Neurology

RoNeuro Institute, Cluj-Napoca, România

Neurology is a branch of medicine that focuses on diagnosing and treating disorders of the central and peripheral nervous system.

The neurologists from the RoNeuro Institute provide a correct and complete assessment of both the congenital diseases of the nervous system (genetic, metabolic) and those acquired (of vascular, inflammatory, degenerative, neoplastic, traumatic).

Neurological investigations

  • EEG

    Electroencephalography (EEG) is a non-invasive and painless method of exploring electrical activity in different areas of the brain, resulting from the graphic recording of the potential variation between two electrodes placed on the scalp. By placing more electrodes, the recording is achieved on several channels, in several regions. At the RoNeuro Institute our specialists have the possibility to register standard EEG (with 21 channels), as well as the 64 channel EEG, depending on the pathology.

    EEG is an essential tool in the diagnosis and evaluation of epilepsy cases, providing information on the type and location of epileptiform activity in seizures, as well as in inter-critical periods.

    Other pathologies in which EEG scanning completes the diagnosis are: stroke, tumors, encephalitis, degenerative diseases (Alzheimer's, Parkinson's), mental disorders (schizophrenia, autism).

    At the same time, aspects of brain electrical activity can be tracked according to age, alertness (wakefulness, slow wave sleep, paradoxical sleep), general condition (stress, hypoglycemia, medication administered).

  • Video EEG

    Video-EEG monitoring (with video-EEG system It. Nicone Wireless) refers to the video recording of the patient's clinical manifestations simultaneously with the electroencephalographic recording, for several hours.

    The correlation of video recorded behavior with EEG activity facilitates the differential diagnosis between epileptic compulsive and non-epileptic seizures, and helps to identify the epileptic outbreak.

  • ENMG

    Electroneuromyography (ENMG) is a diagnostic method that allows the evaluation of nerve and muscle function, having a key role in the evaluation of patients with neuromuscular diseases. This exam includes nerve conduction studies and electromyography. These examinations are complementary and are usually carried out together. In certain special situations, the doctor may only choose one of them. Both examinations are relatively unpleasant, but well tolerated by most patients and without significant health risks.

    The study of nerve management is performed by stimulating the nerves at different points on their path through a low intensity electrical discharge. Thus the artificial activation of the nerve occurs, which allows to evaluate its function. The action potential will be recorded with small electrodes applied to the skin in another area of the member to which the registration is made.

    Electromyography (EMG) is performed by inserting a very thin needle into certain muscles. The needle contains a microscopic electrode that records the normal and abnormal electrical activity of the muscle fibers. The needle is inserted into the relaxed muscle to evaluate the activity at rest, then the doctor requests contraction of the studied muscle to evaluate the muscle in activity. The needle has the role of recording the activity of the muscle and allows the evaluation of both nerve function and muscle function. Electric shocks or chemicals are not administered through the needle.

    Neuromuscular junction evaluation is performed by repetitive nerve stimulation (SR) and single fiber electromyography (SFEMG). It is useful in the diagnosis of myasthenia gravis and myasthenic syndromes.

  • TMS

    Transcranial magnetic stimulation (TMS) is a non-invasive neuro-physiological method of diagnosis and treatment through its ability to record and modulate central nervous system activity. The operating principle is the following: an electric field induces the formation of a magnetic field at the level of an extra-cranial coil, which will in turn induce the formation of an electric field capable of modulating neuronal activity in the underlying brain areas.

    Single-pulse stimulation is used for diagnostic purposes and records the characteristic parameters of the central nervous system (motor threshold, amplitude, area and latency of motor evoked potential, central motor driving time, cortical electrical silence period, duration and latency of trans-callous inhibition) making diagnosis possible and long-term monitoring of patients with various neurological diseases (multiple sclerosis, strokes, head trauma, amyotrophic lateral sclerosis or other motor neuron disorders).

    Repetitive stimulation is used for therapeutic purposes and may have a facilitative or inhibitory effect on motor, sensitive or cognitive functions, depending on the stimulation parameters and the brain area where it is applied. It is successfully used in anxiety, depression, in the neurological recovery of strokes, brain trauma, multiple sclerosis and peripheral facial paresis, in the treatment of migraine and chronic pain in general and in the treatment of cognitive dysfunction.

  • TST

    Triple stimulation technique (TST) is a method of diagnosing and monitoring motor function by assessing both the integrity of the central and peripheral motor pathways. This technique combines electro-neurography with magnetic stimulation to quantify the degree of central recruitment of muscle fibers.

    For this reason, it is an additional method of diagnosing patients with amyotrophic lateral sclerosis and multiple sclerosis as well as an extremely effective method of monitoring the evolution of the disease or of the treatment in patients with these pathologies.

  • PEV

    Visual evoked potentials (PEV) measure the brain's electrical activity in response to standardized light stimulation. These potentials are recorded by electrodes placed at the level of the head skin, above the visual cortex. The most common method of recording these potentials is the "pattern reversal" model. The patient is asked to watch an illuminated chessboard-like screen, in which the squares change their color alternately with a predefined frequency. The recorded electrical responses are displayed on a screen in the form of waves. Currently standard data is based on analyzing the latency and amplitude of the P100 wave, a positive wave occurring in healthy individuals at approximately 100 msec. The other waves observed have high variability and do not allow for clear functional correlations. The pathological aspects are variable, but the increase of the wave latencies corresponds generally to the demyelinating lesions, and the decrease of the amplitudes signifies an axonal affect.

    ENP are mainly used to measure the functional integrity of the visual pathways from the retina through the optic nerves to the visual cortex. ENP better quantifies the functional integrity of optical pathways than scanning techniques, such as magnetic resonance imaging (MRI).

