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CVSOH BVSc4 > Neuro - medicine > Flashcards

Neuro - medicine Flashcards

1
Q

What happens when an upper motor nerve is damaged?

A

Reflex arcs not inhibited - more excitable
Reduced movement (paresis)
No movement (plegia)
Increased tone
Present/increased reflexes
Disuse atrophy over time

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2
Q

What happens if a lower motor neurone is damaged?

A

Reflexes are weaker or absent
Reduced movement (paresis)
No movement (plegia)
Severe rapid atrophy
Reduced tone

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3
Q

What are the 3 questions that are the aims of the neuro exam?

A

1 - is it neurological?
2 - if so, where is it?
3 - What might be causing it?

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4
Q

What cardinal neuro presentations should prompt a neuro exam?

A

Abnormal gait
Abnormalities of head and face
Apparent blindness/deafness
Abnormal behaviour - particularly episodic behaviour
Exercise intolerance
Incontinence

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5
Q

How do you split up the spine?

A

C1-C5
C6-T2
T3-L3
L4-S2

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6
Q

What are the different kinds of lameness?

A

Painful - reduced weight bearing phase
Restrictive - altered swing phase

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7
Q

What is ataxia?

A

Lack of regulation of limbs in space

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8
Q

What is plegia?

A

Inability to make a movement

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9
Q

What is paresis?

A

Reduced ability to make a movement

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10
Q

What is weakness?

A

Cannot generate force in movement

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11
Q

How do you tell the difference between lameness and ataxia?

A

Lameness - same mistake each time
Ataxia - variable mistake in paw placement each time

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12
Q

What do proprioceptive responses require? What do they tell you?

A

Responses involve the FOREBRAIN (reflexes do not)
They act as a screening test - wont tell you where a lesion is in the nervous system, just that there is a neurological problem

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13
Q

What two tests assess proprioceptive responses?

A

Hopping
Paw placement

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14
Q

What do spinal reflexes tell you?

A

DO NOT involve the forebrain
Test well defined sections of PNS and CNS so can localise lesion

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15
Q

What reflex test will test the pudendal nerve and S1-3 spinal cord?

A

Perineal reflex - pinch will constrict anus and drop tail

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16
Q

What reflex test will test the sciatic nerve and L6-S2 spinal cord?

A

Pelvic limb withdrawal - pinch toe, all joints will flex
Tend to lose hock and digit flexion first - less mass/innervation here than hip or stifle

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17
Q

What reflex test will test the femoral nerve and L4-L6 spinal cord?

A

Patella reflex - stifle extends if strike patella tendon
Can be consciously inhibited though - test dependent limb too

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18
Q

What reflex test tests segmental nerve, lateral thoracic nerve and spinal cord up to T1?

A

Cutaneous trunci reflex - pinch skin, will contract on both sides

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19
Q

What reflex test tests median and ulnar nerves?

A

Thoracic limb withdrawal - pinch toes and all joints flex
If abnormal then their kick their leg back caudally instead of not retracting
Not that accurate - lots of nerves in brachial plexus not tested

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20
Q

A lesion in what region causes goose-stepping/floating gait?

A

C1-C5 typical gait - limbs protracted and extended fully before making contact with ground

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21
Q

A lesion in what region causes short strides in thoracic limbs and longer ataxic strides in pelvic limbs

A

C6-T2

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22
Q

What is spinal shock?

A

Temporary reduction in spinal reflexes caudal to an acute spinal cord injury occurring cranially usually to the affected reflex arcs

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23
Q

What does spinal shock mean in practice?

A

Means its easy to mistake a focal T3/L3 lesion for multifocal or diffuse disease - affects neuro exam results

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24
Q

What 4 areas of the brain are we looking to differentiate between on neurolocalisation?

A

Forebrain
Brainstem
Cerebellum
Cranial nerves

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25
Q

What are the 3 important tests of forebrain function?

A

Behavioural responses
Proprioceptive responses
The menace response

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26
Q

Where can lethargy/obtundation come from in the brain?

A

Either brainstem or forebrain sign

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27
Q

Where can mania come from in the brain?

A

ONLY the forebrain

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28
Q

What part of the brain causes seizures?

A

Forebrain disease

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29
Q

What part of the brain regulates proprioceptive responses?

A

The CONTRALATERAL forebrain

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30
Q

What does the menace response screen function in?

A

Eye
Optic tract
Forebrain
Cerebellum
Brainstem
Facial nerve

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31
Q

Which cranial nerves cant be tested reliably?

