Neuro Flashcards
(157 cards)
1
Q
CNS
A
brain
spinal cord
2
Q
peripheral nervous system (PNS)
A
cranial nerves
spinal nerves
3
Q
upper motor neuron (UMN)
A
never leaves the CNS innervates lower motor neuron (LMN) descending control of reflex arc paresis/paralysis hyperreflexia/hypertonus rigid limbs + extension
4
Q
clonus
A
tremors
indicates chronic lesion
5
Q
LMN
A
beings in CNS and exits through spinal nerves
form peripheral/cranial nerves
ventral horn- motor/efferent
flaccid, hyporeflexia, areflexia, no motor
sensory intact
hypotonus
6
Q
sensory nerve
A
local reflex arc
proprioception/pain/reflexes
normal strength and motor
don’t know where feet are
7
Q
dysmetria
A
abnormally metered gait
always cerebellar disorder- controls metering of gait
8
Q
hypermetric
A
large exaggerated gait
what usually see
9
Q
hypometric
A
short gait
10
Q
spasticity
A
increase in tone
11
Q
smooth muscle
A
hypertrophies when denervated
more responsive to stimuli
12
Q
skeletal muscle
A
atrophy when denervated
13
Q
C6-T2
A
LMN to forelimbs come out
14
Q
triceps reflex
A
radial nerve
C7-T1 evaluated
15
Q
quadriceps (patellar) reflex
A
most reliable reflex to interrupt
L4-L6 spinal cord segment
femoral nerve
16
Q
extensor carpus radialis reflex
A
radial nerve
C7-T1 spinal cord segment
most reliable reflex in thoracic limbs
17
Q
biceps reflex
A
musculocutaneous nerve
C6-C8
18
Q
cranial tibial reflex
A
peroneal branch of sciatic nerve
L6-L7
flexion of hock
19
Q
end of spinal cord
A
L5/L6
caudate equine continues past this
20
Q
gastrocnemius reflex
A
tibial branch of sciatic nerve
L7-S1
extension of hock
21
Q
flexor responses
A
sensory component, reflex arc, motor component
lost w/ LMN
present w/ UMN
22
Q
crossed extensor reflex
A
typically absent- normal young animals
UMN lesions
one limb withdrawn, other extends
23
Q
babinski reflex
A
normal:absent or slight flexion of foot
abnormal: extension foot/splaying toes
UMN lesion
sweep hemostat from distal to proximal foot
24
Q
cranial nerve I
A
olfactory
sensory
25
CN II
optic
| sensory
26
CN III
oculomotor
| motor
27
CN IV
trochlear
| motor
28
CN V
trigeminal
| motor/sensory
29
CN VI
aducent
| motor
30
CN VII
facial
| motor/sensory
31
CN VIII
vestibulocochlear
| sensory
32
CN IX
glossopharyngeal
| motor/sensory
33
CN X
vagus
| motor/sensory
34
CN XI
accessory
| motor
35
CN XII
hypoglossal
| motor
36
miotic pupil
horner's syndrome
| sympathetic denervation
37
mydriatic pupil
parasympathetic denervation
| dysautonomia
38
ptosis
droopy upper eyelid
39
enophthalmos
sunken globe
40
pre-ganglionic Horner's syndrome
spinal cord to cranial cervical ganglion
no dilation w/ dilute phenylephrine (direct acting)
dilation w/ hydroxyamphetamine (indirect acting)
41
post-ganglionic Horner's syndrome
cranial cervical ganglion to pupil
denervation hypersensitivity of pupil
no response to hydroxyamphetamine
dilation w/ dilute phenylephrine
42
vestibular disease
brain stem
| central or peripheral
43
central
```
vestibular nucleus w/in brain stem
nystagmus any direction
changing nystagmus
CP deficits
any cranial nerve deficits (PM)
```
44
peripheral
outside brain stem- vestibular apparatus and CN VIII
never vertical nystagmus
CN VII deficits
constant nystagmus
45
pathological nystagmus
slow phase towards lesion
| fast phase away from lesion
46
menace response
CN II afferent limb response
CN VII efferent limb response
central connections in brain stem and cerebrum
47
cerebellar disease
PLR intact but no menace response
| absence of menace response w/ normal vision
48
pupillary light reflex
```
CN II- sensory
CN III- motor
constriction of pupil
direct and consensual responses to localize lesion
can have PLR normal and be blind
```
49
pupil symmetry
CN3 parasympathetic motor
sympathetic innervation
anisocoria
50
anisocoria
different size pupils
51
physiologic nystagmus
turning head in either direction
CN 8
CN 3, 4, 6
fast phase in direction of movement
52
palpebral reflex
CN5 sensory
CN7 motor
brain stem connections
tap medial and lateral canthus- should blink
53
corneal reflex
