Ultrasonography in neurology: A comprehensive analysis and review

Abstract

Neurologists in both the inpatient and outpatient settings are increasingly using ultrasound to diagnose and manage common neurological diseases. Advantages include cost‐effectiveness, the lack of exposure to ionizing radiation, and the ability to perform at the bedside to provide real‐time data. There is a growing body of literature that supports using ultrasonography to improve diagnostic accuracy and aid in performing procedures. Despite the increasing utilization of this imaging modality in medicine, there has been no comprehensive review of the clinical applications of ultrasound in the field of neurology. We discuss the current uses and limitations of ultrasound for various neurological conditions. We review the role for ultrasound in commonly performed neurologic procedures including lumbar puncture, botulinum toxin injections, nerve blocks, and trigger point injections. We specifically discuss the technique for ultrasound‐assisted lumbar puncture and occipital nerve block as these are commonly performed. We then focus on the utility of ultrasound in the diagnosis of neurologic conditions. This includes neuromuscular diseases such as motor neuron disorders, focal neuropathies, and muscular dystrophy as well as vascular conditions such as stroke and vasospasm in subarachnoid hemorrhage. We also address ultrasound's use in critically ill patients to aid in identifying increased intracranial pressure, hemodynamics, and arterial and/or venous catheterization. Finally, we address the importance of standardized ultrasound curricula in trainee education and make recommendations for the future directions of research and competency guidelines within our specialty.

Neurosonology Survey in Europe and Beyond

“…It is internationally recognized that the use of ultrasound by neurologists should be encouraged in the fields of neurovascular, neuro-intensive, neuromuscular, and point-of care ultrasound [2][3][4][5][6]. Guidelines for competency and quality assurance in the different fields of neurosonology have already been reported and can readily be implemented [3,4,7,8].…”

Surface anatomy and levator scapulae muscle injection: A cadaveric investigation

“…Ultrasound imaging enables noninvasive, real-time visualization of soft tissues, including nerves, muscles, and blood vessels. [ 11 ] Some studies have investigated the accuracy of surface anatomy-guided injections in the cervical muscles, including the LS. [ 8 , 9 , 12 ] Ko et al compared the precision of ultrasound-guided and non-guided injection techniques (Perotto technique) in cadaveric cervical muscles, such as the levator scapulae, splenius capitis, and scalenus anterior and medius muscles, and found that ultrasound guidance was significantly more accurate (95.8% vs 54.2%, P < .001).…”

Skeletal Muscle Echo Intensity Values Differ Significantly across Ultrasound Parameter Settings

“…Muscle ultrasound is a well-established tool for screening, diagnosis, and follow-up of acute and chronic clinical conditions in neuromuscular and metabolic disorders [ 4 ]. The assessment of muscle quantity and quality has proven valuable in a variety of pathologies such as severe critical illness, muscular dystrophies and myositis, peripheral neuropathies, cancer, and type 2 diabetes mellitus [ 5 , 6 , 7 , 8 , 9 ]. Echo intensity (EI) as determined by B-mode ultrasound is an accepted marker for muscle quality [ 10 , 11 ].…”