Neurology (1-10) Flashcards by Natalie Bubenheim

name the 4 things to observe in the hands off neurological examination

mentation/sensorium
posture
gait
asymmetry

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name the 4 parts of the hands on neurological exam

proprioception
spinal reflexes
cranial nerves
(nociception)

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name 3 tools needed for a neurological exam

artery forceps
reflex hammer (pleximeter)
pen torch

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name 5 possible mentations - levels of consciousness

normal
dull/depressed
obtundation
stuporous
comatose

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name the term

heard turn + body turn

pleurothotonus

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name the term

hunched spine;
rounded back

kyphosis

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name the term

dip of the back;
characterized by the arching of the spine, the raising of the head

lordosis

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name the special posture

stuporous or comatose;
extension of all limbs;
extension of head and neck (opisthotonus);
acute rostral brainstem injury

decerebrate rigidity

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name the special posture

mentation normal;
extension of head and neck (opisthotonus);
thoracic limbs extended;
hips flexed;
acute rostral cerebellar injury

decerebellate rigidity

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name the special posture

extension of thoracic limbs;
normal mentation;
reduced to normal tone in pelvic limbs;
normal postural responses in thoracic limbs;
acute thoracolumbar injury

Shiff-Sherrington

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name 3 causes of ataxia (uncoordinated gait)

cerebellar
vestibular
general proprioceptive/spinal

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name the term

inability to generate movement;
(weakness)

paresis

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based on the prefix, which limb(s) are affected?

mono-

one limb only

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based on the prefix, which limb(s) are affected?

para-

pelvic limbs only

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based on the prefix, which limb(s) are affected?

hemi-

one thoracic and one pelvc (same side)

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based on the prefix, which limb(s) are affected?

tetra-

all four limbs

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what is it called to test hopping proprioception on thoracic limbs only

wheelbarrow

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what is it called to test hopping proprioception on pelvic limbs only

external postural thrust

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do withdrawal reflexes travel to the brain?

no
(spinal reflex)

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do patellar reflexes travel to the brain?

no
(spinal reflex)

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what nerve does the patellar reflex test?

femoral nerve

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what is the appropriate withdrawal reflex?

flexion of all flexors

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what is the appropriate patellar reflex?

kicking out of limb

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what is the appropriate cutaneous trunci reflex?

bilateral contraction of cutaneous trunci

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does the cutaneous trunci reflex travel to the brain?

no (spinal reflex)

what spinal cord segments are involved in the withdrawal reflexes (afferent nerve)

C6-T2 or L4-S1

what spinal cord segments are involved in the patellar reflex? (femoral nerve)

L4-L6

what spinal cord segments are involved in the cutaneous trunci reflex? (afferent nerve, brachial plexus, lateral thoracic nerves, cutaneous trunci mm.)

C8-L4/5

what spinal cord segments are involved in the perineal reflex?

S1-S3

what two neuro responses should you test for the head | (hands on)

1. menace response 2. nasal septal mucosal response

name 5 neuro reflexes you should test for the head | (hands on)

1. pupillary light reflex 2. palpebral reflex 3. corneal reflex 4. vestibulo-ocular reflex 5. gag reflex

what nerves are involved in the palpebral reflex?

CN V & VII (trigeminal & facial)

what nerves are involved in the corneal reflex?

CN V, VI, & VII | (trigeminal, abducens, facial)

what nerves are involved in the gag reflex

CN IX & X | (glossopharyngeal & vagus)

what nerves are involved in the vestibulo-ocular reflex?

CN III, IV, VI, & VIII | (oculomotor, trigeminal, abducens, vestibulocochlear)

name the 5 spinal cord segments

1. C1-C5 2. C6-T2 3. T3-L3 4. L4-S1 5. S2-S3

what part of the brain is the prosencephalon?

forebrain

what part of the brain is the telencephalon?

cerebral hemispheres

what part of the brain is the diencephalon?

thalamic region

# name the part of the brain more functional subdivision of the brain, including cerebrum and diencephalon (thalamus)

forebrain

# disease of what part of the brain would show these clinical signs? 1. head pressing 2. staring at walls 3. getting stuck in corners 4. circling 5. continuous pacing 6. compulsive behaviour 7. normal gait

forebrain disease

what is the most frequent clinical sign of forebrain disease?

generalised tonic clonic seizures

name the 11 categories of differential diagnoses

1. Vascular 2. Infectious/Inflammatory 3. Traumatic 4. Toxic 5. Anomaly 6. Metabolic 7. Idiopathic 8. Iatrogenic 9. Neoplastic 10. Nutritional 11. Degenerative | (VITAMIN D) (VITTAMIINN D)

name 3 vascular diseases of the forebrain

1. diffuse cerebral ischemia 2. focal cerebral ischemia 3. diffuse or focal hemorrhages

# name the vascular disease of the forebrain cardiopulmonary arrest; anaesthetic complication; severe cerebral oedema following a toxic or traumatic event

diffuse cerebral ischemia

# name the vascular disease of the forebrain causes: chronic kidney disease, hyperadrenocorticism, idiopathic hypertension, septic or neoplastic emboli; hypercoagulable state; migrating parasites

focal cerebral ischemia

name 3 infectious diseases of the forebrain

1. Rabies disease (Lyssavirus) 2. canine distemper virus (CDV) 3. Feline Infectious Peritonitis (FIP)

# name the infectious disease of the forebrain not endemic in the UK; paralytic and furious manifestations

rabies

# name the infectious disease of the forebrain neurological abnormalities 1-3 weeks after systemic disease; hyperesthesia, vestibular signs, ataxia, cerebellar signs, tetraparesis and myoclonus

canine distemper virus (CDV)

# name the infectious disease of the forebrain three presentations: 1. multifocal CNS disease 2. T3-L3 myelopathy 3. central vestibular syndrome

feline infectious peritonitis (FIP)

# name the inflammatory disease of the forebrain most common inflammatory disease in dogs; unknown origin but autoimmune pathology; 2 forms: 1. necrotising 2. granulomatous

meningoencephalitis of unkown origin

this is the pressure exerted by tissues and fluids within the cranial vault

intracranial pressure (ICP)

name 4 causes of increased intracranial pressure (ICP) in head trauma

1. intracranial hemorrhage 2. cerebral oedema 3. systemic hypotension 4. hypoxaemia

name the 4 goals of head trauma management

1. maintain ventilation 2. avoid hypertension 3. prevent/treat cerebral oedema 4. treat increased ICP

name 1 anomalous disease of the forebrain

1. hydrocephalus (congenital or acquired)

# name the anomalous disease of the forebrain increased CSF volume in dilated ventricular cavities

hydrocephalus

what are the 2 treatment options for congenital hydrocephalus?

