[Morettia2]

Ok here it goes..I got report tonight a s/p new onset CVA from the ED that transferred to my floor in the afternoon.I recieved report at 1930. 39 y.o. female, slurred speech, 24 hour EEG completed, MRI & MRA of the brain to be done at 2200. GCS of 13, no weakness of the extremities at ALL, Left sided facial droop and a 3-4 pupil reaction of the L eye with very sluggish response neuro checks q 1h, and could not follow simple commamds, pt. would fall asleep in mid-sentence no hx of narcolepsy. The nurse I recieved report from was telling me the Neuro Dr. ordered a Tinsel test for the pt. Now this nurse has worked Interventional Cardiology for 15 years and has never heard of this test, nor have I. We were trying to brainstorm with text books and came to the conclusion it is for Gullian Barre or Myasthemia Gravis...I am sure I spelled both wrong. I have experience with both types. The nurse did the tinsel test, which we did not understand. I preped the pt. for a LP that was to be done 1 hour after the test. Pt has no ascending or decending paralysis which would be associated with Myasthemia gravis decending and gullian barre ascending..pt's labs were with in normal limits...I took the pt for MRI and MRA of the brain pt was moving all over the MRI which took me who was the RN and a CNA to hold her down, brought the pt back only for the pt to be transferred to the ICU, which she should have went to in the first place. Pt was moving all around, SPO2 normal, BS normal, VS normal, - drug screen, I am wondering if maybe it is a mass in the brain...any input would help me and my collegues with this mystery!

[Dinith88]

Originally Posted by Morettia2

Ok here it goes..I got report tonight a s/p new onset CVA from the ED that transferred to my floor in the afternoon.I recieved report at 1930. 39 y.o. female, slurred speech, 24 hour EEG completed, MRI & MRA of the brain to be done at 2200. GCS of 13, no weakness of the extremities at ALL, Left sided facial droop and a 3-4 pupil reaction of the L eye with very sluggish response neuro checks q 1h, and could not follow simple commamds, pt. would fall asleep in mid-sentence no hx of narcolepsy. The nurse I recieved report from was telling me the Neuro Dr. ordered a Tinsel test for the pt. Now this nurse has worked Interventional Cardiology for 15 years and has never heard of this test, nor have I. We were trying to brainstorm with text books and came to the conclusion it is for Gullian Barre or Myasthemia Gravis...I am sure I spelled both wrong. I have experience with both types. The nurse did the tinsel test, which we did not understand. I preped the pt. for a LP that was to be done 1 hour after the test. Pt has no ascending or decending paralysis which would be associated with Myasthemia gravis decending and gullian barre ascending..pt's labs were with in normal limits...I took the pt for MRI and MRA of the brain pt was moving all over the MRI which took me who was the RN and a CNA to hold her down, brought the pt back only for the pt to be transferred to the ICU, which she should have went to in the first place. Pt was moving all around, SPO2 normal, BS normal, VS normal, - drug screen, I am wondering if maybe it is a mass in the brain...any input would help me and my collegues with this mystery!

I think you mean 'Tensilon' test. It's used to diagnose MG. The drug (Tensilon) is given IV (usually) and if the patient has MG you'll notice a sudden(but temporary) improvement in strength---(especially eye-droop improvements..) . Unfortunately the test is not fool-proof and cant be used to diagnose or exclude MG on its own. Patient should(ideally) be on tele because they can develop arrhythmias.
'Tinsel Test' may be slang for it.

Anyway, Google "Tensilon Test"...you'll get a bunch of stuff.

[Morettia2]

I remember a tensillon test from school I saw done on one of my patients when i was a student nurse. That's what I thought originally but this Dr. Was dead set on calling it a tinsel test..I don't know she was a neuro resident..sooo.. thanks for the post, I appreciate it and so will my collegues!