Neurology Diagnostics

Question 1

What specific testing can you perform to diagnose myasthenia gravis?

Answer 1

Acetyl choline receptor antibodies

The gold standard

Question 2

What specific diagnostic test can you perform in cases of masticatory myositis?

Answer 2

Type II M antibodies

Question 3

How can you make a definitive diagnosis of myasthenia gravis?

Answer 3

Eprodphonium test - anti-cholinesterase

Allows acetyl choline to build up at the synaptic cleft

Question 4

What are the symptoms of a cholinergic crisis associated with edrophonium administration?

Answer 4

Defaecation
Urination
Miosis
Bradycardia
Bronchochonstriction
Emesis
Lacrimation
Salivation

Question 5

How can you treat a cholinergic crisis?

Answer 5

Atropine

Question 6

Where should you collect a CSF sample in relation to the lesion?

Answer 6

Caudal to it

Question 7

What are some contraindications for CSF sampling?

Answer 7

High intracranial pressure
Chiari like malformation
Coagulopathies
Post-contrast study 
Atlanto-axial instability

Question 8

What should you analyse in a CSF sample?

Answer 8

Differential count
Cytology
Protein 
RBC
PCRs

Question 9

What two locations can you sample CSF at?

Answer 9

Cerebromedullary cistern - too deep = risk of tetraparesis or death

Lumbar subarachnoid space - safer
L5-L6 in dogs
L6-L7 in cats

Question 10

What are some differentials for neutrophillic pleocytosis in a CSF sample?

Answer 10

SRMA
MUO - GME & NE
Bacterial meningitis
FIP

Question 11

What are some causes of mononuclear pleocytosis in a CSF sample?

Answer 11

GME
NE
CNS lymphoma 
Canine distemper virus 
Chronic SRMA

Question 12

Was is CT good for investigating in neurology?

Answer 12

Trauma 
Haemorrhage
Middle ear disease
Hydrocephalus
Large masses - iodinated contrast agent 
Bony lesions

Question 13

What can MRI show us?

Answer 13

Everything! Also very useful for the spine

Best image contrast of any modality

Question 14

What can electromyelography tell us?

Answer 14

Identifies denervated or damaged muscles but can’t differentiate between muscle or nerve pathology

Question 15

What can nerve conduction velocities tell us?

Answer 15

About peripheral nerve function

- tell us velocity (myelination) and amplitude (axon)

Question 16

What does repetitive nerve stimulation tell us?

Answer 16

Evaluates the activity of the neuromuscular junction

Question 17

What does F wave tell us?

Answer 17

The function of nerve root and proximal peripheral nerves

Question 18

What does electroencephalography tell us?

Answer 18

Records spontaneous electrical activity in the cortex

Detecting and localising seizure focus

Question 19

What does brainstem auditory evoked response tell us?

Answer 19

Can screen for congenital sensorineural deafness

Assess for brain death

Question 20

What muscles are commonly biopsied?

Answer 20

Cranial tibial 
Biceps femoral
Gastrocnemius 
Temporal 
Vastus lateralis

Question 21

What nerve is commonly biopsied?

Answer 21

Peroneal n. - motor and sensory fibres

Question 22

What should you assess on a spinal radiograph?

Answer 22

Width of the spinal canal
Subluxations
Displacement
Malformation

Question 23

What structures are normal but commonly mistaken for pathology?

Answer 23

Lumbar intumescence - vertical canal widens, then narrows
Bony prominences on ventral L3 and L4 where the diaphragm attaches
Lumbosacral disks are wider

Question 24

What are common incidental findings on spinal radiographs?

Answer 24

Disk mineralisation in chondrodystrophic dogs
Dural ossification
Asymptomatic spondylitis deformans
Facet OA

Question 25

How should you work up brain disease?

Answer 25

Bloods
MRI
CSF analysis