Diagnosis

Question 1

How to diagnose MG:

Answer 1

1. The best initial test is Acetylcholine receptors antibodies are + in 80%
2. Edrophonium (Tensilon test) Anti acetylcholineSterase
3. the most accurate test is EMG
4. Ice test: place an ice pack on 1 eye for 5 minutes and ptosis should resolve
5. CT & Chest X-ray done to check thymoma which is found in only 10-15% of ptn. While Thymic hyperplasia is found in 65%.
6. follow serial FVCs to determine the need to intubate

Question 2

How to diagnose ELS?

Answer 2

• Auto-antibodies against presynaptic Calcium channels
• chest X-ray : because it’s usually Ass. With lung cancer
• EMG (opposite MG)
• pupils are usually dilated

Question 3

How to diagnose GBS?

Answer 3

1. The best initial test is LP for protein and cell count
   (⬆️ Protein >55mg/dl - normal Cell count)
2. the most accurate test is EMG (⬇️ Nerve conduction velocity )

Question 4

How to diagnose ALS?

Answer 4

Diagnosis; the clinical presentation is usually diagnostic

1. The Most accurate test is EMG which shows diffuse axonal disease
2. CPK level might be slightly elevated
3. CSF. MRI are normal (just done to exclude other causes)

Question 5

How to diagnose MS?

Answer 5

The best initial and best of all is MRI

The CSF test is done only if the MRI is non confirmatory