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Y4 SA - Neurology > Diagnostic tests > Flashcards

Diagnostic tests Flashcards

1
Q

What is the single most useful and cost effective test for neuro problems?

A

Neurological examination

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2
Q

List some other diagnostic tests used to test neurological function?

A
  • Blood test
  • Blood Pressure
  • Urinalysis
  • Faecal analysis
  • Imaging
  • CSF analysis
  • Functional testing
  • Biopsy
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3
Q

What are some diagnostic challenges in neurology?

A
  1. CNS is well protected
    - Encased in bone (limits imaging modalities and access)
    - Elood brain barrier
  2. Lack of functional reserve and poor regenerative capacity limit the use of biopsy techniques due to the possibility of severe, permanent dysfunction
  3. Combination of specific and non-specific tests
  4. Diagnosis of exclusion
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4
Q

What are the 3 main causes of seizures?

A
  • Idiopathic epilepsy
  • Structural epilepsy
  • Reactive seizures
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5
Q

Describe idiopathic epilepsy

A

Genetic or presumed genetic in origin
No inter-ictal neurological signs

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6
Q

Describe structural epilepsy

A
  • Epileptic seizures which are provoked by intracranial or cerebral pathology
  • Concurrent neurological signs usually present
  • Inflammatory, neoplastic, traumatic
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7
Q

Describe reactive epilepsy

A
  • Seizure occurring as a natural response from the normal brain to a transient disturbance in function
  • Concurrent neurological signs usually present
  • Metabolic or toxic
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8
Q

List some DDx for epilepsy (think VITAMIN D)

A

Ischaemic encephalopathy
Meningoencephalitis of unknown origin
Traumatic brain injury, toxicity
Hydrocephalus, congenital abnormality
Hepatic or renal encephalopathy
Idiopathic epilepsy

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9
Q

How is idiopathic epilepsy diagnosed?

A

Diagnosis of exclusion

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10
Q

Describe the tier 1 confidence interval for investigation of a patient with seizures

A
  • 2 or more seizures, 24hrs apart
  • Age of onset between 6m and 6y
  • Normal inter-ictal examination
  • No clinically significant abnormalities on minimum database
  • Fasting bile acids +/- NH3
  • Family history of IE
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11
Q

Describe the tier II confidence interval for investigation of a patient with seizures

A

Unremarkable fasting and post-prandial bile acids
MRI of the brain
CSF analysis

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12
Q

Describe the tier III confidence interval for investigation of a patient with seizures

A

Ictal or inter-ictal EEG abnormalities

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13
Q

What would you assess on the blood test of a patient with seizures?

A
  • Haematology and biochemistry (incl electrolytes, Ca and Glu)
  • Liver function testing (Bile acid stimulation test, Ammonia)
  • +/- Endocrine function tests (Fructosamine, insulin levels (insulioma)
  • +/-Clotting function
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14
Q

In which cases is urinalysis useful in neurological patients?

A
  1. Cerebrovascular accident
    - To assess for an underlying cause
    - Cushings
    - Hyperproteinuria (PLN or hypertension)
  2. Discospondylosis - Identify if UTI is underlying cause of infection
  3. Paraparesis/ urinary dysfunction - Increased risk of UTI
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15
Q

What is the imaging modality of choice for the brain?

A

MRI

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16
Q

What are the disadvantages of MRI?

A

Anaesthesia
High cost
Limited availability
Artefacts (metal objects)

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17
Q

When is CSF analysis used in neurological patients?

A

Most useful to exclude inflammatory or infectious conditions
- Can also be abnormal in neoplastic or traumatic conditions

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18
Q

What are the limitations of CSF analysis?

A
  • May not be abnormal due to location (if parenchymal) or nature of the lesion (non-exfoliating)
  • Can have non-specific changes
  • Cell counts correlate with exfoliation into CSF not severity of disease
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19
Q

When is CSF analysis contraindicated?

A
  1. Increased intracranial pressure - mental status, pupil size and PLR, abnormal postures, vestibular eye movement
  2. Coagulopathy
  3. Cervical (cerebellomedullary cistern) collection contraindicated in some conditions (Chiari-like malformation, AA instability, cervical trauma)
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20
Q

What equipment is needed to perform CSF analysis?

A

Spinal needle
Collection pots (sterile plain +/-EDTA, extra for culture)
Clippers, scrub, gloves

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21
Q

What are the 2 sites of CSF analysis?