A

I - olfactory
IV - trochlear
XI - accessory spinal

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32
Q

How should you always look for a head tilt?

A

Look when the dog is walking towards you

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33
Q

What nerves do you test for when just observing head and face?

A

Vestibulocochlear nerve
Trigeminal nerve
Facial nerve

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34
Q

What is tested by looking at the palpebral fissure narrowing?

A

Sympathetic denervation

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35
Q

What is miosis? What is the opposite?

A

Inappropriate constriction
Mydriasis - inappropriate dilation

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36
Q

What is the route of the sympathetic eye supply?

A

Down spinal cord through brachial plexus then back up vago-sympathetic trunk

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37
Q

What are the key differentials for miosis?

A

Horners
Uveitis
Reflex constriction with corneal pain

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38
Q

What nerves are tested in the palpebral reflex?

A

Tap medial canthus - maxillary trigeminal (more reliable)
Tap cornea - ophthalmic trigeminal

Facial
Brainstem

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39
Q

What does it mean if there is no blink on palpebral reflex?

A

Facial, brainstem or trigeminal lesion

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40
Q

How does a brainstem lesion affect facial and trigeminal function?

A

Can affect both - cant feel or cant move

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41
Q

What nerves are tested in menace response?

A

Optic nerve (II) - sensory
Forebrain
Cerebellum
Brainstem
Facial nerve (VII) - motor

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42
Q

What sides of the brain could the lesion be in that are tested in the menace response?

A

Contralateral forebrain
Ipsilateral cerebellum

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43
Q

How do you do the menace response?

A

Hold head, cover contralateral eye
tap face - make sure they blink and are looking at you
Small movement from far away - no air movement

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44
Q

How do you test if they can see? What nerves does it test?

A

Visual fixation - tests retina, optic tract or forebrain

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45
Q

What is the test to see if the eyes respond to light?

A

The pupillary light reflex - shine bright light to see if there is bilateral pupillary constriction

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46
Q

What causes neither pupil to restrict from the bright light in pupillary light reflex?

A

If there is a retinal lesion

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47
Q

What causes only other eye to constrict when shining light into eye during pupillary light reflex?

A

Oculomotor not working
Or iris not working

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48
Q

What does abnormal nystagmus indicate?

A

If there is cerebellar disease or vestibular system disease

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49
Q

What is positional nystagmus?

A

When nystagmus is only visible when animals are in an abnormal position
Must test if disease of cerebellum or vestibular system is possible

50
Q

What nerves are tested when assessing swallowing and barking?

A

Glossopharyngeal (IX)
Vagus (X)
Hypoglossal (XII)

51
Q

How do you do the gag reflex?

A

Open their mouth and try to touch larynx - should push fingers out of mouth

52
Q

What other test of eating/barking can you do?

A

Owner assessment - more reliable than the gag reflex

53
Q

What are the features seen in forebrain lesions?

A

Altered behaviour
Proprioceptive deficits
Reduced menace response

54
Q

What are the features seen in brainstem lesions?

A

Altered behaviour
Proprioceptive deficits
Other cranial nerve disease

55
Q

What are the features seen in cerebellar lesions?

A

Abnormal movement in all 4 limbs
Head tilt/nystagmus
Absent menace with normal vision

56
Q

What are the features seen in cranial nerve lesions?

A

Cranial nerve test dysfunction
No other neuro deficits

57
Q

What is the five finger rule for prioritising clinical information?

A

Signalment
Onset
Progression
Symmetry
Pain
Localisation

58
Q

What disease groups can young animals get?

A

Degenerative (only young and old get these)
Anolamous (eg. congenital abnormality)
Toxic
Traumatic

59
Q

What disease groups can older dogs get?

A

Degenerative
Neoplastic
Metabolic
Vascular

60
Q

What disease groups can you rule out if the dog is middle aged?

A

Degenerative
Anomalous (congenital)

61
Q

What disease groups are fast onset?

A

Toxic
Neoplastic
Inflammatory
Traumatic
Vascular

62
Q

What is the difference between onset and progression?

A

Onset - how long it took to go from normal to their worst (eg. peracute, acute, insidious)
Progression - whether the most severe signs have already been reached

63
Q

What disease groups have strong asymmetry?

A

Vascular disease
Neoplastic disease

64
Q

What disease groups have strong symmetry?

A

Bloodborne diseases - toxic, metabolic
Genetic diseases

65
Q

Where does pain arise from in the CNS?

A

No nociceptors in brain or spinal cord
But adjacent structures do - meninges, muscles, connective tissue etc.

66
Q

What disease groups are non painful?

