Due to the special physiological period of children, when cranio-cerebral diseases occur, it is often more tedious to do auxiliary examinations than adults, and parents often worry about the negative effects of various auxiliary examinations on their children, so they often have concerns.
There are many auxiliary examinations of the pediatric nervous system, such as EEG, EMG, brainstem evoked potentials, cranial ultrasound, X-ray plain film, CT, MRI, nuclear scan and cerebrospinal fluid examination, etc. Only a few are briefly introduced here.
I. Cerebrospinal fluid examination.
Cerebrospinal fluid specimens are obtained by lumbar puncture for routine examination, cytology, pathogenesis, enzymology, immunoglobulin, lactate, C-reactive protein examination, etc., which have important diagnostic and differential diagnostic significance for neurological diseases, especially neurological infections. This test is performed by a professional pediatric neurosurgeon and has no significant effect on children.
Electroencephalogram
The criteria for normal and abnormal EEG in pediatric patients are quite different from those in adults, and the technical requirements for tracing are higher. EEG has a certain diagnostic value for many functional and organic diseases, especially for the diagnosis and typing of epilepsy. Common epileptic discharge waves include spikes, spikes, spikes and slow integrated waves, spikes and slow integrated waves, multiple spikes and slow integrated waves, and paroxysmal or fulminant slow rhythms.
EEG examination techniques include conventional EEG, dynamic EEG and video EEG monitoring. Dynamic EEG can be recorded continuously for more than 24 hours to increase the positive rate; meanwhile, the relationship between clinical seizures and EEG can be identified for diagnosis based on the seizures and time recorded by the patient’s family. Video EEG monitoring can not only monitor the EEG, but also see the seizures of the patient at the same time, which can provide an accurate and reliable basis to exclude non-epileptic seizures and determine the diagnosis and type of epilepsy.
CT examination
There are many methods of CT scan, such as general scan, enhanced scan, positioning scan, thin layer scan, overlap scan, dual voltage scan, etc.
During the entire CT examination, the child must remain motionless, otherwise motion artifacts may occur or the examination may not be possible at all. Therefore, infants and children who are uncooperative in the examination should be given the appropriate amount of sedative medication before the examination. In the case of enhancement scans, an iodine allergy test should be done the day before the examination, or a non-ionic iodine water contrast agent should be used to prevent various adverse reactions.
CT can show the morphology of brain tissue, ventricles, brain pools and other structures at different levels, and is widely used for the diagnosis of pediatric neurological diseases, but the resolution of brain tissue is not as high as MRI, and there are shortcomings in the diagnosis of diseases in the posterior cranial fossa and spinal cord, etc. The main indications for CT in pediatric neurological diseases are.
1, congenital brain development abnormalities: such as anencephaly, cavernous brain, cerebral fissure malformation, cerebral gyrus hypoplasia, corpus callosum hypoplasia, Dandy-Walker syndrome, tuberous sclerosis, etc;
2.Congenital or acquired, traffic or obstructive hydrocephalus;
3, intracranial infection: can timely detect intracranial infection caused by hypodensity, cerebral softening, cerebral atrophy, subdural effusion, hydrocephalus, etc.;
4, hypoxic-ischemic encephalopathy (HIE);
5, cerebrovascular disease: such as cerebral infarction, intracranial hemorrhage, cerebrovascular malformation, smog disease, etc.;
6, intracranial occupying lesions: such as intracranial tumors, abscesses, cerebral cysticercosis, etc.;
7, cranial trauma;
8, brain degenerative diseases: such as various cerebral white matter dystrophy;
9, other: such as intracranial calcification, demyelination, brain tissue necrosis caused by various reasons.
Four, magnetic resonance examination magnetic resonance imaging
It is a new examination method developed according to the principle of nuclear magnetic resonance phenomenon in physics. Its advantages are high resolution, no radiation, not blocked by bone, and it can show clear lesions in the posterior cranial fossa, midline structural lesions, and spinal cord lesions, and can clearly distinguish gray matter and white matter. MRI can show most of the lesions and their histological features, but there are still some lesions that overlap with each other or cannot be identified and need to be scanned for enhancement. In addition, intracranial magnetic resonance angiography (MRA) has a greater diagnostic value for vascular lesions.
V. Digital subtraction angiography
This is a new photographic technique that eliminates the bone and soft tissue shadows on the angiogram film through a computer program and highlights only the blood vessels. It is mainly used for the diagnosis of cerebrovascular diseases (such as cerebral arteritis, cerebral infarction, cerebrovascular malformation, etc.), and also for the diagnosis of intracranial occupational diseases.
Sixth, radionuclide emission tomography (ECT)
ECT is a medical examination developed on the basis of tracer technology and computed tomography in nuclear medicine, and is divided into single photon emission tomography (SPECT) and positron emission tomography (PET) according to the type of radioactive tracer used.
SPECT is a radiological imaging method that quantitatively or semi-quantitatively evaluates changes in cerebral blood flow and metabolic status by measuring the uptake or retention of radioactive tracers, while PET is used to quantitatively measure local cerebral glucose metabolism, local cerebral oxygen metabolism, and local cerebral blood flow by measuring the distribution of positron-emitting tracers in the tissue. Both are important in the localization and diagnosis of epileptic lesions and are also valuable in the diagnosis and pathophysiological study of other diseases of the pediatric nervous system.