1. corticosteroids (medical) 2. ventriculoperitoneal shunt (surgical)

# name the metabolic disease of the forebrain acquired or congenital portosystemic shunt; "toxic" substances (ammonia) from intestinal degradation are not metabolised by liver or bypass it, reaching the brain

hepatic encephalopathy (HE)

name 3 ways to diagnose hepatic encephalopathy (HE)

1. bile acid stimlation test 2. abdominal ultrasound 3. abdominal CT scan with angiogram

name 3 ways to medically treat hepatic encephalopathy (HE)

1. low protein diet 2. antibiotics 3. lactulose

# name the part of the brain coordinates all the motor activities: voluntary movements, postural movements, reflex movements ; assists in maintenance of the equilibrium; controls RATE, RANGE, and FORCE of movement

cerebellum

# name the term swaying of the body (truncal ataxia) from side to side, forward and backward, and occasionally dorsoventrally

titubation

# name the cerebellum disease young dogs (<5y), small breeds; mild non-suppurative encephalitis; suspected autoimmune-mediated eitiology; originally mistaken for seizures; Tx with immunosuppressive doses of corticosteroids tapered over 3-6 months

idiopathic tremor syndrome | ('white shakers')

# name the part of the brain responsible for maintaing balance regulating the position of the eyes, trunk and limbs in relation to changes in position of the head

vestibular system

name 3 things that maintaining balance depends on

1. vestibular receptors 2. vision 3. proprioceptive receptors in joints and tendons

name the 2 parts of the peripheral vestibular system

1. vestibular receptors (in utricle and saccule and semicircular canals) 2. vestibular nerve (CN VIII)

name the 2 parts of the central vestibular system

1. vestibular nuclei (in brainstem) 2. cerebellum

# name the clinical sign of vestibular disease involuntary rhythmic oscillation of the eyes (jerk eye movement with slow and fast phase) ; physiological or pathological

nystagmus

The fast phase of nystagmus is (on the same side OR contralateral) to the lesion?

contralateral

name 4 clinical signs of Horner syndrome (vestibular disease)

1. ptosis (drooping of the upper eyelid) 2. enophthalmus (eyes sinking deeper in socket) 3. miosis (constriction of the pupil) 4. 3rd eyelid protrusion

# peripheral or central vestibular disease? 1. proprioceptive deficits 2. vertical resting or positional nystagmus 3. nystagmus changing direction with changes in head position 4. cranial nerve deficits other than CN VII 5. cerebellar signs 6. decreases level of consciousness 7. paradoxical vestibuar syndrome

central vestibular disease

# name the central vestibular disease contradictory vestibular signs; caused by loss of cerebellar inhibition of the vestibular output; ex: Left head tilt & Right postural reactions deficits

paradoxical vestibular syndrome

# name the vestibular disease 1. absent physiological and/or pathologic nystagmus 2. absent head tilt 3. side-to-side swaying of the head 4. broad-base stance 5. falling to either side

bilateral vestibular disease

what nutritional deficiency can lead to central vestibular disease?

thiamine deficiency

what is the most common viral cause of central vestibular infectious disease?

FIP

# name the central vestibular inflammatory disease subacute ot chronic sterile inflammation, supected immune-mediated disorder; middle age small breed dogs; disseminated, focal and ocular form; prognosis guarded to poor; definitive diagnosis by histopathology; traditional Tx: immunosuppressive doses of corticosteroids

granulomatous meningoencephalomyelitis (GME)

# name the toxic central vestibular disease characterized by anorexia, vestibular ataxia and vertical nystagmus; recovery may be enhanced by administration of diazepam at 0.4 mg/kg TID for 3 days (competitively displaces cause from GABA receptors)

metronidazole intoxication

# name the cranial nerve diseased loss of appetite, anosmia (difficult to assess); nasal discharge, nasal obstruction; DD: viral, bacterial or fungal rhinitis; nasal adenocarcinoma, meningioma, neuroblastoma

CN I (olfactory)

# name the cranial nerve diseased blindness & pupillary light reflex (PLR) deficit

CN II (optic)

what 3 nerves/pathways are involved in the menace response?

1. CN II 2. complete visual pathway to occipital cortex 3. CN VII

what 2 cranial nerves are involved in the blinking reflex

1. CN V 2. CN VII

what cranial nerve is involved in an obstacle course/cotton ball test

CN II | (optic)

what 4 cranial nerves/pathways are involved in the PLR (direct and consensual)

1. CN II 2. complete PLR pathway 3. CN III 4. sympathetic innervation

list the 7 parts of the visual pathway to occipital cortex | (Menace Response pathway)

1. neuroepithelial cells, bipolar and ganglion cells 2. optic nerve 3. optic chiasm 4. optic tract 5. lateral geniculate nucleus 6. optic radiation 7. occipital lobe

name the 12 parts of the complete PLR pathway

1. neuroepithelial cells, bipolar and ganglion cells 2. optic nerve 3. optic chiasm 4. optic tract 5. lateral geniculate nucleus 6. optic radiation 7. occipital lobe - pretectal nuclei 8. Edinger-Westphal nucleus 9. CN III (oculomotor nerve) 10. ciliary ganglion 11. ciliary nerves 12. sphincter pupillae muscle

name the 5 step evaluation of blindness and PLRs

1. menace response 2. palpebral (blinking reflex) 3. obstacle course/cotton ball test 4. PLR (direct and consensual) 5. ophthalmoscopic exam

what is the most common differential diagnosis for blindness WITHOUT PLRs

SARD (sudden acquired retinal degeneration)

where is the oculomotor (CN III) nuclei located?