A

Degenerative
Anomalous
Metabolic
Toxic
Vascular

67
Q

What disease groups are painful?

A

Traumatic
Neoplastic
Inflammatory

68
Q

How do you tell the difference between a central (brainstem) vs peripheral (nerve) cranial neuropathy?

A

Central likely if obtunded or paretic
Peripheral likely if all signs can be explained by one nerve not working
Multiple nerves affected could be central or peripheral

69
Q

What are the different fibres in the spinal cord that help when assessing spinal cord injury severity? Where are they?

A

Proprioceptive fibres - dorsal, superficial
Motor fibres
Nociceptive fibres - deepest

70
Q

What is the worst prognosis when assessing spinal cord injury severity?

A

If cant move, cant feel, no pain perception
Nociceptive fibres deepest so if these damaged then very damaged spinal cord
No pain reaction = ‘deep pain negative’

71
Q

How do you tell pain perception?

A

Behavioural response - moving head, lip licking
Cant tell just from withdrawing leg as this is a reflex

72
Q

What assesses brain injury severity?

A

Modified Glasgow coma score - evaluates movement, reflexes and consciousness

73
Q

What are the signs of raised intracranial pressure in a dog?

A

The Cushing’s reflex:
Increased blood pressure with decreased heart rate
In a comatose dog

74
Q

What is the intervertebral disc made up of?

A

Anulus fibrosis - outside, holds disc together
Nucleus pulposis - fluid filled, allows flexible back

75
Q

What are the features of normal disc ageing?

A

Fibrous metaplasia - less fluid filled, nucleus replaced with collagen
Some tearing and healing of anulus
Enthesiophyte formation - spondylosis

76
Q

What is spondylosis? What is it a sign of?

A

New bone formation ventral to vertebral column
Is a NORMAL sign of aging, not an indicator of spinal disease

77
Q

What are the 3 main types of disc disease?

A

Non-compressive nucleus pulposis extrusion (traumatic)
Disc extrusion (hansen type 1)
Disc protrusion (hansen type 2)

78
Q

What is Non-compressive nucleus pulposis extrusion?

A

Normal segment subjected to supramaximal force
small fragment of nucleus herniates and contuses cord with no compression (bruises)

79
Q

What is Disc extrusion (hansen type 1)?

A

Nucleus pulposis undergoes chondroid degeneration
The hard calcified nucleus of the disc extrudes of out anulus under everyday pressure and causes compression and contusion

80
Q

What is disc protrusion (hansen type 2)?

A

Continued progressive fibroid degeneration - normal
But the anulus ligament degenerates and hypertrophies over time, causing progressive compression

81
Q

What are the 3 conservative treatments of thoracolumber disc disease management?

A

Rest
Medication - Non steroidals (steroids dont work for acute spinal cord injury)
Time - long recovery times

82
Q

What is the surgical treatment for thoracolumbar disc disease?

A

If ventrolateral compression (most common) - mini-hemilaminectomy (window into ventral bone)
Also known as ventral slot

83
Q

What indicates dogs dont need surgery for disc extrusions?

A

If the dog can walk with disc disease it is likely to get better without surgery

84
Q

How quickly do disc protrusions need surgery?

A

Urgent but not an emergency - not critically time dependent as long as more disc doesnt come out

85
Q

How often do dogs with disc extrusions relapse?

A

7% with surgery
18% without surgery

86
Q

When is surgery indicated for disc protrusions?

A

For progressive cases

87
Q

What age dogs get disc extrusions?

A

Always over 2 years old

88
Q

What type of disc disease is typically asymmetrical?

A

Disc extrusion

89
Q

What is a ‘wobbler’?

A

Any cervical spine disease that causes ataxia
(slightly different to horse wobblers)

90
Q

What are the two types of wobbler?

A

Disc protrusions
Degenerative hyperplasia - articular facet hypertrophy (more bone put down to stabilise)

91
Q

What degenerative changes are associated with disc protrusions?

A

Flaval ligament hypertrophy
Dorsal ligament hypertrophy
Disc prolapse

92
Q

What are the two treatments for wobblers disease in small animals?

A

Decompression - ventral slot
Distraction fusion - implant to fix bones

93
Q

What is myelomalacia? When does it occur?

A

Progressive spinal cord death - softening
Fatal, untreatable and irreversible
Occurs 1-5 days after any spinal cord injury in 20% of pain negative dogs

94
Q

What are the signs of myelomalacia?

A

Agitation/lethargy
Hyper/hypothermia
Ascending cutaneous trunci reflex cut off

95
Q

What is the main cause of ischaemic myelopathy?

