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Year 4 Small Animal Studies > Neurology: Diagnostic Tests > Flashcards

Neurology: Diagnostic Tests Flashcards

1
Q

What diagnostic tests can be used for neuology?

A

Neurological examination- best
* Blood tests
* BP
* Urinalysis
* Faecal analysis
* Imaging
* CSF analysis
* Functional testing
* Biopsies

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2
Q

What causes diagnostic challenges in neurology?

A
  • CNS is well protected- bone, BBB
  • Lack of functinoal reserve and poor regen capacity
  • Combination of specific and non-specific tests
  • Diagnosis of exclusion
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3
Q

What are the three causes of seizures?

A
  • Idiopathic epilepsy- genetic or presumed genetic in origin
  • Structural epilepsy- inflammatory, neoplastic, traumatic
  • Reactive seizures- seizure occuring as a natural response from the normal brain to a transient disturbance in function- metabolic or toxic
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4
Q

What are diifferentials for seizures?

A
  • Vascular- ishaemic encephalopathy
  • Infecitous- meningoencephalitis
  • Trauma- truamtic brain injury
  • Anomalous- hydrocephalous, congenital malformation
  • Metabolic- hepatoc encephalopathy, renal encephalopathy
  • Idiopathic
  • Neoplastic
  • Degnerative
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5
Q

How is idiopathic epilepsy diagnosed?

A

Diagnosis of exclusion

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6
Q

What about blood tests can be used for investigation of seizures?

A
  • Haematology and biochem- electrolytes, Ca and Glu
  • Liver function testing
  • ± endocrine function tests
  • ±clotting factor

± infectious disease

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7
Q

What infectious diseases can cause seizures?

A

Dogs
* Neospora caninum
* Toxoplasma gondii
* CDV
* Angiostronglyus

Cats
* Toxoplasma gondii
* FeLV
* FIV
* FIP
* Cryptococcus

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8
Q

When can urinalysis be useful for investiagion of seizures?

A

Rule out primary conditions
* Cerebrovascular accident- cushings/hypoproteinuria
* Discospondylitis- UTI primary cause
* Paraparesis/urinary dysfunction- increased risk of UTI
* Inborn errors of metabolism - unusual metabolites

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9
Q

What are the disadvantages of MRI?

A
  • Contrast required
  • Anaesthesia
  • High cost
  • Limited availability
  • Artefacts
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10
Q
  1. What is CSF analysis most useful for?
  2. What else can cause abnormalities?
  3. What are its limitations?
A
  1. Infectious/inflammatory
  2. Neoplastic or traumatic conditions
  3. May not be abnormal due to location, can have non-specific changes, cell countr correlate with exfoliation into CSF not severity of disease
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11
Q

What are the contraindications of CSF?

A
  • Increased intra-cranial position
  • Coagulopathy
  • Cervical collection in some conditions
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12
Q

What are the indications of increased intracranial pressure?

A
  • Mental status
  • Pupil size and PLR
  • Abnormal postures
  • Vestibular eye movement
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13
Q

How is CSF analysed?

A

Analysis within 1 hr
* Differential cell count
* Cytology

Equipment
* Spinal needle
* Collection pots
* Clippers, scrub, gloves

Site- cerebellomedullary cistern or lumbar cistern

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14
Q

What is normal for CNS analysis?

A

Gross
* Clear

Cell count
* RBC 0
* WBC < 5 ul

Cytospin
* Cytology
* Differential cell count

Protein
* Cervical < 30mg/dl
* Lumbar < 45mg/dl

PCR- infectious disease

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15
Q

What are different CSF abnormalities?

A

Blood contamination
Albuminocytological dissocation
* Increased protein without increased WBC
* Non-specific- neoplasia, vasculitis, trauma, syringomyelia, degen myelopathy

Pleocytosis- increased WBC
Other findings- infectious agents, neoplasia

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16
Q

When is Urine/Blood/CSF culture appropriate?

A
  • Bacterial meningitis- blood and urine culture, disc aspirate
  • Encephalitis- penetrating cranial injuries, extension from otitis media/interna
17
Q

What is EEG?

A

Electroencephalography
* Assess forebrain activity
* Identification of seizure activity
* Can be useful in status epilepticus

18
Q

How are spinal lesions localised?

A
19
Q

What are the differentials for spinal neurolocalisation?

A
  • Vascular- ishaemic myelopathy
  • Infectious/inflammatory- meningomyelitis of unknown origin, discospondlylitis, toxoplasmosis, neosporosis, FIP, FeLV, SRMA
  • Trauma
  • A- AA instability, chiari-like malformation, vertebral abnormalities
  • M- na
  • I- na
  • N- spinal/vertebral neoplasia
  • D- intervertebral disc, cervical stenotic myelopathy, degenerative lumbosacral stenosis, degenerative myelopathy
20
Q

How can the spinal patient be investigated?

A
  • Blood tests- haematology, biochem, c-reactive protein, infectious disease testing
  • Imaging- localise- MRI gold
    radiography- good for bony, radiography, CT, Myelography
  • CSF analysis
  • Culture
21
Q

What are the following bony abnormalities?