    There are numerous clinical applications such as:

    • Central nervous system lesions: demyelinating diseases such as multiple sclerosis; inflammatory or infectious conditions; vasculopathy; space replacement processes; thesaurismoses, neuro-degenerative diseases such as Parkinson's disease; cervical myelopathy; psychogenic visual disorders.
    • Disorders of the optic nerve, optic chiasm and optic tract.
    • Ophthalmological diseases.
  • PEM

    Motor evoked potentials (PEM) are electrical potentials recorded in the muscles, nerves and spinal cord after stimulation of the motor cortex, central motor pathways or peripheral nerve structures. Motor threshold, PEM amplitude, PEM latency and central motor driving time are obtained by standard trans-cranial magnetic stimulation methods and can be used in the diagnosis of demyelinating diseases such as multiple sclerosis, cervical myelopathy, peripheral motor neuron disease or in the assessment of motor recovery capacity of patients with strokes.

  • PESS

    The somato-sensory evoked potentials (PESS) represent the electrical potentials obtained by stimulating a peripheral nerve and recorded in the peripheral nerves, spinal cord and cerebral cortex. In practice, stimulation of the median nerve and tibial nerve is used.

    Through this examination, the path of deep, proprioceptive sensitivity is explored functionally. PESS abnormalities can indicate somato-sensory pathway damage at any level.

    Therefore, PESS are useful in highlighting and evaluating peripheral nervous system disorders such as hereditary neuropathies (Charcot-Marie-Tooth disease, Friedrich's ataxia), diabetic neuropathy, inflammatory polyradiculoneuropathies (Guillain-Barré disease), demyelinating neuropathies, infectious or toxic cause neuropathy, plexopathies and radiculopathies.

    In spinal cord disorders, when the posterior cords are affected, PESS allow the localization of the pathological process as well as the differentiation of the demyelinating processes from the axonal ones.

    PESS are also used in the evaluation of lesions in the brainstem and/or the hemispheres (strokes, multiple sclerosis or other demyelinating diseases, cranial-cerebral trauma).

    PESS allow intraoperative monitoring in spinal cord surgery, intra- and extra-cranial vascular surgery.

    The advantages of PESS are:

    • The ability to detect infra-clinical or silent lesions of the sensory pathways
    • Ability to provide data on demyelinating disease or can also establish lesion topography through multi-segmental stimulation and/or multilocular recording
  • Eye Tracking

    Eye tracking is a modern neuro-physiological technique that allows the analysis of behavior and cognitive functions by exploring how to look at the subject. Eye tracking automatically and objectively detects the pattern and location of watch, the movements of each eyeball in relation to the head, the dilation of the pupil. This method can record two fundamental types of eye movements (fix and saccade), as well as the visual perception, attention, the cognitive interest of the subject, the blink rate.

    The area of clinical applications is extremely wide and includes:

    • Neuro-psychiatric disorders - autism, ADHD, cognitive disorders (Alzheimer's, Parkinson's, dementia with Lewy bodies), dyslexia, strokes, amyotrophic lateral sclerosis, schizophrenia, language disorders
    • Ophthalmological disorders - oculomotric abnormalities, visual deficits, visual cognitive dysfunctions
    • Assessment of psycho-cognitive development - acquisition of attention, visual perception, control of actions, language and social interactions from childhood to adulthood
    • Assessment of the psycho-linguistic domain - recording of eye movements in response to certain verbal or visual stimuli in order to investigate cognitive processes related to speech, reading, figurative language, "body language" and lip reading, audio-visual integration.
  • Eco Doppler cervico-cerebrală

    Cervical-Doppler ultrasound is a method of ultrasound exploration that is based on the ultrasound apparatus's reception of the echoes that the anatomical structures explored emit following contact with the waves generated by the probe of the apparatus (two-dimensional ultrasound), but also on the echoes analysis emitted by blood column moving through arteries or veins (variation of the frequency of a wave emitted or reflected by a moving object relative to a stationary receiver = Doppler effect). It allows real-time visualization of blood vessels from the neck and head (common carotid arteries, internal and external carotid arteries, ophthalmic arteries, vertebral and sub-clavian arteries, as well as internal and external jugular veins.).

    It is a non-invasive investigation, of first intention that has the following major indications:

    • Patients with possible conditions secondary to stenosis or obstruction of the carotid or vertebro-basilar arteries (stroke, vertebro-basilar syndromes, vasculitis, arterial dissections) or patients with symptoms and suggestive clinical signs of these conditions (hemiparesis, hemiplegia, disorders, vision disorders, systolic blast in the carotid arteries, dizziness, balance disorders, headaches, numbness, etc.)
    • Patients with risk factors for atherosclerosis (diabetes, dyslipidemia, high blood pressure, smoking, obesity, etc.).

    Properly performed, this investigation can monitor the effects of medical (hypolipemic, platelet anti-aggregating or anticoagulant), interventional (stent) or surgical (endarterectomy) treatment for primary or secondary prophylaxis of cerebrovascular diseases.

  • TCD

    Transcranial Doppler (TCD) and Transcranial color-coded duplex sonography (TCCS) are non-invasive techniques for exploring intracerebral blood flow velocities. The main indications for adulthood are:

    • Detection and monitoring of stenoses/occlusions in the major intra-cranial arteries, as well as monitoring of thrombolytic therapy in acute stroke
    • Identification and monitoring of vasospasm in patients with sub-arachnoid haemorrhage Detection of cerebral microemboli
    • Evaluation of intra-cranial artery collaterals
    • Identification of right-left shunts (patent oval foramen)
    • Evaluation of brain vore-activity
    • Stroke risk assessment in sickle
    • Evaluation of cerebral arterial-venous malformations
    • Detection and tracing of intra-cranial aneurysms
    • Early diagnosis of Parkinson's disease