moistened q-tip and touch cornea- should blink
CN 5 (opthalmic branch)
CN 7
brain stem connections
54
retractor bulbi reflex
```
same time as corneal reflex
globe should retract when dog blinks
CN5
CN6
brain stem connections
```
55
facial sensory response
rub finger along mandible or touch whiskers
blink or curl up face
pinch cheek skin along mandible- retract lip
CN5
CN7
56
gag reflex
touch either side of pharynx (lateral side)
dog should gag
CN9
CN10
nucleus ambiguus lesion cause damage to CN 9, 10, 12
57
cutaneous trunci (panniculus reflex)
ball point pen pushed into back
twitching of cutaneous trunci
entire sensory pathway- feeds up to C8-T1
58
myopathy
disease of muscle
59
most common myopathy of dogs
masticatory myositis
large breed dogs
immune mediated
azathioprine
60
max safe rate of K supplementation
0.5 mEq/kg/hr
61
C1-C5
cervical
exit point for CN XI
UMN signs to thoracic and pelvic limbs
62
C6-T2
cervico-thoracic segment
thoracic limbs- LMN exit for thoracic limbs
LMN signs to thoracic limbs
UMN signs to pelvic limbs
63
T3-L3
thoracolumbar
| UMN signs to rear limbs when damaged
64
L4-S2
lumbar sacral
pelvic limbs- LMN exit for thoracic limbs
LMN signs to rear limbs
65
Cd
caudal
66
LMN bladder
easy to express
67
UMN bladder
typical to express
| harder to express
68
diskospondylitis
infection of intervertebral disk
| space sometimes
68
Type 1 IVDD
```
Most common
Degeneration/rupture of dorsal annulus
Extrusion nucleus pulposus
Chondrodystrophic breeds
Most common type large breeds
```
69
Hyperesthesia
Increased sensitivity
Esp to pain
Like hyperalgesia
70
Myelomalacia
Morbid softening of the spinal cord
72
Type II IVDD
Progressive thickening of annulus fibrosus
Older large breeds
Slow onset
Damage from compression only
73
cervical IVDD type I
C2-C3 most common
74
cervical IVDD type II
pelvic limb signs precede thoracic limb signs
75
thoracolumbar IVDD type I
T1-T11 lesions are rare
| neurological deficits with pain are common
76
group 1 IVDD
pain w/out deficits
| majority conservative management
77
group 2 IVDD
ambulatory paraparesis
| majority conservative management
78
group 3 IVDD
nonambulatory paraparesis, normal superficial pain
| still conservative management but surgery may be more needed
79
group 4 IVDD
paraplegia urinary and fecal incontinence, deep pain intact
conservative management or surgery
progressive myelomalacia possible
80
group 5 IVDD
paraplegia w/ no deep pain
| surgery w/in 24 hours or no recovery
81
myelopathy
spinal cord pathology
82
cervical spondylomyelopathy
```
wobbler's syndrome
vertebral malformation
C5-6 and C6-7 disc spaces
gradually progressing signs
myelography for diagnosis
```
83
stenosis
abnormal narrowing
84
cauda equina syndrome
```
lumbosacral vertebral canal stenosis
subluxation/instability
GSD
extension of limbs, tail elevation/paresis
incontinence (LMN bladder)
possible 3+ patellars- pseudoreflex
depressed flexion response
LMN disease
MRI diagnosis
strict rest + corticosteroids or decompressive laminectomy
```
85
pontomedullary syndrome
CN deficits 5-12 (minus 11)
| UMN to all limbs
86
cerebellar syndrome
dysmetria in all limbs - cerebellum meters gait
intention tremors
ataxia w/ preserved strength
87
strabismus
eyes do not line up in same direction
| "cross eyed"
88
vestibular syndrome
head tilt, falling, rolling
walking tight circles
nystagmus + V-L strabismus
peripheral vs. central
89
central
horizontal, rotary, vertical, positional nystagmus
| possible CN 5, 6, 7 deficits
90
peripheral
horizontal, rotary nystagmus
| possible CN 7 deficits
91
midbrain
vision, hearing, motor control
sleep/wake, alertness
temperature regulation
92
midbrain syndrome
```
depression, coma
rigid extension of all limbs- decerebrate rigidity
contralateral limb deficits
UMN to limbs
hyperventilation
CN 3 deficits
```
93
hypothalamic syndrome
```
behavior changes
CN II deficits
abnormal temp regulation
abnormal appetite
central diabetes insipidus
normal gait
```
94
cerebral syndrome
```
big wide circles
seizures
contralateral limb and vision deficits
circling, pacing, head pressing, head turn, body turn
