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Specialty Boards Prep > Deck 15 > Flashcards

Deck 15 Flashcards

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1
Q

What was the immune remission rate of cats with acquired myasthenia gravis WITHOUT a mediastinal mass? What treatments were used in cats with remission? When did remission occur by?

A

100%

Half the cats were treated with immunosuppressive steroids, and the other half received no treatments. No cat received an anti-acetylcholinesterase drug.

All cats were in remission by 6 months

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2
Q

What is the definition of myotonia?Pseudomyotonia?

A

Myotonia — delayed muscle relaxation after muscle activation, accompanied by myotonic discharges

Pseudomyotonia — same as myotonia, but without myotonic discharges on EMG

Myotonia should get better with exercise, while pseudomyotonia gets better with rest

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3
Q

What environmental factor caused worsening of signs in these patients? What was a common PE finding? What drug seemed to provide the most benefit?

A

Very cold or hot temperatures

Muscle hypertrophy

Clonazepam

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4
Q

What percentage of these dogs walked? What percent developed fecal / urinary incontinence? What was the likelihood of developing incontinence related to?

A

100% of dogs walked

Fecal incontinence — 23.5%
Urinary incontinence — 9.1%

Worsening neurologic grade at presentation (paraplegic v not), >40% PSCAL, presence of spinal shock, and lack of NSAID therapy (last two are only for fecal).

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5
Q

What were the main results from this paper?

A

The IV and IN routes were very similar in their efficacy (~60 v 75%) at terminating SE, but when time to place an IVC taken into account, intranasal route was superior (100 sec for IN, 270 sec for IV)

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6
Q

True or false — amongst various inflammatory CNS conditions, CSF lactate values were significantly higher for MUE cases.

A

False — no difference was noted across any type of inflammatory CNS condition. The only thing that CSF lactate significantly correlated with was TNCC.

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7
Q

What was the only antibody found in this paper? What is the significance of this?

A

Anti-NMDA receptor antibodies were found in three dogs, all of whom responded to treatment with steroids.

These antibodies are the most common found in humans diagnosed with non-infectious encephalitis. This could help provide an alternative diagnosis from MUE.

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8
Q

What are the latency cutoffs for TMMEPs to detect spinal cord dysfunction in horses for the thoracic limbs and pelvic limbs?

A

Thoracic limb — 22 ms
Pelvic limb — 40 ms

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9
Q

In what type of Wobblers is the primary lesion site NOT C6-7? What site is it instead?

A

Juvenile wobblers — C5-6

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10
Q

What were some features of juvenile CSM?

A
  • primarily osseous compression (18/20)
  • majority of dogs had 2 or more sites of compression
  • majority of dogs had a chronic presentation even though they were only 10 months old on average
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11
Q

What were the risk factors for having neurologic signs?

A

Being a pug dog
More severe kyphosis (cutoff of 34.5 degrees)
Fewer hemivertebrae
Ventrolateral hypoplasia hemivertebrae subtype

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12
Q

What three EDX factors were significantly greater in dogs with LS pain and MRI changes consistent with foraminal stenosis compared to dogs with normal MRIs?

A

Longer F wave latency
Higher F ratio values
Longer CDP latency

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13
Q

What percent of animals experienced hemispheric collapse / subdural hemorrhage? When did this occur?

A

18% and 18 days post-op

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14
Q

What were the risk factors for hemispheric collapse / subdural hemorrhage? What were the outcomes generally in these dogs?

A

Risk factors were a larger VBR and biventricular hydrocephalus > triventricular (compared to tetra).

10/15 underwent surgical decompression and had prompt improvement

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15
Q

What were the only signs related to syrinx size in this paper?

What sign was inversely proportional to syrinx size?

What was the most common clinical sign overall?

A

Phantom scratching
Scoliosis
Postural deficits
Weakness

Scratching at face or ear

Yelping / vocalization

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16
Q

What size syrinx is associated with phantom scratching?

