Diagnosis for Nerve System Disorders

The diagnosis of Nerve System Disorders will involve a comprehensive evaluation of symptoms, physical examination and a Q and A session to identify appropriate diagnostic tests for nervous systems disorders. The goal in diagnostic testing is to rule out conditions and confirm an accurate diagnosis as select conditions may be associated with similar symptoms, such as Erb’s Palsy (EP) and Cerebral Palsy (CP). Other disorders that involve the nerves and the muscles should be considered when presented with a child with signs of CP or EP. Metabolic myopathies may present with weakness, wasting and paralysis of the muscles like CP and EP, but may be differentiated upon identifying the missing enzyme in the muscle metabolism. Metabolic diseases like amyloidosis may present in the same way as CP and EP, but would only elucidate peripheral nerve involvement rather than central, and progression may take years after birth.

Brain Scan – For disorders of the brain, such as CP, imaging technology like magnetic resonance imaging, Cranial Ultrasound and Computerized tomography will detect gross anatomical abnormality like brain size, atrophic lobes or any other injuries. Brain imaging with a restless child might be a challenge, thus mild sedation may be required.

Electroencephalogram (EEG) – EEG attaches multiple electrodes to the brain to detect electrical activity. An EEG reading can also detect Epilepsy which is common in Cerebral Palsy. There will be changes in the normal brain wave pattern in individuals with CP.

Additional Somatic Tests – Select individuals, such as those with CP, often have somatic and sensory impairments. Physicians perform multiple tests to determine these associated impairments: Visual Impairments, Hearing Impairments, Speech delay or impairments, mental retardation, and other developmental delays.

Electromyography – This test measures the integrity of the nerves to conduct impulses to move muscles. Electrodes are inserted to the muscles where voluntary movements are recorded as impulse strength per muscle. Erb’s Palsy will have poor impulses or none in the affected muscle groups.

Magnetic Resonance Imaging (MRI) – MRI utilizes radio waves and magnetic fields to visualize structures in the body and localize lesions in the spinal cord nerve roots. A totally severed nerve root will be revealed in MRI for those with severe Erb’s Palsy.

Computerized Tomography (CT) Myelography – CT myelogram is performed by inserting a radioactive dye during a spinal tap and exposing the spinal cords and nerves to CT for imaging. Nerve roots and the cords will be more accentuated during the imaging process where multiple x-ray beams passes through the target site. Physicians will clearly see the integrity of the nerve roots in individuals with Erb’s Palsy.

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