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Flashcards in James - Neurology Deck (69)
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1

VITAMINN D - what do the letters stand for?

• Vascular accidents
• Immune-­‐mediated / infecTous encephaliTs
• Trauma
• Anomaly: congenital malformaTon (parenchyma, meninges) • Metabolic: hepaTc, renal encephalopathies
• Idiopathic: geneTc (idiopathic) epilepsy
• Neoplasia: brain tumours
• NutriTon: thiamine deficiency
• DegeneraTve: storage diseases

2

What can cause encephalitis (inflammation of the brain)?
Infectious(6)/non-infectious

1. Inflammatory/infectious
a) Viral: CDV, FIP, rabies
b) Rickettsial (very tiny gram -ve, obligate intracellular bacteria): Ehrlichia canis, RMS
c) Bacterial(3): Staph, strep, coliforms
d) Fungal(5): blastomycosis, Histoplasmosis, cryptococcus, coccidioides, aspergillosis
e) Protozoal: Toxoplasma, neospora
f) Parasititc: verminous, larval migrans, cysticercosis
2. Non-infectious (immune-mediated) - approx 99% in Ontario

3

What structures are affected with GME? (Granulomatous meningoencephilitis)

Brain, spinal cord, meninges, can be optical (CN II)

4

What is the breed disposition for necrotizing encephalitis?

Small breeds, younger age (2-5 y)
e.g. pugs, maltese, chihuahua for NME
yorkshire terriers for NLE (Necrotizing Leukoencephalitis)

5

What is the difference between NME and NLE

Necrotizing meningoencephalitis
Necrotizing Leukoencephalitis

NME - immune-mediated against astrocytes, cerebrum/leptomeninges involved.
NLE - brainstem commonly involved (sometimes the cerebrum/leptomeninges)
Both affect grey & white matter

6

What is Necrotizing encephalitis?

NME - Cerebral & white matter + meningitis
NLE - Brainstem, cerebral white matter
--> eating away from mild edema

7

Necrotizing encephalitis - Diagnostic tests

CBC/profile/UA
Thoracic rads, abdominal ultrasound
MRI (brain +/- spinal cord
CSF analysis -> inc. nucleated cells/inc TP
Titres, PCRs
HIstopathology (definative)

8

Necrotizing encephalitis - Diagnostic tests for infectious cause suspected

Titres, PCRs

9

Brain tumours - signalment

Older dogs & cats

10

Brain tumours - primary (5)? Secondary (2)?

Primary(5): neurons, glial cells(supportive, form myelin), choroid plexus, ependymal (thin membrane lining the ventricles), meninges
Secondary: local extension, metastases

11

Most common primary brain tumour? Other common ones?

Meningoma
Glioma (astrocytoma, oligodendroglioma, glioblastoma)
Choroid plesus tumour (papilloma vs. carcinoma)
Ependymoma

12

Secondary Brain tumours - local extension (4)

Local extension:
• Calvarial (osteosarcoma, MLO)
• Nasal carcinoma
• Pituitary tumour
• PNST (CN V)

13

Secondary Brain tumours - metastatic (4)

Metastatic:
• HSA (hemangiosarcoma)
• LSA (lymphosarcoma)
• Carcinoma – mammary, pulmonary, prostatic
• Malignant melanoma

14

Brain Tumours Treatment
Factors for choice
4 options with details

• Factors: tumour type, location, morbidity/mortality, cost
• Corticosteroids
• Chemotherapy: lomustine, hydroxyurea, cytosine arabinoside
• Radiation therapy: linear accelerator, gamma knife
• Surgery

15

Metabolic Encephalopathies - what parts of the body cause these?