midbrain

what nucleus is the parasympathetic component of CN III

Edinger-Westphal nucleus

name 3 functions of CN III (oculomotor nerve)

1. innervation of dorsal, medial & ventral recti and ventral oblique extraocular muscles 2. levator palpebral muscle of upper eyelid 3. sphincter pupillae muscle for contricition of pupil

what extraocular muscle is innervated by CN IV (trochlear nerve)

dorsal oblique

what clinical ocular sign is seen with a CN IV deficit

lateral rotation of the eye

what 2 ocular muscles are innervated by CN VI (abducent nerve)

1. lateral rectus extraocular muscle 2. retractor bulbi muscle

what 2 clinical ocular signs will be seen with a CN VI (trochlear nerve) deficit?

1. medial strabismus 2. inability to retract the globe

name the 3 branches of CN V (trigeminal)

1. mandibular branch 2. ophthalmic branch 3. maxillary branch

# name the trigeminal nerve (CN V) branch Motor - muscles of mastication; sensory - lower jaw

mandibular branch

# name the trigeminal nerve (CN V) branch sensory - dorsal eyelid and cornea

ophthalmic branch

# name the trigeminal nerve (CN V) branch sensory - ventral eyelid and nasal area

maxillary branch

# name the cranial nerve Function: motor - muscles of facial expresion sensory - inner surface pinna taste sensation rostral two-thirds tongue

CN VII (facial nerve)

what test can be performed to asses CN VIII (vestibulocochlear nerve)

BAER test | (brainstem auditory evoked response test)

# name the cranial nerve motor - muscles of pharynx sensory - pharyngeal mucosa and caudal third of tongue parasympathetic function - zygomatic and parotid salivary glands ; gag and swallow reflex

CN IX (glossopharyngeal nerve)

# name the cranial nerve motor - muscles of pharynx, larynx (recurrent laryngeal nerve) and palate (deficit leads to dysphagia); motor parasympathetic - viscera in chest and cranial abdomen (deficit leads to inspiratory dyspnea due to laryngeal paralysis); sensory - pharynx, larynx and viscera (deficit leads to megaoesophagus)

CN X (vagus nerve)

# name the cranial nerve motor - neck muscles (trapezius, sternocephalicus and brachiocephalicus)

CN XI (accessory nerve)

# name the cranial nerve motor - intrinsic and extrinsic muscles of the tongue ; deficits in tongue movements, atrophy, and deviation of the tongue

CN XII (hypoglossal nerve)

# name the term "a non-specific, proxysmal event of the body that represents an abnormality of forebrain neurotransmission" originated by an imbalance of excitatory and inhibitory influences on the cerebral neurons

seizure

# name the epileptic seizure phase behavioural changes or autonomic signs that may precede an observable seizure

pre-ictal phenomenon

# name the epileptic seizure phase a sudden paroxysmal neurologic occurrence

ictus

# name the epileptic seizure phase a transient clinical abnormality of teh CNS function that appears or becomes more evident when the clinical signs of the seizure have ended; disorientation, ataxia, central blindness, behavioural changes

post-ictal phenomenon

# name the type of seizure involvment of both the cerebral hemispheres; tonic-clonic, tonic, atonic, absence seizures

generalized seizures

# name the type of seizure activation of only a part of a cerebral hemisphere; simple or complex

focal seizures

# name the type of focal seizure consciousness is not impaired

simple focal seizure

# name the type of focal seizure with impairment of consciousness

complex focal seizure

# name the term two or more seizures in a 24-hour period or one seizure per day

cluster of seizures

# name the term a seizure that shows no clinical signs of arresting after 5 minutes of activity, or recurrent seizures with no recovery between them

status epilepticus

name 7 differential diagnoses for a seizure

1. syncope 2. narcolepsy/cataplexy 3. neuromuscular 4. paroxysmal diskinesia 5. vestibular episode 6. idiopathic head tremor 7. pain

# name the term signs occur suddenly against a background of normality

paroxysmal

# name the term movement of the body that is involuntary

dyskinesia

name the 3 main categories of epilepsy aetiology

1. idiopathic epilepsy 2. symptomatic epilepsy 3. cryptogenic epilepsy

# name the epilepsy aetiology classification no identifiable cause; genetic/familial predisposition; age dependent; genetic

idiopathic epilepsy

# name the epilepsy aetiology classification result of identifiable intracranial disease (brain tumours, encephalitides, infarcts) or extracranial disease (toxic or metabolic disorders

symptomatic epilepsy

# name the epilepsy aetiology classification epilepsy of unknown cause; usually older animals

cryptogenic epilepsy

name the 5 investigations that should be made for seizure activity

1. signalment 2. history 3. physical and neurological examination 4. CBC, biochem panel, Urinalysis

name 5 investigations that can be made for a more extensive work up for seizure activity

1. bile acids, ammonia 2. serological studies 3. EEG 4. CSF analysis 5. MRI

name 5 guidelines for when to start anti-seizure medication

1. more than 1 seizure w/in a 6 month period 2. one period of cluster seizures 3. one period of status epilepticus 4. prolonged or severe post-ictal signs 5. suspect structural brain disease

name 3 anti-seizure drugs (ASDs) licensed in dogs

1. phenobarbitone/Phenobarbital 2. Imepitoin 3. Potassium bromide

any licensed anti-seizure drugs (ASDs) in cats?

name 5 'off-label' anti-seizure drugs (ASDs) used in dogs and cats

1. Levetiracetam (Keppra) 2. Zonisamide (Zonegram) 3. Gabapentin (Neurontin) 4. Pregabalin (Lyrica) 5. Topiramate (Topamax)

# name the anti-seizure drug (ASD) GABA receptor agonist (potentiating inhibition); barbiturate; 50% protein bound; metabolized by liver (~75%, rest excreted unchanged in urine); autoinducer of hepatic microsomal enzymes; 10-20 days for steady state

