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Specialty Boards Prep > Deck 14 > Flashcards

Deck 14 Flashcards

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1
Q

How do anticonvulsants alter daytime / nocturnal activity in epileptic dogs?

A

Dogs treated with AEDs had an 18% reduction in daytime activity.

This was more significant in dogs treated with both phenobarbital and potassium bromide at 28%.

No differences were found overall in nocturnal activities, except for dogs treated with high-dose bromide who didn’t sleep as well.

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2
Q

Describe the utility of monitoring neurofilament light chain values in dogs with MUE.

A

Firstly, both serum and CSF neurofilament light chain values were significantly higher in dogs with MUE compared to control dogs.

Secondly, in dogs that have good treatment responses to MUE therapy, levels significantly decrease whereas dogs that have a poor response show increases. However, the good responders had values measured at 6 months out (by the time you will probably have a good outcome if you’re still alive), while the bad responders had values measured around 45 days later.

Although there was a generalized trend for increased values in patients with seizures, this was not statistically significant.

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3
Q

True or false: CSF VEGF levels are higher in dogs with intracranial neoplasms or inflammatory diseases

A

True, but they did not differentiate from each other.

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4
Q

What was the median survival time for dogs with intracranial meningiomas treated with CyberKnife RT?

A

> 2000 days

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5
Q

Rank the order of dogs with longest survival/PFI from least to most.

Cerebrum, brainstem and cerebellum

A

Dogs with cerebellar tumors had worst survival/PFI, followed by brainstem and then cerebrum.

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6
Q

You have a young German shepherd puppy that presents with diffuse shaking. What is the diagnosis, the prognosis and what would you expect to find on MRI?

A
  • Hypomyelinating leukodystrophy
  • the puppy will get better with time, but may never be completely norma
  • MRI should show delayed white matter maturation, with T2W hyperintensity of the white matter — it will appear hyperintense to grey matter initially (but longer than the expected 4 weeks), and eventually become isointense to grey matter. The cerebellum is also affected with no apparent arbor vitae.
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7
Q

The majority of dogs in this study were what breed?

What were the common MRI / CSF features?

How were the majority of dogs treated?

A

Frenchies (7/8)

Most of these dogs had normal MRI / CSF. Two had equivocal imaging findings consistent with MUE.

Dogs were all treated with prednisone which significantly improved clinical signs.

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8
Q

Persistent fontanelles in Chihuahuas are associated with what?

A

Low body weight
Syringomyelia
Ventriculomegaly
CCJ overcrowding

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9
Q

What were some additional sites of post-ictal change identified on MRI in this study?

Was it more common to have multiple areas affected or just one?

A

All of the lobes (occipital, frontal, parietal-temporal, oflactory) pulvinar thalamic nucleus, caudate nucleus, and parahippocampal gyri

Multiple

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10
Q

What were the classic imaging features of post-ictal change?

A

T2 and T2 FLAIR hyperintensity

T1 iso to hypointensity

Mild contrast enhancement

Various derangements in DWI and PWI

Mild local mass effect

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11
Q

What is the filum terminale internum composed of? Externum? Where does it insert?

A

Internum — glial cells, ependymal cells, pia mater

Externum — occurs where the dura fuses to the internum

Usually inserts dorsally to one of the caudal vertebra, blending with periosteum

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12
Q

Describe the relationship of spinal cord / dural sac termination in CKCS compared to other small dogs?

What was a more caudal termination associated with?

A

The spinal cord / dural sac of CKCS ends further caudally than other dog breeds.

Presence of thoracolumbar / lumbar syringomyelia.

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13
Q

Is a longer or shorter filum terminale internum length associated with signs of pain in CKCS?

A

Shorter

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14
Q

What value on DTI was negatively associated with neurologic grade in DM patients? Where along the spinal cord were these changes identified?

A

Fractional anisotropy (lower value = less directional movement).

Around the TLJ, where the disease process is the most severe.

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15
Q

What was the median dose of midazolam CRI needed to control dogs with cluster seizures or SE?

A

0.3 mg/kg/hr

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16
Q

What was the main finding of this paper?

