blood vessels. It is performed to evaluate various vascular conditions, such as an aneurysm (ballooning of a blood vessel), stenosis (narrowing of a blood vessel), or blockages. A cerebral arteriogram is an arteriogram of the blood vessels of the brain. REASONS FOR THE PROCEDURE A cerebral arteriogram may be vessels within or leading to the brain. arteriovenous malformation (a condition the arteries and veins), thrombosis (a performed to detect abnormalities of the blood Such abnormalities include aneurysms, stenosis, in which there is an abnormal connection between blood clot within a blood vessel), vasospasm (a

spasm of the blood vessel causing an irregular narrowing of the vessel), or occlusion (complete obstruction of a blood vessel). Other conditions that cause a displacement of the brain's blood vessels may be detected by a cerebral arteriogram. These conditions include tumors, edema (swelling), herniation (dislocation of the brain tissue, caused by pressure within the brain due to swelling, bleeding, or other reasons), increased intracranial pressure (ICP, or increased pressure within the brain), and hydrocephalus (fluid in the brain). A cerebral arteriogram may be performed to locate clips on blood vessels placed during previous surgical procedures, and/or to evaluate the condition of such clipped vessels after a clipping procedure. A cerebral arteriogram may be recommended after a previous test, such as a CT scan, indicates the need for further information that may be obtained by this procedure. There may be other reasons for your doctor to recommend a cerebral arteriogram.

NURSING RESPONSIBILITIES: o o o o Secure the consent form Ask for allergy to contrast dye or iodine NPO post midnight if the exam will be perform in the morning Ask for medications that are currently taking e.g anticoagulants, such as aspirin or medications that affect blood clotting

OTHERS:
When a stroke has been diagnosed, various other studies may be performed to determine the underlying cause. With the current treatment and diagnosis options available, it is of particular importance to determine whether there is a peripheral source of emboli. Test selection may vary, since the cause of stroke varies with age, comorbidity and the clinical presentation. Commonly used techniques include:

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an ultrasound/doppler study of the carotid arteries (to detect carotid stenosis) or dissection of the precerebral arteries; an electrocardiogram (ECG) and echocardiogram (to identify arrhythmias and resultant clots in the heart which may spread to the brain vessels through the bloodstream); a Holter monitor study to identify intermittent arrhythmias; an angiogram of the cerebral vasculature (if a bleed is thought to have originated from an aneurysm orarteriovenous malformation);

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blood tests to determine hypercholesterolemia, bleeding diathesis and some rarer causes such ashomocysteinuria.