CNIM case studies
CNIM · Put your knowledge to work in context.
The Certification Examination in Neurophysiologic Intraoperative Monitoring (CNIM) is a professional credential for technologists and clinicians who monitor neural function during surgery. It is administered by ABRET Neurodiagnostic Credentialing and Accreditation, a body that has credentialed neurodiagnostic professionals since 1964. Earning the CNIM signals that a candidate has demonstrated the knowledge required to record and interpret intraoperative neurophysiologic signals while surgery is in progress - work that demands both technical skill and real-time communication with surgeons and anesthesia teams. Candidates typically come from neurodiagnostic technology, electroneurodiagnostics, or clinical neurophysiology backgrounds and prepare by combining supervised operating-room experience with structured review of neuroanatomy, physiology, anesthesia effects, and recording technique. The CNIM case studies are 5 cases and about 3,877 words.
1Leg MEPs Lost Fifteen Minutes After Aortic Cross-Clamp
A 61-year-old man undergoes repair of a Crawford extent II thoracoabdominal aortic aneurysm. Monitoring includes bilateral median and posterior tibial nerve SSEPs and transcranial MEPs from tibialis anterior and abductor hallucis.
756 words, about 4 min2Sevoflurane Added to a Total Intravenous Anesthetic During Evoked Potential Monitoring
A 47-year-old woman is having a two-level lumbar decompression. Anesthesia is total intravenous with propofol 120 microg/kg/min and remifentanil, no volatile agent, BIS 45.
785 words, about 4 min3Wave V Latency Shift During Retrosigmoid Tumor Dissection
A 52-year-old woman undergoes retrosigmoid resection of a 2.2 cm left vestibular schwannoma. Left ear BAEPs are obtained with a click at 90 dB nHL; baseline wave V latency is 5.7 ms, interpeak I-V is 4.1 ms, and amplitude is 0.35 microV.
784 words, about 4 min4All Four Leg MEP Channels Disappear on a Single Sweep
A 15-year-old girl is undergoing posterior spinal fusion T3-L1 for a 62-degree idiopathic scoliosis. Transcranial MEPs are elicited with corkscrew electrodes at Cz and C2 and recorded from tibialis anterior and abductor hallucis bilaterally, with upper-limb channels from abductor pollicis brevis; posterior tibial and median SSEPs are also running.
755 words, about 4 min5Unobtainable Lower-Limb MEPs at Baseline in Cervical Myelopathy
A 68-year-old man with cervical spondylotic myelopathy undergoes C3-C5 posterior laminectomy and fusion. Preoperatively he has 4/5 deltoid and biceps strength, 4-/5 hip flexion bilaterally, hyperreflexia, and no history of neuromuscular disease.
797 words, about 4 min