Phenobarbitone

what is one of the most important idiosyncratic side effects of Phenobarbitone

hepatotoxicity

what is the ideal range for phenobarbitone serum levels

25-30 mg/L

what is the Phenobarbitone dose in dogs and in cats?

dogs: 2-3 mg/kg PO BID cats: 2 mg/kg PO BID

# name the anti-seizure drug (ASD) bromide hyperpolarises neurons entering via Cl- channels; halide salt; excreted in kidneys (no biotransformation); half-life in dogs 15-30 days; 2-5 months for steady state (long time)

Potassium Bromide

which anti-seizure drug (ASD) should NOT be used in cats becuase it can cause eosinophilic bronchitis

Potassium bromide

what is the dose for Potassium bromide to treat seizures in dogs

20-40 mg/kg PO SID or split BID

# name the anti-seizure drug (ASD) partial GABA agonist; linear pharmokinetic, so NOT currently monitoring serum levels ; anxiolytic (licensed for noise phobia)

Imepitoin (Pexion)

# name the anti-seizure drug (ASD) inhibits neurotransmitter release (binds to synaptic vesicle protein 2A); mostly excreted unchanged by the kidneys; may cause hypersalivation in cats; linear pharmokinetic, so NOT currently monitoring serum levels

Levetiracetam

# name the anti-seizure drug (ASD) inhibition of T-type Ca channels and CG-Na channels = inhibit excitation!; allosterically bind to GABA R to increase function; regulate transporters to decrease glutamate and increase GABA; metabolised by CYP3A4; free radical scavenger; weak carbonic anhydrase inhibitor

Zonisamide

which emergency seizure medication should NOT be used in cats because it can cause idiosyncratic hepatic necrosis

benzodiazepines

name the 4 anti-seizure drugs (ASDs) that can be used in an emergency

1. Phenobarbital 2. Potassium bromide 3. Levetiracetam 4. Midazolam/Diazepam

what 4 tests should be done if a patient is newly seizuring naive of anti-seizure drugs (ASDs)

1. Haematology (CBC) 2. Biochem 3. Ammonia 4. Bile acids (if appropriate)

what 5 tests should be done for a returning patient on anti-seizure drugs (ASDs)

1. CBC 2. Biochem 3. Ammonia 4. Bile acids (if appropriate - phenobarbital) 5. serum levels of anti-seizure drugs (ASDs) (when appropriate)

how to treat Status Epilepticus in the first 5-30 minutes?

Diazepam or Midazolam

how to treat Status Epilepticus after 30-60 minutes?

Phenobarbital, Levetiracetum, OR Potassium bromide

what is the dose of Diazepam for treating Status Epilepticus

0.5-1.0 mg/kg IV or rectally, repeated admin. at least 5 min apart up to 3 times in 24h

what is the dose of Midazolam for treating Status Epilepticus

0.2-0.5 mg/kg IN/IV/IM, repeated admin at least 5 min apart up to 3 times in 24h

what is the dose of Phenobarbital for treating Status Epilepticus in pre-treated patients

3-5 mg/kg IV as a bolus

what is the dose of Phenobarbital for treating Status Epilepticus in non-pretreated animals

loading: 2-4 mg/kg q6-8h (max of 24 mg/kg) OR 3-5 mg/kg IV as a bolus (or orally in event of cluster seizure)

what is the dose of Levetiracetam for treating Status Epilepticus

loading dose: 40-60 mg/kg IV or rectal followed by: 20 mg/kg IV q8h

what is the loading dose of Potassium Bromide for treating Status Epilepticus in a non-pretreated patient

400-600 mg/kg/24h (100 mg/kg PO q4-6h)

what is the treatment for Status Epilepticus after 60-120 minutes

Levetiracetum, Propofol

what is the treatment for Status Epilepticus after more than 120 minutes (refractory or drug-resistant SE)

Ketamine OR Inhalant anaesthesia

name 4 degenerative diseases of the spinal cord of dogs

1. intervertebral disc disease (IVDD) 2. cervical spondylomyelopathy (CSM) 3. Degenerative lumbosacral stenosis (DLSS) 4. Degenerative myelopathy (DM)

name the 2 components of the intervertebral disc

1. nucleus pulposus 2. annulus fibrosus

# name the component of the intervertebral disc inner component, gelatinous in young normal animals

nucleus pulposus

# name the component of the intervertebral disc outer layer, fibrous, ventral portion thicker than dorsal

annulus fibrosus

# name the structure from T2 to T10; cover annulus dorsally; intervertebral disc disease unusual in these locations

intercapital ligament

# name the type of IVDD intervertebral disc extrusion (IVDE); chrondrodystrophic breeds; degeneration process starts < 1y old; acute

Hansen type 1

# name the type of IVDD intervertebral disc protrusion (IVDP); non-chondrodystrophic breeds; older > 5y old; chronic

Hansen type 2

name the 4 stages of IVD degeneration

1. chondroid metaplasia 2. dehydration of nucleus pulposus 3. fissures in annulus fibrosus 4. necrosis and calcification

what 3 things does the severity of neurological deficits with IVDD depend on?

1. volume of disc material 2. rate of extrusion 3. duration of compression

name the 4 spinal refelxes that should be tested in a neurological examination

1. withdrawal reflexes 2. patellar reflex 3. perineal reflex 4. cutaneous trunci reflex

name the 5 grades of dysfunction

1. pain or hyperaesthesia 2. proprioceptive ataxia and ambulatory paresis 3. non-ambulatory paresis 4. plegia 5. plegia with loss of pain perception

what 2 clinical signs will be seen with an upper motor neuron (UMN) lesion

1. increased muscle tone 2. normal or increased spinal reflexes

what 2 clinical signs will be seen with a lower motor neuron (LMN) lesion

1. decreased motor tone 2. decreased or absent spinal reflexes

# localise the spinal lesion tetraparesis/plegia; UMN signs on all limbs (+ bladder); ataxia on all limbs; hypalgesia of all limbs + tail