A

> 4mm with all dogs with a syrinx of greater than 6.4 mm demonstrating phantom scratch in one study

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17
Q

SNAPs have a ___________ threshold to activation and a ____________ conduction velocity compared to motor nerves.

A

Lower threshold
Faster conduction velocity

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18
Q

What is the approximate estimate of sensory nerve conduction velocity in dogs? Is it different in cats?

A

Generally around 60-70 m/s

In cats, it is slightly higher (~80-90)

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19
Q

What is the only (I think) EDX study that is performed with a submaximal stimulus?

A

H reflex

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20
Q

What type of nerve is an H reflex performed on? What type of nerve fibers are being assessed on the ascending route?

A

Mixed nerve

1a fibers

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21
Q

What happens to the H wave as you increase the stimulation impulse during the H reflex test?

A

The H wave amplitude decreases. Remember that the orthodromically conducting sensory impulses are very fast, about double that of the motor impulses. So, the antidromically conducting motor impulses (ie F wave impulses) will collide with the H wave impulses coming down the same nerve. This results in decreased H wave amplitude, until the point where the H wave is abolished as stimulus impulse increases. Concurrent with this, the M wave amplitude that is generated will increase.

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22
Q

What parameter of the H wave might change in dogs with an UMN spinal cord injury? How and why?

A

The amplitude will increase — an increased amplitude is reflective of disinhibition of the LMNs, and thus they are more easily excited / fire when stimulated by the H reflex pathway.

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23
Q

What was the major finding of this study?

A

While 80% of pug dogs improved after traditional surgical means of SAD intervention, 86% of them recurred within 1 year. A longer duration of clinical signs pre-op correlated with recurrence risk.

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24
Q

What are the yellow arrows pointing to?

A

These are CSF hygromas that formed following VP shunt placement.