A

The presence of at least one completely degenerate disc at the time of initial MRI was associated with recurrence (hazard ratio of 2.92)

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17
Q

Where was CSF flow velocity highest in this study?

A

Highest in cervical spinal cord SAS (~2 cm/s), followed by foramen magnum (1.8 ventral, 1.2 dorsal), and then mesencephalic aqueduct (0.9).

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18
Q

What occurs electrophysiologically during a muscle cramp?

A

Gradual increase of the number of motor units activated and frequency of their discharges, followed by gradual decrease.

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19
Q

What are the three patterns of muscle cramps in this paper?

What was associated with these severity of these patterns?

When did these cramps often start?

What was the leading cause of hypocalcemia?

When a cause wasn’t identified, what breed was it?

A

Pattern 1 — migrating pattern starting with thoracic limb and progressing to the pelvic limb, falling over

Pattern 2 — alternating between pelvic limbs

Pattern 3 — single limb, no progression

The degree of hypocalcemia was associated with these patterns
Type 1 — 0.6
Type 2 — 0.8
Type 3 — 1.0

Started during exercise / movement

Primary hypoparathyroidism

German Shepherd

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20
Q

Which one — hypertonic saline or mannitol — has a more of an impact of serum sodium and chloride concentrations?

Did either one have more of an impact of acid-base status?

A

Hypertonic saline caused more of an increase initially as well as a sustained increase at all time points.

No significant differences between the two on acid-base status.

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21
Q

True or false — imepitoin treatment of idiopathic head tremors results in a significant improvement in clinical signs

A

False — only a 17% responder rate

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22
Q

What is the formula for F ratio?

Normal F ratio at hock? Stifle?

What results mean?

A

(F-M-1)/(2M)

Hock — 1.95
Stifle — 0.88

Greater than ref = proximal disease
Lesser than ref = distal disease
Equal to ref — affects the whole nerve equally

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23
Q

Malignant hyperthermia syndrome is due to a breakdown of ____________ in the ____________ of _________.

A

Calcium sequestration in the sarcoplasmic reticulum of skeletal muscle

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24
Q

A decrease in CMAP amplitude by what amount is required to denote something as conduction block?