C1-C5

# localise the spinal lesion tetraparesis/plegia; LMN signs on thoracic limbs; UMN signs on pelvic limbs (+ bladder); ataxia on all limbs; hypalgesia of all limbs + tail

C6-T2

# localise the spinal lesion paraparesis/plegia; UMN signs on pelvic limbs + bladder; ataxia of pelvic limbs; hypalgesia/analgesia of pelvic limbs and tail

T3-L3

# localise the spinal lesion paraparesis/plegia; LMN signs on pelvic limbs; ataxia of pelvic limbs; hypalgesia/analgesia of pelvic limbs and tail

L4-S1

# localise the spinal lesion tail paresis/plegia; LMN signs on anus, tail, perineum + bladder; hypalgesia/analgesia of tail

S1-Cd

# localise the IVDD based on clinical signs 1. pain/hyperaesthesia (reluctance to move) 2. reduced range of movement in the neck 3. low head carriage 4. thoracic limb lameness = 'nerve root signature' 5. ambulatory tetraparesis and proprioceptive ataxia 6. non-ambulatory tetraparesis 7. tetraplegia 8. respiratory arrest (phrenic nerve)

cervical IVDD

# localise the IVDD based on clinical signs 1. pain/hyperaesthesia (reluctance to move) 2. Kyphosis 3. pelvic limb lameness = 'nerve root signature' 4. ambulatory paraparesis and proprioceptive ataxia 5. non-ambulatory paraparesis 6. paraplegia 7. loss of pain perception 8. urinary and faecal incontinence

thoracolumbar IVDD

name 3 radiographic changes supportive of IVD extrusion

1. narrowing of articular facets 2. narrowing of intervertebral foramen 3. presence of mineralised disc material w/in vertebral canal

what is the gold standard for imaging to diagnose IVDD? can differentiate soft tissue structures of vertebral column with 98.5% sensitivity

MRI

what is the most frequent site of IVDD in the thoracolumbar region

T11-L4

what is the most frequent site of IVDD in the cervical region in small breeds

C2-3

what is the surgical treatment option for IVDD in the cervical vertebral column

ventral slot

what is the surgical treatment option for IVDD in the thoracolumbar vertebral column

Hemilaminectomy & Fenestration

# name the term softening or degeneration of spinal cord tissue

myelomalacia

name 3 other types of intervertebral disc disease (IVDD) besides disc protrusion/extrusion

1. acute non-compressive nucleus pulposus extrusion (ANNPE) 2. hydrated nucleus pulposus extrusion (HNPE) 3. fibrocartilaginous embolism (FCE)

# name the type of IVDD sudden extrusion of small volume of disc material, impacts spinal cord with force; any breed, often associated with trauma or high-impact activity; acute onset, non-progressive lateralised neurological deficits; may be painful in first 24h; diagnose with MRI, treat conservatively

acute non-compressive nucleus pulposus extrusion (ANNPE)

# name the type of IVDD partially or non-degenerate disc extrudes, varying degree of compression; any breed, spontaneous; acute onset, non-progressive, symmetrical neurological deficits; cervical location more common; typicall non-painful; diagnose with MRI and treat conservative - surgery if not improving; excellent prognosis

hydrated nucleus pulposus extrusion (HNPE)

# name the type of IVDD ischaemic infarct secondary to occlusion of artery/vein supplying the spinal cord; infarct caused by fragment of fibrocartilage thought to come from intervertebral disc; most common in medium to large breed (mini schnauzer, rare in cats); typically spontaneous; peracute onset of non-painful, lateralising clinical signs; diagnose with MRI and treat conservative, usually excellent prognosis depending on response in first 2 weeks

Fibrocartilaginous embolism (FCE)

# name the degenerative disease of the spinal cord of dogs causes vertebral canal stenosis; 2 forms (disc-associated and osseus-associated); all canine breeds but most common in Doberman and Great Dane ; aka "Wobblers"

Cervical Spondylomyelopathy (CSM)

# name the type of Cervical Spondylomyelopathy (CSM) middle-aged large breed dogs (Dobermans); typically chronic; same clinical signs as cervical IVDD; intervertebral disc protrusion, ligament hypertrophy, C5-6 and C6-7 most commonly affected

disc-associated CSM

# name the type of Cervical Spondylomyelopathy (CSM) young, giant breed dogs; typically chronic; same clinical signs as cervical IVDD; vertebral malformation + degenerative change leading to proliferation of vertebral arch, articular processes and pedicles; C4-5, C5-6, and C6-7 most common

osseus-associated CSM

what is the surgical treatment option for disc-associated Cervical Spondylomyelopathy (CSM)

ventral slot for disc compression +/- stabilisation

what is the surgical treatment option for osseus-associated Cervical Spondylomyelopathy (CSM)

dorsal laminectomy to address osseous compression +/- stabilisation

# name the degenerative disease of the spinal cord of dogs cauda equina: L7, S1-3, Cd1-5 nerve roots; medium to large dogs of middle-older age (GSDs); congenital vertebral malformation; L7-S1 intervertebral disc degeneration; hypertrophy of ligaments of lumbosacral joint; degenerative joint disease of articular processes; spondylosis deformans

degenerative lumbosacral stenosis (DLSS)

name 6 clinical signs of degenerative lumbosacral stenosis (DLSS)

1. pelvic limb hypometria 2. lumbosacral pain 3. lameness 4. urinary or faecal incontinence 5. tail weakness 6. reduced perineal and pelvic limb withdrawal reflexes

name the 2 parts of conservative treatment for cervical spondylomyelopathy (CSM)

1. exercise restriction, body harness 2. anti-inflammatories and analgesia

name the 2 parts of conservative treatment for degenerative lumbosacral stenosis (DLSS)

1. exercise restrictipn and analgesia 2. epidural steroid injections

what is the surgical treatment for degenerative lumbosacral stenosis (DLSS)

dorsal laminectomy +/- foraminotomy

# name the degenerative disease of the spinal cord of dogs middle age to older dogs, usually large breeds; slowly progressive, non-painful; concurrent axonal and myelin degeneration of the spinal cord; multifactorial; genetic and clinical similarities with amyotrophic lateral sclerosis in humans; diagnosed with supportive neurological signs, exclusion of other conditions and genetic test for SOD1 gene BUT only definitive with postmortem of spinal cord

