Brain Diseases Flashcards
(29 cards)
How does idiopathic cerebelitis (white shakers) present?
Small breed, young dogs
Presenting with a fine tremor
+/- another cerebellar sign eg ataxia
How can you diagnose idiopathic cerebellitis?
Exclusion
CSF - mildly inflammatory
MRI
How should you treat idiopathic cerebellitis?
4-6 months of corticosteroids
What is the common presentation of bacterial meningitis?
Obtundation and cranial nerve deficits
Neck pain
Pyrexia
How can you diagnose bacterial meningoencephalitis?
Bloods - neutrophillia
CSF analysis - pleocytosis, high protein, occ engulfed bacteria
CSF / blood culture - positive in only 15-30%
How should you treat bacterial meningioecephalitis?
Antibiotics eg: Fluoroquinolones
Surgical drainage
Poor px
How should you manage a head trauma patient?
Try to reduce the severity of the contre-coup lesion
O2
Initial assessment
ICP management
Isotonic or hypertonic IVFT - maintain cerebral perfusion
Surgical drainage
Maintain a normal temperature and blood pressure
- 90-140 mmHg
Pain management
Where is the brain at the highest risk of herniation with increased ICP?
Forebrain – tentorium cerebelli = compresses brainstem
Cerebellum – foramen magnum
What are the clinical signs of increased ICP?
Obtunded, comatose, stupor Anisocoria, mydriasis, miosis Cushings reflex - bradycardia and hypertension Absent physiological nystagmus Decerebrate or decerebellate rigidity
What signs would make you concerned about forebrain herniation through the tentorium cerebelli?
Anioscoria and absent PLR
How can you reduce CSF volume in a case of increased ICP?
Diuretics - Mannitol
- increases cerebral perfusion, decreases CSF volume
- follow by crystallised fluids to prevent dehydration
Hypertonic saline - hyperosmotic agent
What opioid would be best to use in increased ICP?
Methadone
Less likely to cause emesis than morphine
What nursing care should you provide to a patient with increased ICP?
Keep the head elevated Turn q 4-6h Nutritional support - feeding tube Keep at a stable temperature Catheterise the bladder
What breed is predisposed to hydrocephalus? How does it present and how should it be treated?
Chihuahua - persistent fontanelle and domed head
CP: circling, pacing, abnormal behaviour, seizures, obtundation
Treatment: corticosteroids, furosemide, AEDs
Surgical - ventriculoperitoneal shunt
What is the most common cause of hepatic encephalopathy and how does it present?,
Congenital PSS
Seen in young dogs with stunted growth and forebrain signs
- bilaterally symmetrical
- head pressing, seizures, circling
How can you diagnose hepatic encephalopathy due to PSS?
Dynamic bile acid stimulation test
Ammonia assay
Liver US
CT angiography
How should you medically manage / surgically manage PSS?
Medical Low protein diet Lactulose Amoxi-clav, metronidazole AEDs
Surgically close PSS
How can hypernatraemia present and how should you treat it?
Seizures, changes in mentation
Slowly correct sodium imbalance over 48-72h
How do lysosomal storage disease present and how can they be diagnosed?
Early onset, diffuse neurological signs - bilaterally symmetrical
Progressive until death
Dx: DNA test, blood and urine screening, MRI brain
How can you manage lysosomal storage disease?
AEDs
Anti-anxiety drugs
What are some common differentials for patients with forebrain disease over 6yo?
Cerebrovascular accident Bacterial meningoencephalitis Hepatic encephalopathy Hypoglycaemia Electrolyte imbalances - addisons Idiopathic vestibular syndrome Degenerative - lysosomal storage diseases Neoplasia - meningioma, glial cell tumours
How does hypoglycaemia present, and what are some common underlying causes?
Anxiety, lethargy, depression
Ravenous appetite
Tremors, visual deficits
Seizures
Young puppies that haven’t eaten enough
Insulinoma
Liver disease
How can you diagnose and treat hypoglycaemia?
Blood glucose <3 mmol/L
Tx: IV Glucose, frequent feeding, underlying cause
Name some brain tumours that are seen.
Intra-axial - glioma
Extra-axial - meningioma, choroid plexus tumours
Metastasis - haemangiosarcoma
Direct extension - nasal tumour, pituitary tumour