A

Cerebellomedullary cistern or lumbar cistern - caudal to lesion

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22
Q

What must not be done when collecting CSF?

A

Do not aspirate!

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23
Q

What volume of CSF is sampled?

A

Maximum volume - 1ml/5kg

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24
Q

Describe the normal features of CSF on analysis

A
  1. Gross - clear
  2. Cell count
    - RBC 0/μl
    - WBC <5/μl
  3. Protein (via Lab spectrophotometer)
    - Cervical <30mg/dl
    - Lumbar <45mg/dl
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25
Q

How does blood contamination affect a CSF sample?

A

Falsely increases WBC count (1/μl per 500 RBC) and protein (~1mg/dl per 1000 RBC)

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26
Q

How is albuminocytological dissociation seen on CSF analysis?

A
  • Increased protein without increased WBC
  • Non specific: extradural compression (disc disease), neoplasia, infection, vasculitis, trauma, syringomyelia, degenerative myelopathy
27
Q

What does pleocytosis mean?

A

The presence of an abnormally large number of lymphocytes in the cerebrospinal fluid.

28
Q

List some causes of a neutrophilic pleocytosis

A
  • Granulomatous meningoencephalomyelitis
  • Bacterial meningitis
  • Fungal
  • FIP
  • Post myelography, haemorrhage, neoplasia, trauma
29
Q

List some causes of a mononuclear pleocytosis

A
  • Granulomatous meningoencephalomyelitis
  • CNS lymphoma
  • Viral
  • Bacterial meningitis
30
Q

List some causes of a mixed pleocytosis

A
  • Granulomatous meningoencephalomyelitis
  • Non-inflammatory disease e.g. infarct
  • Bacterial meningitis
  • Protozoal
  • Fungal
31
Q

List some causes of an eosinophilic pleocytosis

A
  • Eosinophilic meningoencephalomyelitis
  • Parasitic
  • Protozoal
  • Fungal
32
Q

What is electroencephalography and when is it used?

A

Assess forebrain activity
Identification of seizure activity
- Ictal = at the time of the seizure
- Inter-ictal = between seizures

33
Q

List the DDx for spinal neurolocalisation

A
  • Ischaemic myelopathy
  • Meningomyelitis of unknown origin (MUO), discospondylitis, Toxoplasmosis, Neosporosis, FIP, FeLV, SRMA*
  • Fracture and luxation, traumatic disc extrusion
  • AA instability
  • Chiari-like malformation, vertebral abnormalities
  • spinal/ vertebral neoplasia
    – Intervertebral disc disease (IVDD) type I and II, cervical stenotic myelopathy (CSM), degenerative lumbosacral stenosis (DLSS), degenerative myelopathy (DM)
34
Q

Describe the use of blood tests for patients with spinal disease

A

+/- infectious disease testing
Haematology and biochemistry (incl electrolytes, Ca and Glu)
C-reactive protein (CRP) (SRMA)

35
Q

Which agents might affect the spinal cord in dogs?

A

Neospora caninum
Toxoplasma gondii
Angiostrongylus vasorum (SNAP blood test, Baermann faecal)

36
Q

Which agents might affect the spinal cord in cats?

A

Toxoplasma gondii
FeLV
FIV
FIP (FCoV)

37
Q

Radiography is most useful for what type of abnormality?

A

Bony

38
Q

Describe the use of CT for spinal lesions?

A

Excellent for bony detail
Rapid acquisition of images
Contrast can be used – intra-thecal (myelography) or IV
Useful for
- Trauma patients
- Surgical planning of stabilisation

39
Q

What is the imaging modality of choice for spinal lesions?

A

MRI

40
Q

Myelography is useful for what types of lesions?

A

Extradural or bony lesions

41
Q

What must be done before myelography?

A

CSF analysis

42
Q

How is myelography carried out?

A
  • Inject 0.3ml/kg contrast (Iohexol)
  • Lumbar or cervical medullary cistern
  • Minimum of 2ml and maximum of 0.45ml/kg
  • Keep head elevated
43
Q

When is myelography contraindicated?

A
  • Coagulopathy
  • Spinal instability
  • Cloudy/turbid CSF (suggestive of inflammatory process)
44
Q

What are the main risks of myelography?