A
22
Q
  1. What is CT useful for in spinal patients?
  2. What are the contraindications for myelography?
  3. What is the purpose of myelography?
A
  1. Excellent for bony detail, rapid acquisition, contrast can be used
  2. Coaguloapthy, spinal instability, cloudy/turbid
  3. See the spinal cord- extradural or bony lesions
23
Q

What are the three problems that can be identified of myelography?

A

Extradural
* 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

Intradural
* Filling defect within the contract column
* ‘Golf tee’ sign or widening of subarachnoid space
* DDX- neoplasia, arachnoide diverticulum

Intramedullary
* Divergence of contrast columns
* DDx- neoplasia, actue ishaemic myelopathy, contusion, haemorrhage, myelitis

23
Q

What are the three problems that can be identified of myelography?

A

Extradural
* 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

Intradural
* Filling defect within the contract column
* ‘Golf tee’ sign or widening of subarachnoid space
* DDX- neoplasia, arachnoide diverticulum

Intramedullary
* Divergence of contrast columns
* DDx- neoplasia, actue ishaemic myelopathy, contusion, haemorrhage, myelitis

24
Q

What are the risks of myelopgraphy?

A
  • Seizures
  • Neurological deterioration
  • Dysrythmias
  • Respiratory arrest
  • Infection
  • Chemical myelitis
  • Death
25
Q

When is CSF of spinal patient investigations appropriate?

A
  • SRMA
  • Meningomyelitis
  • Bacterial myelitis
  • Empyema
  • Discospondylitis
26
Q

When is urine/blood/disc/CSF culture indicated for a spinal patient?

A
  • Discospondylitis
  • Bacterial meningitis
  • Emypema, paraspinal abscessation
  • Parapelgia/paresis
27
Q

What are the differentials for neuromusclar disease

A

Infectious/inflam
* Polymyositis
* acquired Myasthenia gravis
* Polyradiculonephritis
* Botulism
* Tick paralysis
* Protozoal

Trauma- focal, organophospate, lead, vincristine
Anomalous- congenital
Metabolic- addisons, cushings, hypokalaemia, diabetes, insulinoma
Idiopathic
Neoplastic- thymoma, paraneoplastic
Degenerative- MD, neuroaxonal dystrophy

28
Q
  1. What may be identified on blood tests of neuromuscular patient?
  2. What can be assessed on imaging?
A
  1. Haem and biochem, T4/TSH, insulin, ACTH stimulation test, immune mediated disease
  2. Check for concurrent disease- thymoma, megaoesophagus
29
Q

What is the neostigmine response test for?

A

Junctionopathies- MG
* IV administration
* Prolongs action of acetly choline at NMJ

Care- cholinergic crisis
* Bradycardia, salivation, miosis, dysponea, tremors

30
Q
  1. What is the best imgaing for neuromuscular
  2. What is electrodiagnostics useful for?
  3. Where should muscles be biopsied?
  4. Other then muscle what can be biopsied?
A
  1. MRI
  2. Identifying denervated muscels, extent and severity, treatment monitoring
  3. Distant from tendons
  4. Nerve
31
Q

What can be assesed using electrodiagnostics?

A

Motor nerve conduction velocity
* Assess conduction along a nerve

F-waves- assess nerve roots

Repetitive nerve stimulation- NMJ

32
Q

What tests may be approapriate in the following conditions?
1. Cerebrovascular accident
2. Movement disorder
3. Intracranial neoplasia/inflammatory disease
4. Hearing

A
  1. T4/TSH, ACTH stimulation test
  2. Anti-gluten antibodies
  3. Brain biopsy
  4. Brainstem auditory evoked response
33
Q

What are the clinical signs of dysautonomia in cats and dogs?

A

Cat
* Cough
* Vomit/retch
* Anorexia
* Third eyelid protrusion
* mydratic unresponsive pupils,
* dry eye and nose
* constipation
* incontinence
* bradycardia
* megaoesophagus

Dog
* Cough
* Vomit/retch

Disorder of the ANS

33
Q

What are the clinical signs of dysautonomia in cats and dogs?

A
  • Cough
  • Vomit/retch
  • Anorexia
  • Third eyelid protrusion
  • mydratic unresponsive pupils,
  • dry eye and nose
  • constipation
  • incontinence
  • bradycardia
  • megaoesophagus
  • Decreased anal tone
  • Atonic bladder

Disorder of the ANS

34
Q

What are the clinical signs of dysautonomia in cats and dogs?

A

Cat
* Cough
* Vomit/retch
* Anorexia
* Third eyelid protrusion
* mydratic unresponsive pupils,
* dry eye and nose
* constipation
* incontinence
* bradycardia
* megaoesophagus

Dog
* Cough
* Vomit/retch
* Anorexia
* Hypersalivation
* Diarrhoea or constipation
* Dry MMs
* Dry eye
* Mydriasis
* Megaoeohagus
* Bradycardia
* Decreased anal tone
* Atonic bladder

Diagnosis- constellation of clinical signs
Definitive- PME

Disorder of the ANS

35
Q
A

Year 4 Small Animal Studies (97 decks)

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