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25
What did this paper show was related to neurologic improvement following VP shunt placement? What clinical sign often persisted?
Decreases in ventricular volume / increase in parenchymal volume Blindness often persisted
26
What is the overall diagnostic accuracy for stereotactic brain biopsy compared to pathology? Where did SBBs fall short? What factors contributed to less accurate diagnosis?
~95% — it was perfect for meningiomas, but less perfect for gliomas. When there was disagreement, the SBBs often inaccurately called a glioma low-grade when it was really high-grade. Smaller tumors and less SBB samples were associate with lower accuracy.
27
What medication / combination of medications can be used to treat horses with head shaking?
Magnesium +/- with boron
28
True or false — transdermal levetiracetam reaches therapeutic serum concentrations in healthy cats.
True
29
What was the most common VP shunt complication per this review article?
Shunt obstruction (10%)
30
Which molecule — GFAP, pNFH or S100b — predicted outcome in dogs with TL IVDH that were DPN? How long was this molecule present in the serum following SCI?
GFAP - “the vast majority of dogs without detectable GFAP at presentation walked again” 3-4 days post-injury compared to up to 2 weeks for the other 2.
31
What drug administered rectally can be used in combination with diazepam and phenobarbital to improve cluster seizure control in dogs?
Levetiracetam
32
Describe the modified Zdichavsky grading scheme for vertebral pin placement.
Grade 1 = good Grade 2 = medial deviation (canal breach) Grade 3 = lateral deviation A = partial B = full
33
What is the PBR, and what is considered normal?
This is the pituitary height to brain area ratio, measured in transverse. Anything below 0.31 is normal
34
What was the most common presenting complaint? What was the survival rate in this study? What was unique about the dogs that died post-op? Median survival time for dogs that left the hospital?
Mentation change (12/15) 10/15 survived to discharge. The 5 that died were all animals that didn’t have a true pituitary tumor or meningioma. ~700 days
35
How are pituitary tumors graded?
Grade 1 — no extension above to dorsum sella Grade 2 — extension above dorsum sella up to third ventricle w/o contact of optic chiasm / mammillary bodies Grade 3 — same as two but with extension to those structures Grade 4 — contact with ITA Grade 5 — within 3rd ventricule A — no involvement of cavernous sinus / arterial circle B — vascular involvement
36
What is the ventral compression index?
This is an objective way to diagnose AAI on MRI/CT. It is a ratio of the distance between the dens and the ventral arch of C1, and the distance between the dens and the dorsal arch of C1. Anything greater than >0.16 in extension or 0.2 in flexion is consistent with AAI.
37
In a cadaver model, which method reduced temperatures more — intermittent bolus irrigation or continuous irrigation?
Intermittent bolus
38
What clinical feature may help you distinguish between an LS IVDE and IVDP in an older large breed dog?
The duration of clinical signs — more often acute (<3 weeks) in dogs with IVDE
39
What were the imaging features of a large proportion of dogs with IVDEs in this study?
The disc material was heterogeneously T2 hyperintense, T1 isointense and often contrast enhancing.
40
You see this on post-op MRI of a craniotomy patient. What is the diagnosis? What is this often associated with? Why are these imaging signs present? What medication could be considered?
This is diffuse pachymeningeal contrast enhancement consistent with intracranial hypovolemia. CSF leakage, or rhinorrhea To account for the hypovolemia, the volume of blood expands, filling the vessels more, resulting in obvious contrast enhancement. Theophylline
41
What were the odds of paraplegic DPP v DPN dogs walking again following surgery? What were two factors that influenced recovery odds?
DPP — 78% DPN — 38% Length of HASTE attenuation and the number of site decompressed
42
What value is significantly higher in the blood of dogs with cPSS? What value is lower?
Manganese is higher, benzodiazepines are lower
43
What are some risk factors for the development of PANS?
Pre-operative HE Older age +/- extra-hepatic morphology +/- JRTs, Maltese and Pug dogs
44
Does pre-operative administration of anti-convulsants help prevent PANS? The presence of what pre-operatively results in better outcomes of PAS? What type of seizures post-op were better?
No Seizures Focal
45
What technique can be used to improve access to the ventral aspects of the C6-T2 discs/vertebrae?
Manubriotomy
46
List the whether the head turn was ipsilateral or contralateral, as well as the features of the corresponding head tilt - Forebrain - Brainstem - Cerebellum - Cervical
- Forebrain — ipsilateral w/ uncommon head tilt - Brainstem — ipsilateral w/ ipsilateral head tilt - Cerebellum — ipsilateral w/ contralateral head tilt - Cervical — contralateral w/ contralateral head tilt
