Mount Sinai's Department of Neurology addresses a wide array of neurological maladies, such as headaches, seizures, nerve damage and hearing disorders. Our multi-disciplinary approach provides a full range of services, from sophisticated diagnostics to advanced rehabilitation resources in virtually every neurological field. These services include:

Electroencephalogram

An electroencephalogram (EEG) helps doctors diagnose a variety of neurological problems, from common headaches and dizziness to seizure disorders, strokes and degenerative brain disease. The highly sensitive equipment records the brain's electrical activity (known as brain patterns), helping doctors ascertain a variety of conditions from irreversible brain death to organic aberrations that induce psychiatric symptoms and disabilities in children.

The EEG is conducted with electrodes on the scalp recording electric brain activity over a 90-minute period as the patient sits in a relaxed state. Sometimes participants are asked to hyperventilate, sleep or watch a strobe light in order to record different brain patterns.

Auditory evoked response

Brainstem Auditory Evoked Potential (BAEP) or Auditory Brainstem Response (ABR) equipment provides doctors valuable data in evaluating the auditory nerve pathways between the brainstem and the ears. Electrodes are placed on the scalp and on each earlobe. Clicking noises or tones emit through earphones as the electrodes pick up the brain's response and record it on a graph. Earphones deliver a series of clicks or tones to each ear separately.

Evoked Potential (EP) testing records the electrical activity from the brain, spinal nerves or sensory receptors in response to specific external stimulation; each type of EP looks at a different neurological pathway, helping doctors diagnose a number of different neurological problems, including spinal cord injuries, acoustic neuroma and optic neuritis.

Visual evoked response

Visual Evoked Response (VEP) evaluates the visual nervous system from the eyes to the occipital (visual cortex of the brain). The patient is usually asked to stare at an alternating checkerboard pattern on a video screen or look at flashing lights. Each eye is tested separately.

When repeated VEP stimulation causes no changes in EEG results, the subject's brain isn't receiving visual information. This makes VEP useful in diagnosing blindness in non-vocal patients. Meanwhile a delayed VEP result can ascertain conditions like multiple sclerosis or optic neuritis.

Evoked Potential (EP) testing records the electrical activity from the brain, spinal nerves or sensory receptors in response to specific external stimulation; each type of EP looks at a different neurological pathway, helping doctors diagnose a number of different neurological problems, including spinal cord injuries or acoustic neuroma.

Somatosensory evoked potentials

Somatosensory (SSEP) assesses whether pathways from the nerves can transmit sensory information like pain, temperature and touch to the cerebral cortex. A small electrical current is applied to the skin overlying nerves on the arms or legs. Each leg or arm is tested separately.

SSEP is used to ascertain nerve damage from such conditions as a bone spur, herniated disc or other source of pressure on the spinal cord or nerve roots. During spine surgery, SSEP is used to double check whether the sensory part of the nerve is working correctly.

Evoked Potential (EP) testing records the electrical activity from the brain, spinal nerves or sensory receptors in response to specific external stimulation; each type of EP looks at a different neurological pathway, helping doctors diagnose a number of different neurological problems, including spinal cord injuries or acoustic neuroma.

Otoacoustic emission test

Otoacoustic Emission Test (OAE) is a hearing test for infants. The test measures the "echo" made when the inner ear responds to a clicking sound generated by a normal hearing system. Using a sensitive microphone encased in a soft tip, a strong OAE result indicates normal hearing. Babies who do not pass the second test are referred for an Auditory Brainstem Response (ABR).

24-hour ambulatory electroencephalogram

The 24-Hour Ambulatory electroencephalogram (EEG) records brain activity for 24 hours on a small digital recorder that is worn comfortably around the waist or shoulder. Electrodes are applied to the scalp with an adhesive and then patient goes home with a diary. Throughout the day, the patient records their activities and any symptoms during the 24 hours.

An EEG helps doctors diagnose a variety of neurological problems, from common headaches and dizziness to seizure disorders, strokes and degenerative brain disease. The highly sensitive equipment records the brain's electrical activity (known as brain patterns), helping doctors ascertain a variety of conditions from irreversible brain death to organic aberrations that induce psychiatric symptoms and disabilities in children.

Long-term electroencephalogram/video epilepsy monitoring

Long-term video electroencephalogram (EEG)/video epilepsy monitoring assists doctors in distinguishing epileptic seizures from conditions that only mimic epileptic seizures since over one-third of patients suffering from seizures do not have epilepsy.

A traditional EEG only records brain activity for 90 minutes whereas long-term EEG/video epilepsy monitoring can be performed over several days allowing doctors to see how seizure behavior is related to the electrical activity of the brain, and it can help doctors identify the region of the brain where seizures begin. The test records a patient's EEG along with the video and sound in a hospital room onto a computer. The doctors review the data simultaneously to diagnose the cause of the seizures.

Nerve conduction studies

Nerve conduction study (NCS) uses electrodes to read the electric activity from a muscle connected to a nerve or specific nerve tissue. Patients referred for NCS vs. NVS tests suffer from nerve conditions which produce numbness, tingling, pain or loss of sensation, or neurological diseases affecting primarily the peripheral nervous system. Common disorders diagnosed by NCV are peripheral neuropathy, carpal tunnel syndrome, ulnar neuropathy and Guillain-Barré syndrome.

The most common measurement during the test is nerve conduction velocity (NCV). While the test provides other forms of measurement, the test itself is often inaccurately called an NCV study.

Electromyography

An electromyogram (EMG) is a medical technique using small needles to evaluate and record the properties of muscles at rest or contracting (in either a gentle or vigorous fashion). The test is often used to find the cause of muscle weaknesses such as paralysis, involuntary twitching and abnormal levels of muscle enzymes. It can help diagnose neuromuscular disorders such as motor neuron disease, neuropathy, nerve damage and muscle damage or ascertain if a patient is avoiding muscle use because of pain or lack of motivation during physical therapy. EMG is also used in biofeedback studies and training, helping migraine patients learn to ease muscle tension in the face, neck and shoulders.

George Diaz, MD
Chief, Division of Neurology

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