A

> 50%

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25
What is a differential for an unexplained steady increase in a patient’s CO2 level under anesthesia? What other vital parameter is often increased?
Malignant hyperthermia syndrome Temperature
26
What clinical finding can help distinguish motor neuron diseases from peripheral neuropathies?
Preservation of reflexes
27
What muscles are affected first in Brittany Spaniels with HCSMA?
Tail and epaxial musculature, followed by proximal limb musculature and then distal limb musculature.
28
What are the two classic histopathologic changes in HCSMA?
Chromatolysis and spheroids
29
What are three causes of a CMAP amplitude decrease without temporal dispersion?
1. Axonal disease 2. Severe myopathy 3. Neuromuscular junctionopathy (severe botulism)
30
What is the recommended distance between stimulation sites during MNCV?
10 cm
31
What is the down side of stimulating above what is needed for supramaximal stimulation?
This results in spread of current distant to the intended stimulation site, causing the nerve to fire closer to the muscle, thus shortening latency.
32
When performing MNCV studies, where along the nerve should the anode and cathode electrodes be placed? For SNCV? Why?
MNCV — the cathode should be placed more distally along the course of the nerve relative to the anode SNCV — opposite of MNCV This is to avoid anodal conduction block.
33
What is the effect of physiologic temporal dispersion when performing MNCV studies?
This results in slightly smaller amplitudes and slightly longer durations at proximal stimulation sites compared to distal stimulation sites.
34
How do you calculate residual latency? What does value provide information on?
This is the difference between measured distal latency (obtained during routine MNCV) and the expected distal latency. To calculate the expected distal latency, you just need the distance between the distal stimulating site and the recording site, and the calculated MNCV. Device the distance by the MNCV to get something in milliseconds (expected distal latency). Then just subtract the expected latency from the actual distal latency. This value provides information on the speed of nerve terminal activity and muscle membrane activation (neuromuscular transmission).
35
Describe the relationship between CSF lactate and seizure activity in dogs. What is normal CSF lactate?
CSF lactate DID NOT correlate with seizure activity or duration, with the sole exception that dogs with focal seizures had higher concentrations compared to dogs with generalized seizures. CSF lactate also was higher in dogs with neoplastic or inflammatory brain disease, and was never elevated in dogs with epilepsy. 1.0-2.5
36
Describe the results of this study.
rTMS improved seizure control in dogs versus sham treatment. Sham treated dogs that then were actually treated also experienced seizure control. No significant reduction in the frequency of cluster seizures was noted The reduction in frequency lasted about 4 months.
37
What is the cutoff between low and high frequency stimulation for repetitive transcranial magnetic stimulation? Which one is recommended for treatment of epilepsy?
Low is <1 Hz, and high is > 1 Hz Low frequency stimulation is used to treat epilepsy.
38
Are seizures a common clinical sign in patients with idiopathic communicating hydrocephalus? Are they common following shunt placement?
No to both (1.7% frequency in one paper)
39
What are some MRI criteria to help distinguish between ventriculomegaly and hydrocephalus?
- flattening of gyri/sucli - defamation of ITA - disruption of internal capsule - olfactory recess dilation - periventricular edema - A VBR of > 0.62 - increased corpus callosum height
40
True or false — dogs with osseous CSM had significant progression of their clinical signs and lesions on MRI ~2.5 years after their initial scan?
False — “no identification of clinical or MRI progression in the majority of dogs”
41
What were the main clinical signs of dogs in this paper?
Regurgitation / megaesophagus Dysphonia NO/minimal weakness
42
What are the long arrows pointing to? Short arrows? What disease is this? What is the genetic defect? What are the expected EDX findings?
Long arrows are pointing to abnormally folded myelin, forming structures known as tomacula. Short arrows are pointing to thinly myelinated fibers. This is the demyelinating polyneuropathy of Miniature Schnauzers. The genetic defect is in the SBF2 gene which controls myelin folding via MTMR protein. The EDX findings are indicative of demyelination with significantly delayed MNCV and reduced CMAP amplitudes with polyphasia.
43
In cases of traumatic skull fractures, where are cats more likely to have fractures? Dogs? Anything to note about the number of fractures?
Cats are more likely to have fractures involving the facial bones and base of the cranium, whereas dogs are more likely to have fractures involving the cranial vault. Cats were more likely to have more fractures than dogs.
44
True or false — non-fragmented traumatic skull fractures are more likely to be displaced than fragmented ones True or false — displaced skull fractures were more likely to result in neurologic signs. What other factor was more likely to be associated with the presence of neurologic signs?
False — fragmented traumatic skull fractures are more likely to be displaced. True The presence of cranial vault fractures (compared to facial or cranial base fractures)
45
What were the survival rates in this paper? What things were associated with a worse survival?
~85% survival at 1 week Cranial vault fractures, neurologic deficits, fragmented fractures and displaced (but not depressed) fractures.
46
In this paper, what were two variables associated with adverse events following stereotactic brain biopsy? What was the complication rate? What was the recommended platelet count cutoff? Why?
T2W heterogeneity and a lower platelet count 27%, with only one patient experiencing a permanent deficit >185k — all 7 patients that had platelet counts below this developed an adverse event.
47
What finding on pre-biopsy MRI may correlate with an increased likelihood of post-biopsy hemorrhage for SBB?
Signal voids on GRE sequences
48
What were the two main takeaways from this paper?
- Neurologic forms of FIP can be successfully treated with the GS drug - higher doses than used for non-neuro FIP may be needed for successful treatment
49
What is the relationship between duration of anesthesia / surgery in DPN IVDH dogs?