47
What were the recovery rates in this paper? Within what timeframe? Was recovery dependent on any initial MRI features? Follow-up MRI features?
DPP — 96%, walking in 11 days DPN — 48%, walking in 25 days 12 weeks Recovery was not dependent on any initial MRI features, nor was it related to degree of compression improvement on follow-up MRI.
48
Besides miniature Schnauzers, what two small breed dogs may be over-represented for FCEM? What is the relationship between FCEM and chondrodystrophy?
Yorkies and Shetland Sheepdogs “FCE is uncommon in chondodystrophic dog breeds”
49
True or false — disc herniations in cats generally have better outcomes when managed surgically compared to conservatively
False — although the absolute numbers favored surgical patients, the recovery rates were very similar between conservative and surgical management. 6 weeks Conservative — 54% Surgical — 62% 6 months Conservative — 65% Surgical — 74%
50
What was one factor in these cats that was associated with a better prognosis, regardless of management strategy?
History of trauma
51
What is the electrographic definition of a seizure?
Epileptiform discharges lasting greater than 10 seconds / any pattern with definite evolution in frequency, location or pattern.
52
What is this an example of?
Burst suppression on EEG
53
In this paper, approximately what percent of dogs had NCS / NCSE? What was impact of this finding?
NCS — ~30% NCSE — ~15% The impact was that these patients had a higher euthanasia rate (72%) compared to those patients without (27%).
54
What were the main takeaways from this study?
Juvenile dogs have a poorer prognosis than adult dogs with MUE.
55
Approximately what percentage of dogs with thoracic limb nerve root signature will have a cranially located disc herniation?
42%
56
True or false — disc herniations can cause nerve root signature without overt foraminal involvement on MRI
True — appropriately 1/3 of cases in the Schachar et al paper had disc herniations affecting the ‘medial compartment’ without overt foraminal involvement
57
What four segmental spinal reflexes have high inter and intraobserver agreement?
Patellars Withdrawals Extensor carpi Cranial tibial
58
True or false — MUE dogs with normal MRIs have similar outcomes compared to those with abnormal MRIs
False — dogs with normal MRIs have significantly better outcomes
59
True or false — MUE dogs with normal MRIs have similar outcomes to MUE dogs with abnormal MRIs. What are some previously proven prognostic factors of MUE?
False — MUE dogs with normal MRIs have significantly better outcomes (5% v 33% death) Seizures, mentation change, mass effect on MRI, +/- body weight
60
Did zonisamide improve seizure control in cats? By how much?
Yes — on average, it reduced monthly seizure frequency by 1, and monthly seizure days by 1 (up to 2 in epileptic cats specifically), with 62% of cats classified as responders.
61
What does the initial triphasic wave of the CDP represent?
Represents a compound nerve action potential in the axons of the nerve root. The initial positive deflection is a reflection of the current flowing towards the nerve root (sodium spilling out to balance out the previous node of Ranvier depolarization) The negative deflection represents depolarization of the nerve root at the last node of Ranvier (sodium rushing in). The last positive deflection represents hyperpolarization at the node of Ranvier (potassium rushing out).
62
What does the large negative deflection of the CDP represent? The following positive deflection?
Depolarization of the interneurons at the dorsal grey horn — massive amount of sodium rushing into the these depolarizing neurons (sink) and then positive ions coming out in the more ventral parts of the cord (source). Then, the positive charges (sodium ions) start to diffuse back to the top to balance out the charges (positive deflection).
63
What is the formula for CDP onset latency for the canine tibial nerve? What is the normal onset to peak latency?
-1.194 + (0.014 x pelvic limb length mm) 3.1 ms
64
For the trigemino-facial (blink) reflex, what nerve is stimulated and what muscle(s) are recorded? What is a normal expected response?
Nerve — frontal nerve at supraorbital foramen Muscles — both orbicularis oculi mm Expected response - ipsilateral — early R1, middle R2, +/- late R3 - contralateral — middle RC
65
What is the expected pattern for the blink reflex with the following scenarios? - ipsilateral trigeminal lesion - contralateral trigeminal lesion - ipsilateral facial lesion - contralateral facial lesion
- ipsilateral trigeminal lesion All waveforms delayed to absent - contralateral trigeminal lesion All waveforms normal - ipsilateral facial lesion Delay to absence of R1-3, preservation of RC - contralateral facial lesion Normal R1-3, delayed to absent RC
66