behavior changes
```
95
canine distemper encephalitis
cerebellar, optic tract, spinal cord, cerebrum
hyperkeratosis of foot pads
DX: PCR or CSF mononuclear pleocytosis
96
bacterial meningitis/encephalitis
```
middle aged to older
gradual onset
lethargy, reluctance to walk, anorexia
neck pain, hyperthermia, bradycardia (cushing's reflex)
depression, seizures
meningitis- more fever and pain
DX: CSF tap- neutrophilic pleocytosis
```
97
fungal meningoencephalitis
```
Cryptocccus neoformans
dog/cat
c/s like bacterial meningitis
granulamatous fungal plaques on fundic exam
Dx: CSF, serology
TX: fluconazole
```
98
aseptic meningitis
#2 inflammatory CNS dz (#1 distemper)
young (8-18m) large breeds
neck pain, fever, stiffness, ataxia-b/c neck pain
dx: leukocytosis w/ left shift, CSF neutrophilic pleocytosis, + response to steroids
tx: immunosuppressive prednisone
99
beagle pain syndrome
necrotizing polyarteritis
| frequently recurrent
100
idiopathic vestibular disease
old dogs
acute to peracute onset
rapid recovery- marked improvement 24-48 hours
supportive care
101
granulomatous meningoencephalitis (GME)
```
nunsuppurative inflammatory dz
unknown etiology - immune mediated?
cerebrum, cerebellum, pontomedullary
diffuse/coalescing lesions
toy breeds 1-8 yo, females
3 major forms
```
102
GME 3 forms
ocular
focal form
disseminated form
103
ocular form
rarely by itself
acute visual loss- blind
slowly progressive form
104
focal form
mass lesion
signs related to site of compression
dead w/in 6 months
105
disseminated form
most common
meningitis w/ neck pain, fever
brainstem, cerebral, cerebellar
rapidly progressive
106
GME dx
c/s signs, signalment
MRI
CSF: mononuclear pleocytosis, elevated protein
107
therapy
prednisone- cornerstone
azathioprine- not best choice
cyclosporine- good choice
cytosine arabinoside - like cyclosproine and good choice
108
necrotizing meningoencephalitis
pug dog encephalitis (earlier age onset)
Yorkshire terrier necrotizing encephalitis (middle aged)
nonsuppurative- extensive cerebral necrosis
latent canine herpesvirus?
9mo-7y w/ variable onset
109
pug dog encephalitis
acute: sudden onset seizures w/ abnormal behavior between; rapid progression to death
chronic: seizures w/ normal behavior between; gradually progresses to full disease
dx: signalment/history, CSF, necropsy
tx: antiepileptics (TOC), immunosuppressives
110
Yorkie encephalitis
```
variable CN deficits
variable long tract signs -UMN
fewer seizures
immunosuppressives TOC
eventually fatal- stabilize disease is goal
```
111
caudal occipital malformation
cavalier king charles spaniels
syringohydromyelia
c/s: spinal pain, paresis, ataxia, facial scratching/rubbing, resentment touching/grooming, LMN signs to thoracic limb
chiari- like malformation
112
syringohydromyelia
abnormal spinal cord fluid accumulation
| complex pathogenesis
113
COMS MRI findings
```
small foramen magnum
small caudal fossa volume
cerebellar herniation
hydrocephalus
syringohydromyelia
```
114
COMS tx
medical: corticosteroids, carbonic anhydrase inhibitors (decrease CSF formation)
surgical: enlargement of FM, caudal fossa
115
metabolic encephalopathies
uremic encephalopathy
hepatic
hypothyroidism
116
uremic encephalopathy
long standing chronic renal failure
| hypertension, hyperparathyroidism, acidemia
117
hepatic encephalopathy
congenital (PSS) and acquired liver disease
acute or chronic liver disease
neurodepressive
ammonia, benzodiazepine like substance, GABA
118
hypothyroidism
myxedema stupor or coma
119
lysosomal storage disease
hereditary disease: accumulation of intermediate metabolite from lysosomal pathway defect- cell death
clinical syndromes: central/peripheral NS disease, hepatomegaly, skeletal abnormalities, young onset
Dx: clinical (presumptive), MRI, urine metabolite screen (limited), histopath (definitive)
therapy: none
acetyl-l- carnitine- slows progression maybe
120
CNS neoplasia
```
Meningioma
astrocytoma
oligodendroglioma
choroid plexus tumor
ependymal tumors
gangliocytomas
medullolastomas
```
121
meningioma