A

Usually a fibrocartilaginous embolism in the ventral artery

96
Q

What disease does ischaemic myelopathy behave almost identically to?

A

Acute non-compressive nucleus pulposis extrusions

97
Q

What is the clinical presentation of ischaemic myelopathy (and acute non-compressive nucleus extrusions)?

A

Signalment - any dog (non-chondrodystrophic)
Onset - acute (hours)
Progression - non progressive
Symmetry - asymmetrical
Pain - none
Localisation - any spine

98
Q

How do you treat ischaemic myelopathy and acute non-compressive nucleus extrusions?

A

Currently no surgical treatment for either condition
Most will be able to walk and not have incontinence depending on severity
50% of no pain sensation dogs will recover walking ability

99
Q

What most commonly causes haemorrhagic myelopathy?

A

Angistrongylus vasorum

100
Q

What is the clinical presentation of haemorrhagic myelopathy?

A

Acute onset
Not painful
Non progressive
MULTIfocal

101
Q

What tends to cause spinal fractures?

A

Need significant trauma eg. RTA
Not just from exercise

102
Q

So what are the 3 conditions of acute onset, non progressive myelopathies?

A

Acute, non-compressive nucleus extrusion
Ischaemic myelopathy
Spinal fracture

103
Q

What are 5 conditions causing progressive myelopathies?

A

Degenerative myelopathy (like motor neurone disease in humans)
Arachnoid fibrosis
Vertebral malformations
Neoplasia
Myelitis/meningomyelitis

104
Q

What is degenerative myelopathy?

A

Non-painful, progressive neuronal death of the spinal cord
Asymmetrical
In older dogs

105
Q

What is the most common risk factor for degenerative myelopathy?

A

Genetics - SOD1 mutation

106
Q

What is arachnoid fibrosis?

A

Non painful, progressive obstruction to CSF flow around spinal cord
Often caused faecal incontinence - atypical for ambulatory animals

107
Q

What tends to cause arachnoid fibrosis?

A

Meningeal injury or developmental anomaly

108
Q

What is the clinical presentation of neoplasia affecting the spinal cord?

A

Older than 6 years
Insidious but often acute worsening after bleed/fracture
Strongly asymmetrical
Painful (but not always)
Any spine region

109
Q

What are the main causes of myelitis/meningomyelitis?

A

Autoimmune - dogs
FIP - cats
Toxoplasma/neopsora

110
Q

What is steroid responsive meningitis/arteritis?

A

Immune mediated inflammation of the meninges and small arteries

111
Q

What is the clinical presentation of steroid responsive meningitis/arteritis?

A

Neck pain - NO NEURO DEFICITS (only affects meninges)
Always less than 2 years old
Acute
Strongly waxin and waning
Symmetrical
Very painful

112
Q

How do you diagnose steroid responsive meningitis/arteritis?

A

Fever
Cisternal spinal fluid analysis - lots of neutrophils

113
Q

What is the prognosis for steroid responsive meningitis/arteritis?

A

Tend to relapse but very good for eventual remission

114
Q

What causes atlantoaxial subluxation?

A

Failure of dens to form properly or traumatic fracture

115
Q

What is the clinical presentation of atlantoaxial subluxation?

A

Toy breed dogs - less than 6 months at first episode
Acute
Progressive - wax and wane
Symmetrical
Very painful

116
Q

What is discospondylitis?

A

Haematogenous spread of bacteria/fungus to vertebrae allowing local invasion into discs
Causes slow abcess development in disc, spreading to end plates and vertebrae

117
Q

What is the clinical presentation of discospondylitis?

A

Multisystemic localisation, systemic disease
Any dog
Insidious onset
Progressive - may wax and wane
Symmetrical
Moderate to marked pain - more pain than neuro deficits

118
Q

What disease can cause discospondylitis in imported dogs?

A

Brucella

119
Q

So what are the neck pain differential diagnoses depending on age?

A

Under 2yo - steroid responsive meningitis/arteritis or atlantoaxial subluxation
Over 2yo - disc disease, discospondylitis or tumour

120
Q

What is lumbosacral disease?

A

When the cauda equina is compressed by a combination of degenerative vertebral changes and traumatic damage from disc extrusion

121
Q

What does lumbosacral disease cause?

A

Very painful
Inflammation
Tail flaccidity
Incontinence

122
Q

What is the treatment for lumbosacral disease?

A

Rest
Epidural steroids
Surgical stabilisation and/or decompression

CVSOH BVSc4 (86 decks)

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