What are the stimulation and recording sites for the facial-facial reflex? Expected waveforms?
Stimulation sites — either at base of ear (right after emergence from stylomastoid foramen) or at supraorbital foramen. Recording site — ipsilateral orbicularis oculi There are ipsilateral direct and reflex waveforms.
67
What were the main side effects of zonisamide in this paper — clinical and on bloodwork?
Clinical — inappetance, sedation, ataxia and vomiting (maybe correlated with dose) Bloodwork — mild hepatopathy, mild metabolic acidosis, mild anemia
68
What was the frequency of side effects? What were the main side effects? What were two thing side effects were related to? What was the overall efficacy of phenobarbital?
47% of cats had some side effects Sedation > ataxia > polyphagia > PU/PD > anorexia One case with neutropenia Serum level and concurrent AED use ~70% of cases responded
69
What were the five diagnostic tests used in this study? What were the ultimate recommendations of this study?
Serology (most sensitive at 87%) Basic histopath PCR (next most sensitive 69%) IHC ISH At least two diagnostic tests for neospora should be done — a direct (based off of muscle path) and an indirect (serology).
70
What breed of dog has been suggested to have more fragile astrocytes? What is the basis of this?
Pugs Shown to have higher levels of circulating GFAP when they get MUE compared to other breeds with MUE.
71
What were the main outcomes in this paper? What factors were associated within decreased 6 month survival? What factors were associated with relapse risk?
82% of dogs survived to discharge 63% of dogs survived to 6 months Of surviving dogs, 50% relapsed (this correlates nicely with the rule of thirds!) Factors for poor survival — being a Pug, seizures, paresis, and a higher NDS (>7) Factors for relapse — persistent neuro deficits, higher NDS (>7), and longer duration of clinical signs prior to treatment (>1 week).
72
What are these two photos demonstrating? What is the diagnosis?
Left photo is illustrating occipito-atlantal joint effusion, while the right photo is showing a rupture of the transverse ligament of the dens. These are from a cat with a traumatic cervical hyperflexion injury.
73
What is photo B specifically showing? What other bony change was reported in these cats?
Laxity of the transverse ligament of the dens, secondary to an avulsion of this ligament off of the right lateral arch of C1 Two cats had fractures of the proatlas (pictured).
74
What are the classic clinical features of cats with a traumatic AA hyperflexion injury? What is an unexpected finding that half of these cases had? What is the general prognosis with these cats?
Young Male Peracute Non-painful Non-lateralizing Following trauma Obtunded to stuporous mentation. Prognosis for walking again is good with just supportive care and time.
75
What is an important differential diagnosis for a traumatic AA hyperflexion injury in a cat? How might distinguish it?
Ischemic myelopathy The gold standard way would likely be diffusion weighted imaging, which would reveal restricted diffusion for ischemic myelopathy cases. Perhaps the more central nature of the lesion in the SC (as opposed to being restricted ventrally) and the presence of T2W hypointensity (indicative of hemorrhage) could help raise suspicion for hyperflexion injury.
76
What lobe/lobes are implicated in vestibular epilepsy?
Parietal and temporal
77
Possible breed disposition? Supportive evidence for epilepsy? What was the most frequently used AED?
Pugs Response to AEDs (100%), EEG findings (3/3 dogs), presence of GTCS in 2 of the dogs Levetiracetam
78
List the top 5 causes from most to least common. Breed predisposition? Which diagnosis was associated with an “older” age? Which one was associated with a lower body weight? Which one was negatively associated with brachycephaly?
Vertebral malformations Subarachnoid diverticula Traumatic fracture Atlantoaxial instability Osseous CVM Frenchies, pugs, English bulldogs and MBD IVDH dogs were older. AAI was associated with lower weight / non-brachycephaly.
79
What clinical signs were associated with a high IVP? What MRI findings were associated with high IVP? What findings were associated with syringomyelia? What is a possible explanation for why some of these signs occurred in animals without elected IVP (>12 mmHg)
Obtundation, head tilt and nystagmus Periventricular edema, T2 signal void sign, more ventricles affected (tetraventricular highest) Number of ventricles, smaller VBR, signal void sign, periventricular edema, lack of internal capsule disruption, pain and increasing age. Maybe the IVPs are lower in anesthetized dogs compared to awake dogs.
80
Which brachycephalic breed of dog is not considered screw-tailed? What is this breed of dog lacking?
Pug dogs because they are lacking a truncation of the DISHEVELED 2 gene (ie they are normal).
81