A
  • Seizures
  • Neurological deterioration
  • Dysrhythmia’s
  • Respiratory arrest
  • Infection
  • Chemical myelitis
  • Death
45
Q

What are the risks of MRI?

A

Anaesthesia
Movement/heating of implants
Foreign bodies

46
Q

Describe an extradural finding on myelography

A
  • Axial displacement of 1 or more contrast columns
  • Columns often thin or partially disrupted at the site of the lesion
  • MOST COMMON
  • Ddx – IVD herniation, Vertebral stenosis, Neoplasia
47
Q

Describe an intradural/extramedullary finding on myelography

A
  • Filling defect WITHIN the contrast column
  • ‘Golf tee’ sign or widening of subarachnoid space due to a arachnoid diverticulum
  • Ddx – Neoplasia (meningioma, peripheral nerve sheath tumour), Arachnoid diverticulum
48
Q

Describe an intramedullary finding on myelography

A

Divergence of contrast columns
Ddx –Neoplasia, Acute ischaemic myelopathy, Contusion, Haemorrhage, Myelitis

49
Q

In which conditions is CSF analysis indicated?

A
  • Steroid responsive meningitis-arteritis (SRMA)
  • Meningomyelitis of unknown origin
  • Bacterial myelitis/ meningitis
  • Empyema
  • Discospondylitis
50
Q

List some DDx for neuromuscular disease

A
  • Polymyositis (immune mediated or infectious), acquired myasthenia gravis, polyradiculoneuritis, Botulism, Tick paralysis, protozoal (Toxo/Neo), Viral (FeLV/ FIV)
  • focal trauma, organophosphate, lead, vincristine
  • Addisons, Cushings, hypokalaemia, Diabetes, insulinoma
  • thymoma, paraneoplastic
  • muscular dystrophy, neuroaxonal dystrophy
51
Q

Which blood tests would you want to perform for neuromuscular disease?

A
  • Haematology and biochemistry (incl electrolytes, Ca2+ and glucose)
  • T4/TSH
  • Fructosamine/ insulin
  • ACTH stimulation test
  • Immune mediated disease: Specific autoantibodies
52
Q

When is imaging used in neuromuscular disease?

A

To check for concurrent disease
Radiography
Abdominal ultrasound
CT

53
Q

What is the neostigmine response test and when is it used?

A
  • For Junctionopathies - acquired and some congenital Myasthenia gravis
  • IV administration of neostigmine
  • Prolongs action of acetylcholine at the NMJ
  • Slower onset but longer duration of action compared to edrophonium
54
Q

Describe the use of MRI for neuromuscular disease

A

Good for assessment of muscle and nerve
Contrast generally required

55
Q

Describe the uses of electrodiagnostics for neuromuscular disease

A

Identifying denervated muscles
Extent and severity
Treatment monitoring

56
Q

What is motor nerve conduction velocity used for?

A
  • Assess conduction along a nerve – used to investigate suspected peripheral neuropathies
  • Stimulate a motor nerve at a minimum of 2 sites and record the evoked electrical activity (CMAP)
57
Q

What is a muscle biopsy used for?

A

Sample affected muscle (EMG to help identify)
- Area where muscle fibres are orientated in a single direction
- Distant from tendons

58
Q

When a nerve is biopsied how can you minimise defects?

A

Third to half of the nerve width and ~1cm in length
Keep straight, but not stretched
Fix in formalin

59
Q

Name the hearing test used for deafness

A

Brainstem Auditory Evoked Response

60
Q

What are the signs of dysautonomia in cats

A

Cough, vomit/retch, anorexia, third eyelid protrusion, mydriatic unresponsive pupils, dry eye and nose, constipation, incontinence, bradycardia, megaoesophagus

61
Q

What are the signs of dysautonomia in dogs?

A

Cough, vomit/retch, anorexia, hypersalivation, diarrhoea or constipation. Dry mucous membranes, dry eye and nose, mydriasis or anisocoria, megaoesophagus, bradycardia, decreased anal tone, atonic bladder

62
Q

How is dysautonomia diagnosed?

A

Mainly based on the constellation of clinical signs seen
Definitive diagnosis requires PME

63
Q

What are the signs of Horners syndrome?

A

Miosis, ptosis of upper eyelid, protrusion 3rd eyelid, enophthalmus, conjunctival hyperaemia

Y4 SA - Neurology (7 decks)

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