Basic Neurological Investigations

Question 1

What are the 5 most common neuroimaging modalities

-what are they used for

Answer 1

CT - vascular lesions, tumour

MRI - inflammatory lesions
-MS

SPECT - movement disorders

PET - dementia

Angiography - vascular lesions

Question 2

When would you use EEG

Answer 2

Diagnosis and monitoring of electrical brain activity

-epilepsy, seizures

Question 3

When would you use EMG

Answer 3

Measures electrical activity in response to nerve stimulation in muscle

Diagnosis and monitoring of neuromuscular disease, polyneuropathy, entrapments

Question 4

Describe how you would do a lumbar puncture

Answer 4

Suspecting nerve inflammation

Left lateral recumbent position
Line across tops of iliac crest intersecting at L4 process

Wash, gloves, equipment, disinfect
Lidocaine
Needle in at 90deg through ligaments
Collect CSF

Ask patient to lie flat, mobilise early

Question 5

Complications and risks of LP

Answer 5

Infection
Bleeding
Post LP headache

Question 6

Contraindications to LP

-when would you do a head CT beforehand

Answer 6

Low platelets
Low INR (U1.5)
Local skin infection
Local developmental abnormality
High ICP

Suspect high ICP
60+
IC
Past CNS disease
Recent seizure
Reduced consciousness
Papillodema
Abnormal neuro exam

Question 7

What blood and urine tests would you order for

• Wilsons
• HD
• hereditary neuropathies
• acquired neuropathies-myasthenic syndromes
• myopathy, dystrophy

Answer 7

Wilsons - serum copper, ceruloplasmin

HD - CAG repeat assay

Hereditary - genetic testing

Acquired - antiganglioside AB

Myasthenic syndromes - ACh, MuSK AB

Myopathy, dystrophy - CK, genetic testing

Question 8

What can you biopsy

Answer 8

Brain
Muscle - muscle diseases
Peripheral nerves