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Neuro Flashcards

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1
Q

What defect do cats with complex partial seizures have?

A

ABs against voltage gated potassium channels (alter excitability neural membrane) - NG hippocampal necrosis

Dogs juvenile epilepsy mutation of voltage gated K channel

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2
Q

Threshold for voltage gated sodium channels?

A
  • 55

Membrane usually - 70

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3
Q

Mechanism of phenobarbital and diazepam?

A

GABA receptor agonist - increase time chloride channel open when GABA binds, make cell more neg

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4
Q

Glutamate - what is it and what does it do?

A

Major excitatory neurotransmitter.

AMPA and NMDA receptors.

AMPA depolarises membrane, release Mg ion, block NMDA. Bind NMDA allow sodium conduction and increase excitatory effect. NMDA channel also allow calcium in - more prolonged synaptic effects.

Can cause cell death from too much calcium if too much NMDA agonism.

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5
Q

Coton de Tulear motor learning/cerebellar dysfunction?

A

mGluR1 mutation (GRM1) - which is conc on purkinje cells cerebellum

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6
Q

Segments for patellar reflex?

A

L4 - L7

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7
Q

How to manage different kinds of brain oedema?

A

Cytotoxic/interstitial - underlying cause

Vasogenic - steroid/osmotics

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8
Q

What lactate most likely to produce encephalopathy?

A

D-lactate, not usually measured - bacteria in GI tract?

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9
Q

L-2-hydroxyglutaric aciduria?

A

Staffie and Yorkie, around 4y, grey matter hyperintensity

Measure in urine.

L2HGDH mutation.

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10
Q

First signs of lysosomal storage disease?

A

Cerebellar

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11
Q

Brain tumour characteristics that predict seizures?

A

Frontal lobe, contract enhancement, subfalcine/subtentorial herniation.

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12
Q

When should brain neoplasia be considered as a differential for seizures?

A

> 4y

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13
Q

Prognostic indicators for brain tumours?

A

Pos - meningioma, esp cat, supratentorial, surgery + RT

Neg - glioma, metastatic infratentorial

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14
Q

Idiopathic epilepsy dogs/cats?

A

Cats only 22 % idiopathic vs majority dogs

Dog male > female

Idiopathic epilepsy in cats later onset cf familial

Idiopathic more likely dog if > 4w between first and second seizure

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15
Q

Genetic evidence IE?

A

Pure breed

Offspring (more chance and earlier age)

Genetic up to 33 % incidence

Lagoto Romagnolo - LGI2

Belgian shephard - ADAM23

Both voltage gated potassium channel

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16
Q

Tier dx idiopathic epilepsy?

A

I 2 + seizure > 24h apart 6m-6y no exam abnormalities no min bloods abnormalities

II plus BAST MRI and CSF

III EEG

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17
Q

When is MRI/CSF recommended?

A 
After exclusion reactive seeizures
Age < 6m > 6y
Intracranial neuro abnormaltiies
Status/cluster
Drug resistance single AED highest dose
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18
Q

MRI changes idiopathic epilepsy?

A

Might have vasogenic/cytotoxic oedema with recent seizure, resolve 10 - 16w

Piriform, temporal, hippocampus, cerebral cortex

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19
Q

When to give AED?

A 
Structural
sTATUS
2 + IN 6m
Bad interictal
Increasing frequency or severity over 4 seizures (three interictal periods)
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20
Q

What AED to use first?

A

Phenobarbital > bromide

Phenobarbital similar efficacy imepitoin (latter less SEs)

30 % IE need > 1
50 % need SEs to be seizure free

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21
Q

Goal of tx IE?

A

Seizure freedom = extend inter seizure interval to 3 x pretx after min 3m tx.

Partial = prevent status/cluster, decrease frequency/severity

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22
Q

Negative px control IE?

A

Male, entire, young, cluster, border collie, GSD, Staffie

Euthanasia - young, high initial frequency, poor control, status

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23
Q

Criteria for CVA?

Study These Flashcards
A

> 24h clin signs (otherwise is transient ischaemic attack)
Ischaemic (non-hemorrhagic > haemorrhagic ischaemic) more common than haemorrhagic

Territorial infarct = large vessel - cerebellum/cerebrum

Places - cerebellum, cerebrum, thalamus/midbrain, often ischaemic stroke does middle cerebral artery in dogs

24
Q

Ischaemic stroke?

Study These Flashcards
A

No cause found 50 %

Greyhounds more than all other breeds combined - hypertension? - non haemorrhagic ischaemic

Territorial cerebellar CKCS, rostral cerebellar artery

Lacunar thalamic/midbrain large breed

Hyperlip and mini schnauz?

Haemorrhagic ischamic - venous thrombosis/vascular damage with leakage during repercussion - eg HSA

Cats - feline ischaemic encephalopathy middle cerebral artery.

