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Neuro Flashcards

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1
Q

Which 2 clinical signs can be expected with neuromuscular disease?

A

Weakness
Exercise intolerance

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2
Q

What are the systems that can cause weakness?

A
  • Cardiovascular and respiratory (ie. arrhythmia, hypotension, hypoxemia…)
  • Systemic/ Metabolic (i.e sepsis, electrolyte imbalance such as hypocalcemia, hypoglycemia..)
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3
Q

Weakness can be 2 things

A

1) focal
2) generalised (may involve CNs leading to signs such as dyphagia, dysphonia, regurgitation..)

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4
Q

What clinical signs may be seen with weakness?

A
  • difficulty getting up
  • short strides
  • stiff gait
  • plantigrade stance
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5
Q

On Physical exam, what signs may you see that makes you think of signs of weakness?

A
  • muscle hypertrophy
  • muscle atrophy
  • myalgia (muscle pain)
  • ventroflexion in cats
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6
Q

What do postural reaction tests assess?

A

Proprioception

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7
Q

If a patient has a spinal cord injury, would the postural reactions be affected?

A

If the lesion is cranial to the limb segment- then yes.

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8
Q

If a patient has neuromuscular weakness, what would the postural reactions be like?

A

Intact, can be reduced. The animal is weak but knows where its limbs are (it is only the motor unit that is affected)

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9
Q

In neuromuscular disease, are the spinal reflexes increased or decreased?

A

Typically decreased (especially if neuropathy)

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10
Q

If all spinal reflexes are reduced and reduced tone in all limbs- what is the most likely explanation and the least likely?

A
  • Most likely: generalised myopathy, neuropathy or junctionopathy
  • Least likely: Spinal cord lesion in C6-T2 and L4-S3
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11
Q

What happens to muscles in a neuromuscular disorder? (LMN loss)

A

Atrophy

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12
Q

Common cause of ventroflexion in the cat

A

hypokalaemia

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13
Q

Common cause of eclampsia in the bitch?

A

hypocalcemia

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14
Q

What is ‘reflex fatigue’?

A

If you repeat reflex again and again it will eventually stop occurring i.e. Palpebral reflex. This mimics exercise tolerance (i.e Myasthenia Gravis)

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15
Q

Ventroflexion in a cat- is it a neuropathy? a junctionopathy? or a myopathy?

A

Myopathy

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16
Q

You have a patient with really flaccid limbs, decreased spinal reflexes and a plantigrade stance- Is it more likely to be a neuropathy, junctionopathy or myopathy?

A

neuropathy

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17
Q

You have patient with weakness, myalgia, exercise intolerance and normal spinal reflexes- neuropathy? a junctionopathy? or a myopathy?

A

myopathy

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18
Q

80% of dogs with acquired Myasthenia Gravis will have…

A

Megaesophagus

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19
Q

Megaesophagus predisposes to …?

A

aspiration pneumonia

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20
Q

What diagnostic tests can we do to test for myopathy?

A

Look at muscles enzymes: CK, AST, ALT enzymes.
Urinalysis: myoglobinuria

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21
Q

What test can be used to differentiate between muscle disuse due to orthopedic problems Vs myopathy/neuropathy?

A

electromyogram

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22
Q

What test helps us differentiate between neuropathy, junctionopathy or a myopathy

A

nerve conduction test

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23
Q

Acute Canine Polyradiculoneuritis is cause by?

A

Immune mediated inflammatory disease affecting the ventral nerve root

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24
Q

If a dog has miosis, ptosis and facial paralysis - is it peripheral or central vestibular disease?