Canine degenerative myelopathy (CDM)

name 2 immune mediated diseases of the spinal cord

1. steroid responsive meningitis-arteritis (SRMA) 2. meningomyelitis of unknown origin aka Granulomatous meningoencephalomyelitis (GME)

# name the immune mediated disease of the spinal cord young, med-large breed dogs (can also be small breeds); acute onset, recurrent episodes, wax/waning; immune-mediated inflammation of the meninges and associated blood vessels; severe neck pain, loww carriage head and neck; pyrexia; exercise intolerance and stiff gait

steroid responsive meningitis-arteritis (SRMA)

how to treat steroid responsive meningitis-arteritis (SRMA)

immunosuppressive dose of corticosteroids (prednisolone), slowly tapering over 4-6 months

name 3 infectious diseases of the spinal cord

1. Discospondylitis 2. Distemper myelitis 3. Feline Infectious Peritonitis (FIP)

# name the infectious disease of the spinal cord infection of the intervertebral disc (IVD) and adjacent vertebral body endplates; large breed (GSD and Dobermans), male intact dogs, reported in cats; subacute or chronic, typically >72h duration; vague spinal pain, lameness, pyrexia, lethargy, etc; neurological deficits range from mild ataxia to plegia

Discospondylitis

name 4 bacterial or fungal causes of Discospondylitis

1. Staph. intermedius (most common) 2. E. coli, Bacteroides, Strep 3. Brucella canis 4. Aspergillus

name the 3 possible routes of infection for Discospondylitis

1. haematogenous spread (most common) 2. migrating foreign body (grass awn) 3. iatrogenic (surgery or epidural complication)

what is the treatment for Discospondylitis?

1. minimum 6-8 weeks antibiotics or antifungal agents 2. analgesia 3. surgery

name 4 anomalous (congenital) diseases of the spinal cord

1. Syringomyelia (+ Chiari-like malformation) 2. vertebral malformations 3. Dermoid sinus 4. spinal arachnoid diverticulum

# name the anomalous (congenital) disease of the spinal cord congenital malformation of small-breed dogs; causes a mismatch between the volume available in the caudal fossa and the brain parenchyma located in this space, resulting in herniation of the cerebellum into the foramen magnum

Chiari-like malformation (CLM)

# name the term intracranial space between tentorium cerebelli and occipital bone; contains cerebellum, pons and medulla

caudal fossa

# name the term fluid filled cavity within the spinal cord

syringomyelia

name 2 clinical signs of Chiari-like malformation and Syringomyelia (CLM/SM)

1. 'phantom-scratching' neck/shoulder/flank 2. spinal pain and/or allodynia

how to medically treat Chiari-like malformation and Syringomyelia (CLM/SM)? (3 meds)

1. analgesia 2. drugs that may reduce CSF production 3. corticosteroids

what is the surgical method of treatment for Chiari-like malformation and Syringomyelia (CLM/SM)

foramen magnum decompression & cranioplasty

# name the anomalous (congenital) disease of the spinal cord failure of vertebrae to form properly, typically wedge-shaped; vertebral column instability and spinal cord compression; screw-tail brachycephalic breeds (pugs, frenchie, boston terriers); conservative treatment, anti-inflammatories, pain relief; surgical stabilisation

hemivertebrae

# name the anomalous (congenital) disease of the spinal cord congenital malformation of the dens (agenesis or hypoplasia) or abnormal ligaments, so joint is unstable; mild: neck pain; moderate: ataxia and tetraparesis; severe: tetraplegia and respiratory difficulties; toy or small breed dogs less than 2 years old

atlanto-axial subluxation

# name the anomalous (congenital) disease of the spinal cord fluid-filled dilation of subarachnoid space, leading to progressive compression of the spinal cord; often associated with vertebral malformation, IVDD or myelitis; congenital: Rottweilers; acquired: pugs and frenchies; typically no associated pain; tetra- or paraparesis and proprioceptive ataxia; urinary and faecal incontinence

spinal arachnoid diverticulum

what is the surgical treatment option for spinal arachnoid diverticulum

durectomy and treatment of concurrent disease

what is the conservative treatment for spinal arachnoid diverticulum

anti-inflammatories (steroids)

name 4 examples of primary spinal cord injury (SCI)

1. vertebral fracture and luxation (VFL) 2. traumatic intervertebral disc herniation 3. extra-axial haemorrhage 4. spinal cord contusion

# name the term complete dislocation of a joint

luxation

# name the term partial or incomplete dislocation of a joint

subluxation

# name the primary spinal cord injury (SCI) damage to blood vessels surrounding the spinal cord; can result in haematoma formation and spinal cord compression; rare secondary to trauma

extra-axial haemorrhage

# name the primary spinal cord injury (SCI) damage to blood vessels within spinal cord parenchyma; rarely occurs alone, most often in combination with VFL or traumatic intervertebral disc herniation

spinal cord contusion

what is the gold standard for diagnostic imaging of the vertebral column? allows 3D reconstruction, intravenous contrast allows identification of spinal cord oedema or haemorhage, full body to assess concurrent injuries

CT scan

what is the best modality for assessing spinal parenchyma and support soft tissue structures

MRI

name 3 indications for surgical treatment of primary spinal cord injury (SCI)

1. severe neurological deficits 2. unstable fracture 3. deterioration despite medical treatment

name 3 indications for medical treatment of primary spinal cord injury (SCI)

1. mild neurological deficits 2. non-displaced/stable fracture 3. financial constraints

what 2 things make up a motor unit

1. single motor neuron 2. all the muscle fibres it innervates

what 2 diagnostic procedures should all patients with suspected peripheral nerve or muscular diseases have done?