most common in dogs and cats
multiplies in cats
dural tails present
122
astrocytoma
equal occurence in dogs
variable malignancy
increased risk in brachycephalics
123
oligodendroglioma
more in males, brachycephalics
| more often in frontal lobes
124
choroid plexus tumor
arise in 4th ventricle
| can occur in lateral and 3rd ventricles
125
syncope
sudden loss of consciousness
deprivation of oxygen/glucose
complete recovery in seconds to minutes
126
seizure
any involuntary activity that is brief and episodic
distruption in normal electrical activity
alteration in behavior, consciousness, motor activity, sensation, autonomic function
seizure focus
127
pre-ictal period
period right before the seizure
128
ictus
the seizure itself
| usually relatively brief
129
post-ictus
period of recovery after the seizure
variable duration
temporary blindness for up to 2-4 days
130
interictal period
time between seizures
| important to determine normalcy
131
primary epileptic
no underlying cause
| familial epilepsy
132
secondary epileptic
identifiable structural cerebral lesion
| hydrocephalus, neoplasia
133
reactive epileptic
normal brain
| metabolic cause
134
dogs <1 year, > 7 years
secondary or reactive
135
cats
secondary or reactive
136
abnormal interictal period
secondary
137
time between seizures
< 4 weeks- secondary or reactive
| >4 weeks- primary
138
asymmetric localizing signs interictal
secondary
139
abnormalities CBC/chem
reactive
140
primary/familial epilepsy
most common
beagles, GSD, poodles, labs
1-5y first seizure
large breeds hard control
141
treatment- no
very infrequent seizures (2-3/year)
infrequent w/ not change (1/month or less)
repetitive seizures can lead to kindling and mirroring
142
kindling
recruiting additional neurons outside seizure focus to make larger seizure focus
143
mirroring
making seizure focus in opposite hemisphere in exact same spot
144
treatment- yes
```
frequent seizures (>1/month)
decreasing interictal period
cluster seizures
```
145
treatment options
phenobarbital
potassium bromide
zonisamide- first choice
felbamate, gapabentin (not effective as sole), levetiracetam, topirmate
carbamazepine, diazepam, primidone, phenytoin- don't use these 4
146
phenobarbital
```
standard therapy
sedation, polyphagia, PU/PD
15 days to steady state
idea therapeutic range 20-30
trough levels not important
long term monitoring- serum levels, hepatic enzymes, serum bile acids
```
147
potassium bromide
```
first line or add on
non-hepatotoxic
sedation, ataxia
don't use in cats- pulmonary toxicity
usually phenobarb works better
28 day T1/2
```
148
gabapentin
not effective by itself
| Q8 hr dosing
149
felbamate
nervousness at high doses
risk of hepatotoxicity
Q8-12h dosing
expensive but less so now- reasonable add on
150
zonisamide
drowsiness, ataxia, GI upset (levels needed control seizures)
Q12h dosing
expensive - very
151
levetiracetam
```
favorite add on
100% bioavailable
very safe in dogs
Q8hr dosing- long release for BID use
expensive (cheaper than others though)
```
152
fish oil
high omega 3-FA decrease excitatory potential of cells
| stabilize cell membrane increasing seizure threshold
153
goals therapy
ideal: stop all seizures - almost never happens
realistic: increase time between seizures, decrease seizures in a cluster
realistic expectations for clients
154
therapy fails
```
check phenobarbital fails
check thyroid/triglyceride levels
add potassium bromide
add fish oil
eliminate other issues (allergies)
evaluate KBr levels
newer anti-epileptic agents
CT/MRI? castrate male dogs? antioxidant therapy?
```
155
cluster seizures
multiples seizures in 24 hour period
per rectum diazepam or intranasal
may decrease # or severity
156
status epilepticus
failure of normal termination
any seizure >5 minutes
>3 seizures w/out return to consciousness
more severe cluster
brain damage: hypoxia, hyperthermia, acidosis, loss of autoregulation
must terminate all seizure activity
157
status epilepticus tx
diazepam first line
propofol CRI second line
isoflurane anesthesia- 3rd line
initiate phenobarb therapy at same time