A negative association between duration of these things and regaining the ability to walk exists. For every additional hour of surgery / anesthesia, the chances of walking decreased by 25%. Note that this is not necessarily a causal relationship.
50
What were the main findings from this article?
MRI is more accurate at determining the presence of intracranial hypertension compared to scoring systems based off of clinical signs. MRI features that correlated with confirmed ICP elevations included larger tumor size, larger ONSDs, and anatomic shifts.
51
What is the relationship between the diameter of the optic nerve sheath and intracranial pressure? How do you interpret an ONSD value?
ONSD will increase along with intracranial pressure elevations. ONSD increases proportionally with body weight, and so a ratio of ONSD:body weight is how you evaluate the ONSD.
52
What is the other breed of dog that might have a gluten responsive paroxysmal dyskinesia?
Maltese — some of them even had GI and skin signs!
53
True or false — the presence of autonomic signs can be used to distinguish between PD and epilepsy.
False — more and more dogs with confirmed PD have signs of hypersalivation and vomiting
54
What is the proposed MOA of acetazolamide?
Decreased pH decreases neuronal excitability
55
Excluding an issue with the shunt, what are two reasons that a patient with a previous VP shunt for an obstructive third ventricular mass could show signs of relapse months after initial shunt placement? Management strategy?
Tumor progression / obstruction of the other lateral ventricle Second VPS placement
56
What percentage of TL IVDH dogs may develop chronic neuropathic pain as assessed by mechanical sensory threshold testing? What clinical feature may be related to chronic neuropathic pain? When did MST scores normalize post-operatives?
15% Hyper-reactive cutaneous trunci reflex Generally normalized by 6 months post-op.
57
Does the administration of sedation or GA to place an ambulatory EEG apparatus to a dog influence the diagnostic utility of this diagnostic? What about in dogs that are receiving AEDs versus those that aren’t? What is the recommended minimum duration of time the EEG device should be worn?
No — just as diagnostic / no delay in the time for the first SED to be seen No — just as diagnostic in dogs on one AED 4 hour duration
58
True or false — repeated CSF taps in horses alters the CSF results.
False
59
What is the rate of improvement for dogs following FMD for COMS? Recurrence rate?
80% improvement, 25% recurrence
60
What was the median target point deviation when using this 3D printed SBB frame?
0.83 mm (sub-millimeter)
61
True or false: Radiation therapy for brain tumors increases seizure frequency compared to dogs that are just medically managed
False — it significantly decreases seizure frequency (24 moths of seizure freedom v 1.7 months)
62
What were the main results of this study?
- no difference in adverse effects in either slow or rapid taper groups (1 out of 3 dogs in each group needed to restart pred) - majority (84%) of rapid-taper dogs were able to be tapered completely off of prednisone compared to only 50% of slow-taper dogs - dogs in rapid taper group were off of prednisone on average in 41 days
63
64
What are the two antibodies associated with acute canine polyradiculoneuritis?
Anti-GM2 IgG Anti-GalNAc-GD1a IgG
65
True or false — pug dogs with constrictive myelopathy often have histopathologic evidence of inflammation. If so, where is this inflammation located?
True — almost 50% of them did; typically located peri-vascularly within the parenchyma
66
67
What are the risk factors for developing post-encephalitic epilepsy? What is the impact of this?
“Acute symptomatic seizures”, MRI lesions of the hippocampus and young age. Significantly shorter survival times
68
What were the differences between CSF collected at the C1-2 space versus the LS space in horses?
Lower protein and RBC counts at C1-2
69
What layer of meninges supplies blood to meningiomas in dogs? Cats? What is the clinical significance of this?
Dogs — pial Cats — dural This may explain why dog meningiomas can be invasive / extend along the Virchow Robins spaces.
70
What drug can be used to treat deer-stalking in CKCS?
Clonazepam — unfortunately dogs develop a tolerance to this drug pretty quickly
71
What is the main physiologic difference between canine and feline muscle?
Cats actually have three types of myofibers (one slow twitch, and two fast twitch types)
72
What is the only type of abnormality that may be appreciated with neuropraxia on EDX testing?
Evidence of conduction block
73
What type of junctionopathy can cause abnormal CMAPs?
Pre-synaptic (ie botulism)
74
What is the formula for central latency? What is central latency?
Central latency = (F-M-1)/2 This is the conduction time along the proximal portion of the motor nerve.
75
What are the classic F wave findings in acute canine polyradiculoneuritis?
Increased minimum latency Increased F ratio (indicating proximal segment disease) Decreased F wave amplitude
76
Between what responses on RNS is the 10% decrement assessed?
First and fifth
77
What are the names of the three pools of acetylcholine vesicles within the pre-synaptic nerve terminal?
From smallest to largest — ready for release pool, recycling pool, reserve pool
78
How long should you wait between successive RNS trains?
30 seconds to allow replenishment of acetylcholine stores
79
What is pseudo-facilitation in RNS?
This is when the amplitude (but not that the area) of the RNS waveforms increases near the end of the train, and is due to more synchronous firing of the myofibers.
80
What is facilitation in regards to RNS?
Facilitation occurs due to a mechanism known as neurosecretory potentiation AKA calcium accumulation within the distal nerve terminal, facilitating the release of more acetylcholine vesicles.
81
Before ruling out myasthenia gravis on routine RNS, what step should you do?
Test a more proximally located muscle (or facial muscle).
82
What protein does the mutation in Old Danish pointers with pre-synaptic MG affect? What are classic RNS findings?
The choline acetyltransferase protein (CHAT). You can get decrement on RNS, but only after pre-conditioning.
83
What are some breeds that get a synaptic congenital myasthenic syndrome? What is the cause?
Labs, Goldens, Sphinx and Devon Rex cats Acetylcholinesterase deficiency due to due a ColQ gene mutation, causing the enzyme to not be anchored to the basal membrane of the synaptic cleft.
84
True or false — both neuropathies and myopathies can cause a decrement on RNS
True — if severe enough, both can cause decrementation
85
Describe the classification system for congenital myasthenic syndromes in dogs / cats.

