CS: Seizures Flashcards Preview

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Flashcards in CS: Seizures Deck (45):
1

What is the neuro 6 finger rule?

1. localisation
2. signalment
3. onset
4. progression
5. symetry
6. pain

2

What is the neuro 6 finger rule?

1. localisation
2. signalment
3. onset
4. progression
5. symetry
6. pain

3

How can ^ WBC (neutrophils and monocytes) with leucopenia and eosinopenia be explained in an apparently not - infected animal?

Stress leucogram

4

How can ammonium biurate crystals be visualised? When would these be seen?

ultrasound bladder - see calculi in empty bladder

5

What effect would ^ ammonia have on the kidneys?

Enlarged

6

What effect does extrahepatic PSS have on the liver?

Small d/t lack of blood suppply

7

1st line tx of idiopathic epilepsy in dogs?

- phenobarb (lic epilepsy)
- imepitoin (lic single generalised tonic clonic seizure - modern, more specific license) §

8

1st line tx of idiopathic epilepsy in dogs?

- phenobarb
- imepitoin (single generalised tonic clonic seizure - modern, more specific license)

9

How can ^ WBC (neutrophils and monocytes) with leucopenia and eosinopenia be explained in an apparently not - infected animal?

Stress leucogram

10

How can ammonium biurate crystals be visualised? When would these be seen?

ultrasound bladder - see calculi in empty bladder

11

What effect would ^ ammonia have on the kidneys?

Enlarged

12

What effect does extrahepatic PSS have on the liver?

Small d/t lack of blood suppply

13

When is tx starting indicated in dogs?

14

1st line tx of idiopathic epilepsy in dogs?

- phenobarb
- imepitoin (single generalised tonic clonic seizure - modern, more specific license)

15

When should serum plasma levles of phenobarb be checked in dogs?

@ 14d post tx
- ^ liver enzymes ALT etc. >7d so no point checking before this pont as metabolism will change
- if checking plasma levels as unresponsive to AED then measure trough levels (jsut before due next tx)
- if >10mg/kg/day need to measure peak and trough

16

Side effects of phenobarbitone?

- sedation
- PUPD
- polyphagia
- liver tox if >35ug/ml
- ataxia
- anaemia (IMHA blood dyscrasia ~= sulphonamides)

17

What antiepileptics are lic for cats? 1st line tx?

NONE!
- phenobarb- chronic use ok
- diazepam for status epilepticus only (Not chronic use)
> metabolism diazepam slower in cats cf. dogs, can -> fulminant hepatic necrosis

18

What AEDs are liv in horses? Most common tx?

NONE!
- phenobarb (cheap)

19

How do phenobarb doses differ int he cat cf. dog?

- only need SID as no induction of liver enzymes like in dogs

20

When should serum levels of KBr be checked?

>60-90d (takes long time to reach steady state)

21

Side effects of KBr

~= phenobarb
- no blood dyscrasia
- GI irritant -> D+
- with ^ salt intake, will compete with KBr -> loss of function
- ataxia worse than phenobarb
- PANCREATITIS possible
- Br toxicity if loaded (loading does = 3-4x daily dose in one hit to rapidly reach therapeutic levels)

22

If focal seizure is seen on the LEFT where is the lesion?

Right forebrain

23

On MRI what are T1W, T2W and flare images?

T1: fat is white
T2: water and fat are white
flair= Fluid Attenuated Inversion Recovery : nulls fluid so can clearly see other structures without CSF interfering

24

Side effects of imepitoin?

- sedation
- polyphagia
- ataxia
- hyperactivity (transient)
- less cf. other AEDs

25

Side effects of diazepam, KBr and levacitracin and gabapentin in the cat?

- diazepam: severe liver necorisis
- KBr: feline asthma
- levacitram and gabapentin -> sedation and ataxia

26

How do phenobarb doses differ int he cat cf. dog?

- only need SID as no induction of liver enzymes like in dogs

27

Dog having recurrent seziures despite tx with phenobarb.. next course of action?

- check serum levels
- add another drug
> KBr lic 2nd line drug for phenobarb 1st line
> if on imepitoin initially more likely to add in Leviteracitam (no evidence for interaction)

28

Can idiopathic epilepsy cause asymetrical focal seizures?

NO!!!

29

If focal seizure is seen on the LEFT where is the lesion?

Right forebrain

30

On MRI what are T1W, T2W and flare images?

T1: fat is white
T2: water and fat are white
flair= Fluid Attenuated Inversion Recovery : nulls fluid so can clearly see other structures without CSF interfering

31

Further diagnostics in equine epilepsy

- EEG for partial seizures (refer)
- skull rads are NOT USEFUL!!!
- endoscopy/CT/MRI RARELY USEFUL!!!
> though owners still may want tehse to r/o other things

32

What is amaurosis? When may this be seen?

central blindness (normal PLR, no menace)
- may be seen for several hours post ictally
- depression, sedation, blindness of eye CONTRALATERAL to side of seizure

33

What does PE in between status epilepticus show you?

-typically normal (if stimulated may -> seizure)
- if neuro deficits present inbetween seziures indicates STRUCTURAL brain dz more liekly

34

When can horses said to be safe to ride if epileptic?

- seizure free for 6 months may ok? Still a risk (based on human driving legislation)

35

How may blood results be altered by a seizure?

^ CK 2d post

36

How should you approach a status epilepticus horse?

DONT! Leave it to finish - dont last long. very dangerous
> diazepam
> phenobarb dilute IV saline
> Pentobarbitone (careful! Usually used for PTS)

37

Tx status epilepticus horses?

Talk to owner $$$ tx not definitive so may be a waste of money

38

Further diagnostics in equine epilepsy

- EEG for partial seizures (refer)
- skull rads are NOT USEFUL!!!
- endoscopy/CT/MRI RARELY USEFUL!!!
> though owners still may want tehse to r/o other things

39

What advantages does KBr have over phenobarbitone?

Less sedation - use if level of sedation on PB unnacceptable

40

What biochemical changes occour to cells with chronic brain activity?

^ calcium -> 1* damage

41

What is 2* damage associated with seziures?

> everything othrer than ^ ca
- hypoxia
- hypertension
- hypercarbaemia
- lactic acidosis
- myoglobinuria
- hyperkalaemia

42

Tx course of action for stauts epilepticus

1. stop the seizures
2. protect the brain (cool, fluids, oxygen)
3. think about seizures

43

Always 1st line tx of status

Diazepam up the bum

44

When may diazepam not be effective at controlling status? What should be given in this case?

- if seziuring >1hr GABA may be depleted so use PHENOBARB aswell
- but still give diazepam!!
- phenobarb takes min 20 mins to act
- if >120mins give propofol to induce anaesthesia

45

What may be seen with propofol used to tx seizures?

Twitches - hard to differentiate from seizures!
> if you move the animal twitches will stop, seizures wont