1. physical and neurological exam 2. CBC, biochem with electrolytes & urinalysis

name 3 electrodiagnostic tests for peripheral nerve or muscular diseases

1. electromyography (EMG) 2. nerve conduction velocity (NCV) 3. repetitive nerve simulation (RNS)

name 5 clinical signs of lower motor neuron (LMN) dysfunction

1. paresis or plegia 2. hypometria 3. hypotonia 4. hyporeflexia or areflexia 5. rapid onset muscle atrophy

# name the term short strided gait +/- reduced stride height

hypometria

# name the term decreased muscle tone

hypotonia

# name the term decreased or absent spinal reflexes

hyporeflexia or areflexia

# name the vascular neuromuscular disease most common in cats, also in dogs; cat clinical signs: LMN dysfunction in 1 or both PLs; loss of pain perception; muscle firm and painful on palpation; loss of peripheral pulses, cyanotic nail beds and cool extremeties; cat pathogenesis: assoc. with cardiomyopathy and aortic thromboembolism (ATE) interrupting blood supply to pelvic limbs; supportive treatment and anti-coagulant therapy

ischaemic neuromyopathy

name 7 immune mediated and infectious neuromuscular diseases

1. acute polyradiculoneuritis 2. Myasthenia gravis (MG) 3. Masticatory Muscle Myositis 4. Protozoal Polyradiculoneuritis and myositis 5. Botulism 6. Tetanus 7. Tick bite paralysis

# name the immune mediated/infectious neuromuscular disease some cases assoc. with bite/scratch from racoon "coonhound paralysis"; raw chicken consumption is a risk factor (Campylobacter species); clinical signs: paresis, reduced withdrawal reflexes, muscle tone and myotatic reflexes, neurogenic atrophy; hyperesthesia on spinal palpation; suspected immune-mediated inflammation of axons and myelin of ventral nerve roots

acute polyradiculoneuritis

# name the immune mediated/infectious neuromuscular disease auto-immune disease affecting the neuromuscular junction - serum antibodies formed against nicotinic acetylcholine receptors (AChRs); results in decr. numbers of functional receptorson post-synaptic surface; more common in dogs v. cats (Abyssinian, Somali)

Myasthenia gravis (MG)

what test can be performed to diagnose acquired myasthenia gravis?

anticholinesterase challenge test (incr. time ACh remains in synaptic cleft)

what is the anticholinesterase drug of choice for treatment of acquired myasthenia gravis?

pyridostigmine bromide (Mestinon)

# name the immune mediated/infectious neuromuscular disease GSD predisoposed; painful swelling of masticatory muscles and trismus which progresses to muscle atrophy in chronic stages; caused by Abs directed against the masticatory muscle; treated with immunosuppressive dose of corticosteroids

masticatory muscle myositis

how to diagnose masticatory myositis?

serology - Abs against Type 2 myofibres

# name the immune mediated/infectious neuromuscular disease exposure to intermediate hosts (cattle or sheep); acute paraparesis with rigid pelvic limb extension, patellar reflexes absent, severe muscle atrophy; Toxoplasma gondii and Neospora caninum; inflammation of lumbosacral nerve roots

protozoal polyradiculoneuritis and myositis

# name the immune mediated/infectious neuromuscular disease ingestion of spoiled or raw food; toxin blocks release of ACh at the NMJ and cholinergic autonomic synapses

botulism

# name the immune mediated/infectious neuromuscular disease 5-10 days following wound or procedure; localised or generalised muscle stiffness, facial involvement; spores of Clostridium introduced into tissues under anaerobic conditions, spores germinate to become exotoxin-producing, toxin enters NMJ of skeletal muscle and travels retrograde to CNS and interferes with inhibitor interneurons of the spinal cord

Tetanus

# name the traumatic neuromuscular disease associated with road traffic accident; caused by severe abduction or traction on forelimb; lameness, monoparesis, monoplegia, proprioceptive deficits

Brachial plexus avulsion

name 3 types of peripheral nerve injury

1. neuropraxia 2. Axonotmesis 3. Neurotmesis

# name the type of peripheral nerve injury * little or no damage to axon and connective tissue supporting structures, can be due to ischaemia or mild myelin damage * mild motor or proprioceptive dysfunction, nociception intact * neurogenic muscle atrophy unlikely; spontaneous recovery in days to a month

neuropraxia

# name the type of peripheral nerve injury * axons disrupted but connective tissue support intact (basal lamina of schwann cells, endo/peri/epi-neurium) * axons can regrow along connective tissue scaffold * substantial motor, proprioceptive and nociceptive dysfunction * neurogenic muscle atrophy likely

axonotmesis

# name the type of peripheral nerve injury * axons and connective tissue support disrupted * axons will not regrow without surgical intervention * complete motor, proprioceptive and nociceptive dysfunction * neurogenic muscle atrophy expected

neurotmesis

at what rate do axons regrow at?

1-4mm per day

# name the traumatic neuromuscular disease most common in cats, assoc. with road traffic accidents; caused by traction on the tail, often in combo woth trauma to pelvis/nerve roots of terminal spinal cord

Sacrococcygeal or Intercoccygeal luxation ("tail pull" injuries)

# name the traumatic neuromuscular disease * working dogs (labradors, pointers, setters, and foxhounds) * strenuous exercise after period of under-conditioning, prolonged cage transport and cold weather * transient tail flaccidity, painful on tail palpation * treat with analgesia and anti-inflammatory

"limber tail" coccygeal muscle injury

# name the congenital (anomalous) neuromuscular disease * springer spaniels, jack rusel terriers, smooth-haired fox terriers, Samoyeds, mini dachshunds * recurrent and progressive muscle fatigue at 6-9 weeks old * abnormal reduction in number of ACh receptors on muscle endplate * diagnose with a muscle biopsy

congenital myasthenia gravis

# name the congenital (anomalous) neuromuscular disease * young adult labradors * episodic limb weakness followed by ataxia and collapse 5-20 min after intense exercise, hyporeflexia during collapse * mutation in Dynamin 1 (DNM1) gene which is involved in prolonged muscle stimulation

Exercise-Induced Collapse (EIC)