86
Describe the classification system for congenital myasthenic syndromes in dogs / cats.

87
In which congenital myasthenic syndrome does the administration of anti-acetylcholinesterase drugs cause worsening of clinical signs?
The synaptic group with the CoLQ mutation.
88
What is different about the synaptic CMS in cats compared to dogs? What treatment may be able to help both species?
The EDX findings for cats are strange — there is spontaneous EMG activity (PSWs and CRDs), as well as inconsistent decrement on RNS. Albuterol or other beta-2 adrenergic agonists
89
What were the recommendations of this paper?
Collect paired CSF samples in dogs with intracranial and cervical NALs. Stand-alone lumbar CSF samples is likely appropriate in dogs with focal thoracolumbar disease.
90
What type of cell do histiocytic sarcomas arise from?
Interstitial dendritic cells
91
What are 6 breeds of dog predisposed to CNS histiocytic sarcoma? What was unique about a few of these breeds?
Bernese Mountain Dogs Corgis Goldens Labradors Rottweilers Shetland Sheepdogs Corgis and Shetland Sheepdogs had predominantly primary CNS forms, while Rottweilers always had disseminated forms.
92
What were the differences between CSF samples between primary HS, disseminated HS, and meningioma in this paper? How common was it to identify neoplastic cells on CSF cytology?
TNCC — primary HS were significantly higher than disseminated HS and meningioma TP — primary HS and disseminated HS were significantly higher than meningioma 50% of cases had neoplastic cells visible
93
What were the survival times for palliatively treated dogs? Definitively treated dogs?
5 days v 44 days
94
What are some unique features regarding seizure semiology in dogs with seizures triggered by eating? What was the most effective way to help these dogs?
No pre-ictal phase and all started as focal and progressed to generalized Anti-epileptic drugs were significantly more effective than alterations to feeding strategies.
95
What should ponazuril be coadministered with to increase serum and CSF concentrations?
Corn oil
96
True or false — medium chain triglyceride supplementation improved seizure control in dogs with epilepsy
True — both seizure frequency and seizure-day frequency were lower in dogs fed the MCT compared to controls, although only 5/28 dogs would be considered responders (>50% reduction)
97
By how much did phenobarbital levels drop in dogs fed the MCT dietary supplement in this paper? What biochemical value was elevated in dogs fed this diet?
8% Beta hydroxybutyrate
98
What was the most common neurologic finding on examination of these cats that indicated neuromuscular weakness?
Skeletal muscle weakness / fatigability via the wheelbarrow exercise stress test (WEST)
99
What was the sensitivity of collar-worn accelerometers in the detection of seizures in dogs? What else happened in this study?
Only about 20% Dogs had a significantly improved quality of life score
100
What are the three most common causes of facial nerve paralysis in horses? What percent completely improve?
Trauma Central nervous system disease “Idiopathic” (only a small percentage of these had complete workups) ~50%

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