25
Global ischaemia?
Peracute neuro dysfunction after GA/CPR Mouth gag cat - maxillary arteries - cerebral ischaemia vision hearing Ketamine, brachycephalic
26
Prognosis with CVA?
Good if survive > 30 d. Ischaemic stroke cause = neg Intracranial haemorrhage (non traumatic) - 60 % good/excellent, cerebellum neg , hypertension neg A vasorum good outcome
27
GME tx?
Procarbazine, cytarabine (both cross BBB) Ciclosporin - might cross in GME? Trapped endothelial cells? Female predip
28
NME/NLE?
NME cerebrum with meningeal, loss demarcation white/grey matter - pug/maltese - lymph NLE cerebrum and brainstem with less meninges/cerebral cortex - yorkie - lymph/mono Procarbazine not as effective
29
What AB cross BBB?
TMPS
30
Most common fungal meningoencephalitis?
Crypto (neoformans) both cats and dogs Crypto more likely to be in CSF also Antigens Crypto, coccidioides, blastomyces NOT aspergillus/histoplasma Culture hazardous to humans - blasto, coccidiosis, histo - these might be assoc with pulm lesions
31
What antifungals cross BBB?
Fluconazole, flucytosine (NB drug resistance latter) NOT itraconazole
32
CSF FIP?
Neutrophilic then lymph/macro
33
Metronidazole tox?
Maybe GABA - treat with diazepam Vestibular dog forebrain cat
34
SRMA CSF?
Increased IgA, B:T cell ratio (blood too), IL6 and IL 8 CD11a expression - neutrophils to subarachnoid space MMP2 Serum and CSF IgA v sens less spec
35
Clinical presentation SRMA?
Can have deficits if chronic, may be due to subarachnoid bleeding Half of IMPA BMD/Boxer/Akita have concurrent meningitis
36
SRMA remission?
80 % IgA might still be increased CRP predicts relapse
37
Discospondylitis bacteria?
Staph, strep, e coli Aspergillus in young GSD female Young basset systemic TB Brucella
38
Discospondylitis sites?
L2-4 for migrating plant material (diaphragmatic crus insertion) L7 - S1,. caudal cervical, mid-thoracic, thoracolumbar May be assoc empyema
39
Discospondylitis presentation?
Spinal pain 30 % fever/systemically unwell Blood/urine culture pos 75 %
40
Imaging discospondylitis?
XR may be N 1st 2-4w XR - narrow disc space, irregular end plate, lysis/osseous proliferation XR change lags behind clin imp
41
Discospondylitis neg px?
Fungal, fracture/subluxation, endocarditis
42
Hypothyroid neuropathy?
GAG/glycogen accum in Schwann cells causes dysfunction and demyelination. Microtubule assembly and axonal transport req T4 NaKATPase dysfunction and impaired axonal transport Mucinous deposits compress cranial nerves?
43
Neuro in hypothyroidism?
Single/several limbs Trigeminal, facial, vestibular, often unilateral often multiple Axonal degeneration/demyelination
44
Polyradiculoneuritis?
Racoon, vax, infection Guilian Barre syndrome - shared antigen inciting stim with peripheral nerves anti-GM2 ganglioside ABs Ventral nerve roots inflamm Ddx MG tick paral botulism Steroids not helpful. IVIG might be
45
Tick paralysis?
Dermacentor/Ixodes Neurotoxin female ticks prevents ACh release 5-9d post tick attachment Cats resistant AUS - cats too, plus ANS/cardiac dysfunction, get worse after tick removal
46
Botulism?
Neurotoxin type C (BoNTC), v rare cats SNARE cleaved by toxin, no Ach release Aminoglycoside and ampicillin potentiate NM blockade
47
Myaesthenia gravis pathophys?
AutoAB cf nicotinic AChR, complement mediated destruction
48
MG signalment?
<4 or >9 Akita, GSD, GRet Abyssinian, Somali
49
Clinical presentation?
Mesaoesophagus less common in cats Cervical ventroflexion more common cats Spinal reflexes usually there generalised diminished fulminant. fulminant not better with rest. Fulminant - around 15 % dog and cat, u retention poss, assoc with thymoma Focal - ocular, facial, oesophagus, pharyngeal, laryngeal
50
Concurrent dz MG?
Thymoma, hT4, hAC, polymyositis, masticatory myositis
51
AChR AB titre?
Species specific. 98 % generalised. May be neg early, affected by steroids.
52
Edrophonium test?
Inhibits anti cholinesterase Isn't perfectly specific and not all MG improve Cholinergic crisis - weakness salivation tremors vomiting bradycardia bronchoconstriction resp distress Atropine and intubation req
53
MG tx?
Pyridostigmine/neostigmine Bradycardia hyper salivation diarrhoea vomiting muscle cramping weakness Mycophenolate, ciclosporin, azathioprine spare innate target adaptive immune - MMF no diff survival Spontaneous remission 88 %
54
Congenital MG?
JRT, springer, mini dachs - AChR deficiency Other breeds probably the same, samoyed/smooth fox terrier Auto recessive GDH JART SFT 6 - 9 W Gammel Dansk Honsehund 4m and not responsive to anticholinesterase - presynaptic? Need to quantify AChR in muscle bx Spontaneous resolution mini dachs, GDH stable and mild
55
Labrador EIC?
DNM1 auto rec Enzymes maintain synaptic vesicle function in sustained neurotransmission < 2y Los patellar reflex Pyruvate/lactate normal
56
Feline panleukopenia?
FPV in last 3w gestation/1st 3w life, destruction germinal layer, cerebellar hypoplasia Hydrancephaly Vac mod live FPV in pregnancy
57
FIP?
33 % neuro, most common in non-effusive, cerebellum/pons/medulla oblongata Eyes 53 % Seizures 1/3 = poor px 37 % normal MRI RTPCR in CSF, serology unhelpful

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