# name the metabolic neuromuscular disease * dogs and cats with diabetes mellitus * symmetric pelvic limb LMN paresis (may extend to thoracic limbs), proprioceptive deficits, cats typically have plantigrade stance in PLs * aetiology not fully understood, affects distal portions of peripheral nerves

Diabetic polyneuropathy

# name the degenerative neuromuscular disease * degenerative polyneuropathy of autonomic nervous system * acute onset (dogs in rural area) * mydriasis with absent PLR, third eyelid protrusion, dry MM, v+/regurgitation, megaoesophagus, dysphagia, dysuria , constipation (cats) or d+ (dogs) * unknown pathogenesis

dysautonomia

are most brain tumours in dogs/cats primary or secondary?

primary

name 3 types of tumours originating from glial cells

1. astrocytoma 2. oligodendroglioma 3. oligoastrocytoma

are the majority of meningiomas benign or malignant?

benign

# based on the clinical signs, where is the brain tumour likely located? * circling towards the side of the lesion * pacing * head pressing * seizure activity

cerebral cortex

# based on the clinical signs, where is the brain tumour likely located? * altered mental state * +/- Diabetes insipidus * visual impairment )optic chiasma, optic II)

hypothalamus

# based on the clinical signs, where is the brain tumour likely located? * oculomotor (III) deficits * strabismus * pupil dilation * contralateral spastic hemiparesis

midbrain

# based on the clinical signs, where is the brain tumour likely located? * irregular respiration * paresis * crania; nerve deficits (V, VI, VII, IX, X)

ventral brainstem

# based on the clinical signs, where is the brain tumour likely located? * head tilt * circling * nystagmus * vestibular strabismus

vestibular region

# based on the clinical signs, where is the brain tumour likely located? * dysmetria * ataxia * wide-base stance * intention tremor

cerebellum

what is a useful chemotherapy drug that is often used palliatively for a brain tumour since it can cross the BBB

Lomustine

# name the spinal cord tumour arise within the spinal cord; tpyes: * glial tumours * metastatic tumours * lymphoma

intramedullary

# name the spinal cord tumour arise from the connective tissue of the dura mater; types: * meningioma * poorly differentiated tumour of young dogs * peripheral nerve sheath tumours * ependymoma (neuroepithelioma)

intradural extramedullary

# name the spinal cord tumour arise from connective tissue in the spinal cord/column; types: * primary bone tumours * metastatic tumours * lymphoma * multiple myeloma

extradural

this type of therapy can induce ischaemic damage to the spinal cord and is therefore rarely performed to treat tumours

radiation therapy

what percent of cardiac output does the brain receive

15%

# name the doctrine the skull is a non-compliant closed 'box' filled with: * brain parenchyma (84%) * blood (4%) * cerebrospinal fluid (16%) increases in volume of one component must be compensated for by decreases in other components ; failure to compensate results in increased intracranial pressure (ICP)

Monro-Kellie Doctrine

name the equation for cerebral blood flow

CBF = CPP/CVR (cerebral blood flow = cerebral perfusion pressure / cerebral vascular resistance)

name the equation for cerebral perfusion pressure

CPP = MAP - ICP (cerebral perfusion pressure = mean arterial pressure - intracranial pressure)

name the 4 determinants of cerebral blood flow

1. CPP (cerebral perfusion pressure) 2. PaCO2 3. PaO2 4. ICP

what range of MAP (mean arterial pressure) is CBF (cerebral blood flow) constant between

50-150 mmHg

what direction will the cerebral perfusion pressure (CPP) curve shift? with chronic hypertension

shift to the right

what direction will the cerebral perfusion pressure (CPP) curve shift? with anaesthesia OR reduced sympathetic tone

shifts to left

what will a CBF (cerebral blood flow) that is too high lead to

oedema and aneurysm

what will a CBF (cerebral blood flow) that is too low lead to?

tissue hypoxia

what is a normal ICP (intracranial pressure)

10-15 mmHg

name 5 ways to decrease ICP (intracranial pressure)

1. elevate head <30 degrees 2. analgesia 3. hyperventilation 4. cerebrospinal fluid drainage 5. drugs (osmotic diuretics; barbiturates)

what is the major function of cerebrospinal fluid system

cushioning

# name the anaesthetic increases CSF production and inhibits reabsorption of CSF by the arachnoid villi

enflurane

name 5 clinical signs of raised ICP (intracranial pressure)

1. neurologic changes 2. nausea/vomiting 3. papillary oedema 4. anisocoria 5. hypertension, bradycardia

name the 3 parts of Cushing's triad

1. increased MAP 2. bradycardia 3. altered breathing pattern

# name the response/reflex critical point is reached with increasing ICP ("cerebral hypoxic response"); massive sympathetic discharge: neurogenic pulmonary oedema, neurogenic cardiomyopathy

Cushing's Response (Cushing's Reflex)

name 4 possible pre-medications that can be used for anaesthesia for CNS disease

1. alpha-2-agonists 2. Acepromazine 3. Opioids 4. Benzodiazepines

name 2 induction agents that are preferrable for anaesthesia for CNS disease

1. propofol 2. alfaxalone | (over thiopental and ketamine)

what do isoflurane and sevoflurane disrupt at high concentrations? therefore must be mindful when using with CNS disease

flow-metabolism coupling

name 5 analgesics that are suitable for CNS disease

1. opiates 2. lidocaine 3. ketamine 4. paracetamol 5. NSAIDs

# name the analgesic (suitable for CNS disease) mainstay of analgesic approach; premed, induction, intraoperative CRI, MAC reduction

opiates

# name the analgesic (suitable for CNS disease) useful at induction to reduce coughing; MAC sparing effect of CRI; local techniques

lidocaine

# name the analgesic (suitable for CNS disease) avoid in seizure disorders and intracranial disease; useful as CRI for IVDD surgery; good analgesic for surgical and chronic pain

ketamine

# name the analgesic (suitable for CNS disease) useful alternative to NSAIDs in the dog, must ensure NO liver disease; very good adjunct to opiates and ketamine

paracetamol

Neurology (1-10) Flashcards

(291 cards)