A

peripheral

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25
If a cat seems obtunded and has a horizontal strabismus that can change direction- is it peripheral or central vestibular disease?
central
26
Central vestibular disease includes what structures?
the vestibular nuclei the cerebellum the cerebral cortex
27
Peripheral vestibular disease includes which structures?
the hair cells the vestibulocochlear nerve the ampulae cristalis the maculae
28
Could a peripheral lesion causing vestibular disease also lead to facial paralysis?
Yes
29
Could a peripheral lesion causing vestibular disease also lead to Horner's syndrome?
Yes
30
What is this and how do you treat it?
SCCED or 'indulent ulcer' or 'boxer ulcer' Ulcerative disease treatment: only ulcer that can be debrided (cotton bud, diamond burr or keratectomy)
31
What is this? What is the risk?
A foreign body. Ulcerative disease It can migrate and damage the lens.
32
What is this? How do you treat it?
This is a melting ulcer caused my Pseudomonas. Ulcerative disease Fluroquinolones required. This is an emergency do not wait!
33
What is this? How do you treat it?
This is a perforation filled with a fibrin plug. Ulcerative disease Do not remove the fibrin plug. Requires surgical treatment.
34
What does this represent?
a desmetocoele. Ulcerative disease. Pattern caused by uneven fluorescein staining
35
What is this?
Corneal oedema due to endothelial disease.
36
What is this? What are the causes? Treatment?
Mineral deposits in the cornea Non ulcerative Can be there for lots of different reasons : - Old age - Chronic irritation - Hereditary Can also occur with some systemic disease i.e. hypothyroidism, diabetes, lipid deposits- you need to treat the systemic underlying cause
37
What is this? Treatment?
Pigmentary keratitis is found in almost in every brachycephalic pug. It can progress to the degree where it becomes blinding. So important to monitor the progression
38
What is this?
Acute Bullous Keratopathy. Non ulcerative Very rare Patients present suddenly with extreme corneal oedema
39
What causes this?
Feline Herpes Non ulcerative
40
What is this?
Chronic superficial keratitis (Pannus) Caused by UV damage Treatment is cyclosporin and corticosteroids
41
What is this?
Eosinophilic keratitis Full of eosinophils Non ulcerative disease Treat with cyclosporin and corticosteroids
42
What is this?
Keratoconjunctivitis Sicca (Dry eye) Ulcerative disease
43
What is this?
Deep ulcer Ulcerative disease When the ulcer becomes deeper than 50 % then we need to provide some mechanical support to prevent it from this also from rupturing.
44
What is this?
Corneal sequestrum Non ulcerative disease necrotic part of the cornea Would need to be removed
45
Causes of corneal edema
endothelial degeneration uveitis lens luxation glaucoma
46
What are the 4 medical management treatments for corneal opacity
- anti-collagenase - antibiotics - mydriatic cyclopegics - anti-inflammatories/ immunosupressives
47
How long does it take for the epithelium
1 - 2 hours
48
If deeper layers of the epithelium are lost how long may it take to repair?
a week if the limbus stem cells are still intact.
49
How long do vessels take to grow per day in the process of corneal healing?
0.5mm per day
50
How long does it take for the stroma to heal?
weeks to months
51
How long does it take for the endothelium to grow?
Unfortunately the endothelium is only one cell thick and is non-regenerative.
52
What features can be seen with progressive retinal atrophy (PRA) when examining the fundus?
- hyperreflective tapetum - vascular attenuation - end stage: catarracts
53
What can cause retinal toxicity in cats?
enrofloxacin
54
What causes symblepharon in cats?
FHV1
55
What is this?
pigmentary keratopathy
56
What is this? What does it need to be differentiated from?
synechia Needs to be differentiated from persistent pupillary membranes (PPM)
57
What is this?
Hypopyon
58
7 causes of cataracts
- congenital - inherited - nutritional - traumatic - metabolic - PRA - senile
59
What are the clinical signs of uveitis?
- hypopyon - hyphaema - aqueous humour flare (tyndall effect)
60
Uveitis is a local or systemic problem?
Both local: a trauma, corneal ulcer systemic: pyometra, urinary tract infection, hyphaema could be due to coagulopathies
61
What is the pathophysiology of glaucoma?
Aqueous humous is produced by the ciliary body, flows through the pupil and should exits in the drainage angle. There is a problem of outflow leading to increased IOP and optic nerve damage.
62
What are the signs of acute glaucoma?
- corneal oedema - episcleral congestion - hyperemia
63
What does this show?
Persistent pupillary membranes These can extend from either iris to iris, iris to lens or iris to cornea.
64
What is this?
iris atrophy can occur with age. The pupil margin ragged; this can appear as mydriasis if the pupil margin is not examined closely
65
What does this represent?
an iris coloboma. Developmental defect leaving a hole is this iris at 6 o clock
66
What does this represent?
Iris melanoma- can be benign melanosis or a neoplastic change for example iris melanoma
67
What is this?
a uveal cyst. Spherical cysts formed from the uveal epithelium, these are usually free floating in the anterior chamber, however can also burst and leave pigment on the corneal endothelium
68
What is this?
anterior lens luxation. anterior displacement of the lens means the pupil cannot constrict and dilate as normal.
69
What is SARDs?
Sudden acquired retinal degeneration syndrome. Acute blindness - idiopathic
70
What does the fundus of a SARDs dog look like?
Normal
71
When doing an electroretinogram for a SARDs patient what may you expect?
a flat line
72
What is this?
optic nerve neurits This is an inflammation of the optic nerve and manifests as blindness or if very early reduced vision. The optic nerve head is pink/ haemorrhagic, swollen and there can be peripapillary oedema/ retinal detachment.
73
Cataracts can lead to glaucoma. How?
cataracts---> uveitis---> pre-iridal fibrovascular membranes (PIFM)---> synechia---> glaucoma
74
uveitis can cause miosis or mydriasis?
Miosis
75
Horner’s syndrome can be defined by what 4 characteristics?
Miosis, enophthalmos, third eyelid protrusion and ptosis (drooping of the upper eyelid)
76
Glaucoma- miosis or mydriasis?
Mydriasis
77
Dysautonomia- miosis or mydriasis?
mydriasis Means dysregulation of the autonomic system.
78
Fear- miosis or mydriasis?
Mydriasis- When animals are very stressed, they have a heightened sympathetic stimulation and thus mydriasis that is usually not very responsive to bright light and therefore a reduced or absent PLR
79
In a chiasmal lesion would the pupils be constricted or dilated? PLR absent or present?
dilated- Nothing works!
80
In a re-chiasmal lesion (right) what would the PLR direct and indirect be in each eye?
81
In an oculomotor nerve lesion (left) what would the PLR direct and indirect be in each eye?
82
Parasympathetic nucleus of CN3 lesion (right)
83
With SARDs what would the menace response and PLR be?
No menace response, absent or decreased PLR
84
Enophthalmia define
retraction of the bulb within the orbital cavity known as enophthalmia. Due to ocular pain, reduced amount of retrobulbar fat, periocular/facial muscle atrophy (typical of elderly cats, weight loss, long-term use of steroids)

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