How much more likely are English and French bulldogs to developing discospondylitis? What is different about their signalment compared to other dogs? What percentage of them had discospondylitis at a site adjacent to a CVM? Theories as to why?
English — 4.3 times more Frenchie — 3.4 times more They were significantly younger (~1 yo v 7 yo) English — 50% Frenchie — 80% Abnormal vascular channels leading to slow flowing blood, or accelerated degeneration of the disc near the CVM and subsequent predisposition
82
True or false — dogs that received cytosar in addition to corticosteroids had better outcomes at all time points (7, 30 and 200 days)
False — no change in survival noted between groups at any time point
83
What is this an example of? What is the background activity?
This is a sleep spindle, with a background activity of high voltage low frequency activity (delta or theta).
84
What did the results of this study show? What was the potential downside of this technique?
Reversing the sedation resulted in more frequent SEDs compared to not reversing it / control dogs. Reversed dogs had more muscle artifacts, but this did not apparently hamper the ability to detect SEDs.
85
How do you know where the seizure activity here originated from?
It originated from T4 — in the referential montage it’s the highest amplitude at T4, while in the bipolar montage, you get phase reversal centered at T4.
86
True or false — SRMA dogs treated with 6 weeks or prednisone had similar outcomes as SRMA dogs treated with 6 months of prednisone
True — all dogs had improved by 2 weeks, the relapse rate was ~30-40% in both groups.
87
What is the most common metastatic brain tumor in dogs? What location does it like to affect?
Hemangiosarcoma — telencephalon
88
What are the classic MRI features of intracranial hemangiosarcoma?
T2 — heterogenous w/ mixed hypo and hyperintensity T1 — heterogeneous w/ mixed hypo to isointensity All were contrast enhancing, various patterns to include ring enhancement. Multiple, lots of edema with signal voids and various ages of hemorrhage
89
What are three types of spinal hemangiosarcoma? Are the imaging features similar to intracranial HSA?
Vertebral — frequently polyostic Epidural Intramedullary — always in neck? Yes very similar in terms of T1 + T2 heterogeneity with strong contrast enhancement and signal voids.
90
What are the four criteria associated with multiple myeloma? How many of these criteria need to be present to diagnose this?
1. Lytic bony lesions 2. Bence jones proteinuria 3. Monoclonal gammopathy 4. Bone marrow plasmacytosis At least 2 out of 4
91
Describe the signal characteristics of multiple myeloma on MRI. Does this tumor respect the cortical boundaries of the vertebrae?
T2W - iso to hyper T1W - hypo to iso to hyper STIR - always hyper CE - always present Yes, the outer cortical boundaries in particular as all of them had canal invasion / neuroparenchymal compression
92
In this study, where did all dogs neurolocalize? What was unique about their signalments? About the worms removed? What anatomic space were all worms found in? What were the signal characteristics of the worm?
Cervical All toy breed dogs All female L5 larvae Intradural-extramedullary The worm itself was T2 and T1 hypointense, and didn’t contrast enhance. It was always located in a fusiform T2 hyperintense space dorsal/dorsolateral to the spinal cord causing compression.
93
What were the main clinical findings of this paper?
- normal cats can have olfactory recess dilation - olfactory recess dilation is associated with abnormal CSF and venticulomegaly, in which cases it’s frequently bilateral
94
What is this white arrow pointing to?
Basivertebral canal
95
Describe the naming criteria for these vertebral vascular canal dysplasias.
The first letter refers to the depth: A <50% B 50-99% C 100% The second letter refers to morphology S - single D - double C - complex
96
What material is filling in the space created by the vertebral vascular canal dysplasias?
Fat
97
What is located within the vertebral vascular canal dysplasia areas? Are these more common in French or English Bulldogs? In which breed were these changes more severe in?
Fat English > French (for both)
98
Explain why water movement becomes restricted in cytotoxic edema.
- the various organelles and proteins within the cell limit the movement of water compared to the extracellular space - the cell swelling associated with cytotoxic edema also decreases the size of the extracellular space, and can result in limitations of extracellular water movement
99
What is the diagnosis? What is unique about the diffusion weighted imaging technique used here?
This is a feline ischemic myelopathy The diffusion weighted imaging is using a reduced FOV — reduced in the phase encoding direction.
100
101
What disease process is associated with lack of FLAIR suppression of the inner ear? Was this lack of suppression correlated with CSF tap results?
Otitis media / interna Not correlated with CSF findings

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