Cerebrocortical neurones are most susceptible to metabolic disrutpion (high energy demands, litter reserve)
Hepatic encepalopathy (congenital PSS, microvascular dysplasia, acutehepatotoxicity)
Renal encephalopathy (aka uremic encephalopathy)
Others:
Hypoglycemia
Electrolyte imbalances (e.g. sodium)
Hypoperfusion

16

Metabolic Encephalopathies - clinical signs

Clinical Signs:
• Symmetrical (whole system affected)
• ThalamocorTcal
• Depression, disorientaTon • Pacing, head pressing
• Menace response deficits • Seizures

17

Examples of congenital disorders

• Hydrocephalus
ly means a smooth brain without evidence
eopallium.
rtical fo•l diAngratochpnrooduidcecgysritsa,ndlysuslcei.nIct eispahaly, etc.

18

Circling to the right?

Thalamo-cortex, right (Direction they circle in is not *contra*)

19

Neurological exam

• MentaTon
• Gait & Posture
• Cranial Nerves
• Postural ReacTons
• Spinal Reflexes
• PalpaTon (Spinal Pain)

20

Depressed/obtunded - what is it & where is the lesion?

• Drowsiness, inattention, less responsive to environment
• Brainstem (ARAS)
• Thalamocortex

21

Stuporous - what is it & where is the lesion

• Unconsciousness +êresponsiveness • Can be aroused with noxious sTmulus • ParTal disconnecTon
• Brainstem (ARAS)

22

Comatose - what is it & where is the lesion

• Unconsciousness + NO responsiveness • Total disconnecTon
• Reflexes may be intact
• Brainstem (ARAS)

23

Disoriented - where is the lesion

• Thalamocortex &/or vestibulocerebellar

24

Thalamocortex: NE

• Mentation: depression / delirium / disorientation / Δ behaviour
• Head pressing, compulsion, wandering, pacing
• Gait & Posture: circling (ipsi), body turn (ipsi pleurothotonus)
• Mild hemiparesis (contra)
• Cranial Nerves: menace & nasal septum responses (contra)
• Postural Reactions (contra, almost normal gait)
• Spinal Reflexes
• PalpaTon (Spinal Pain): possible neck pain

25

Cranial Nerves: Tests

• Menace response (II, VII, cortex, cerebellum) • PLRs (II, III)
• Physiological nystagmus (VIII, MLF, III, IV, VI) • Nasal septum response (Vs, cortex)
• Muscles of masTcaTon (Vm) • Palpebral reflexes (Vs, VII)
• Facial symmetry (VII)
• Head Tlt (VIII)
• Swallow (IX, X, XII) • Voice (X)
• Tongue tone (XII)

26

Brainstem: NE

• Mentation: depression / stupor / coma
• Gait & Posture:
• UMN tetra/hemiparesis/plegia
• Decerebrate rigidity / opisthotonus
• Vestibular ataxia
• Cranial Nerves:
• Deficits III -­‐ XII
• Postural ReacTons:
• Deficits all limbs (ipsi)
• Spinal Reflexes: NAF
• PalpaTon (Spinal Pain): possible neck pain

27

Encephalopathy: Clinical Signs

• Thalamocortex ± Brainstem ± Cerebellum
• Lesion localizaTon: diffuse vs mulTfocal
• Beware the focal lesion:
• Extensive mass invading mulTple CNS regions
• Focal lesion w/ extensive 2nd surrounding edema • Focal obstrucTon of CSF flowèhydrocephalus

28

EncephaliTs: Differentials

• Vascular accidents
• Immune-­‐mediated / infecTous encephaliTs
• Trauma
• Anomaly: congenital malformaTon (parenchyma, meninges) • Metabolic: hepaTc, renal encephalopathies
• Idiopathic: geneTc (idiopathic) epilepsy
• Neoplasia: brain tumours
• NutriTon: thiamine deficiency
• DegeneraTve: storage diseases

29

EncephaliTs: Clinical Signs

MulTfocal / diffuse CNS • Acute / subacute
• Progressive

30

What areas are there problems in for the following:
encephalitis
Brain
MyeliTs

Spinal Cord
Meningitis
Meninges