Neurology

Question 1

what locations of the brain can a lesion be localised to?

Answer 1

forebrain
brainstem
cerebellum
vestibular system (central/peripheral)

Question 2

what mnemonic can be used to generate a differential diagnosis list?

Answer 2

Vascular
Inflammatory/infectious
Trauma
Anomalous
Metabolic
Idiopathic
Neoplasia
Degenerative

Question 3

what are the main four clinical signs that would localise the lesion to the forebrain?

Answer 3

seizure
disorientation
contralateral blindness (normal PLR)
circling

Question 4

what clinical signs would suggest a forebrain lesion?

Answer 4

seizures
behavioural changes
disorientation, depression
contralateral blindness (normal PLR)
facial hypoasthesia
normal gait
circling (ipsilateral), head pressing, pacing
decreased postural response (contralateral limb)

Question 5

what are the two main clinical signs that suggest a cerebellar lesion?

Answer 5

hypermetria
tremors (intention)

Question 6

what clinical signs suggest a forebrain lesion?

Answer 6

normal mentation
abnormal menace (normal vision/PLR)
vestibular signs - head tilt…
ataxia, broad stance, hypermetria
intention tremors
decerebellate rigidity
hypermetric postural response

Question 7

what are the main three clinical signs of a brainstem lesion?

Answer 7

cranial nerve deficits
vestibular signs
paresis (all four/ipsilateral limbs)

Question 8

what are the clinical signs of brain stem lesions?

Answer 8

depression, stupor, coma
cranial nerve deficits
vestibular signs
paresis
decerebrate rigidity
decreased postural response
respiratory/cardiac abnormalities

Question 9

what are the differentials for a focal/lateralised brain lesion?

Answer 9

neoplasia
vascular

Question 10

what are the differentials for a multifocal brain lesion?

Answer 10

inflammatory
infectious

Question 11

what are the differentials for a diffuse/symmetrical brain lesion?

Answer 11

metabolic
toxic

Question 12

what contributes to intracranial pressure (ICP)?

Answer 12

brain
blood supply to brain
cerebrospinal fluid

Question 13

what is compliance in relation to intracranial pressure?

Answer 13

can accommodate mild changes in ICP as when one factor contributing to it (eg. blood supply) increases the others with decrease

Question 14

what happens when ICP gets too high?

Answer 14

herniation underneath the tentorium of through foramen magnum

Question 15

what structure of the brain does formen magnum herniation effect?

Answer 15

cerebellum

Question 16

what are the signs of raised ICP?

Answer 16

mental status (ARAS)
bushings reflex
pupil size and PLR
vestibular eye movement
posture - decerebrate/decerebellate

Question 17

why does raised ICP effect the mental status of patients?

Answer 17

(ARAS - ascending reticular activation system)
awakeness centre in brainstem will decrease in activity with raised ICP causing depression, stupor and coma

Question 18

what is bushings reflex?

Answer 18

very unwell patients with bradycardia and hypertension due to cerebral ischaemia (end stage sign)

Question 19

how can pupil size change with raised ICP?

Answer 19

anisocoria
miosis
mydriasis

Question 20

what is anisocoria?

Answer 20

pupils are different sizes

Question 21

what is miosis?

Answer 21

excessive constriction (shrinkage) of pupil

Question 22

what is mydriasis?

Answer 22

excessive dilation of pupils

Question 23

how does physiological nystagmus change with raised ICP?

Answer 23

eyes don’t move due to a delay in connection between vestibular system and cranial nerves

Question 24

what is a peracute presentation?

Answer 24

extremely sudden onset (change from one second to the next)

Question 25

what are the differentials for peracute onset brain disease?

Answer 25

vascular (stroke) trauma (RTA...) toxic

Question 26

what primary injuries are associated with head trauma?

Answer 26

concussion contusion laceration (physical disruption of parenchyma)

Question 27

what secondary injuries are associated with head trauma?

Answer 27

inflammatory mediator release haemorrhage (raised ICP)

Question 28

what is used to assess head trauma?

Answer 28

modified Glasgow coma scale

Question 29

what is the modified Glasgow coma scale based on?

Answer 29

signs of raised ICP

Question 30

how does the score of the modified Glasgow coma scale compare to the prognosis?

Answer 30

low the score the worse the prognosis

Question 31

how can the modified Glasgow coma scale be used to monitor ICP?

Answer 31

do every couple of hours, if it is getting worse then ICP is increasing

Question 32

what is done to treat head trauma patients?

Answer 32

fluid therapy

Question 33

what is the aim of fluid therapy for head trauma cases?

Answer 33

restore intravascular volume to ensure adequate cranial perfusion pressure

Question 34

what fluid should be avoided for fluid therapy of head trauma cases?

Answer 34

glucose containing fluid - hyperglycaemia is associated with poor outcome

Question 35

what fluid should be given as an initial bolus in head trauma cases?

Answer 35

7.5% saline

Question 36

what are the advantages of 7.5% saline boluses in head trauma cases?

Answer 36

treats shock decreases intracranial pressure increases blood flow and oxygen delivery to the brain

Question 37

what fluids are indicated for head trauma with raised ICP?

Answer 37

mannitol or hypertonic saline

Question 38

what needs to be monitored in head trauma cases?

Answer 38

blood pressure oxygenation pain temperature

Question 39

what pain management should be avoided in head trauma cases?

Answer 39

morphine - vomit resulting in raised ICP and herniation

Question 40

why does temperature need monitoring in head trauma cases?

Answer 40

hyperthermia - affects metabolic rate hypothermia - shivering/oxygen demand

Question 41

in terms of general care, what are some good things to do to head trauma cases?

Answer 41

keep head elevated catheterise bladder nutritional support

Question 42

should steroids be given to head trauma patients?

Answer 42

no - hyperglycaemia, increased infection risk, lactic acid production

Question 43

what are the main differentials for acute/subacute onset brain disease?

Answer 43

inflammatory infectious metabolic (wax and wane)

Question 44

what are the three main routes of infection of bacterial meningitis?

Answer 44

haematogenous direct invasion (eyes, ear, nose, bone, trauma) CSF

Question 45

what is the prognosis for bacterial meningitis?

Answer 45

guarded

Question 46

what are the main two infectious brain disease?

Answer 46

Neospora caninum FIP

Question 47

what are the two main metabolic diseases of the brain?

Answer 47

hepatic encephalopathy hypoglycaemia

Question 48

what is the main cause of hepatic encephalopathy?

Answer 48

portosystemic shunts

Question 49

what causes the clinical signs of hepatic encephalopathy?

Answer 49

hyperammoneaemia neuroinflammation deranged neurotransmission cerebral oedema

Question 50

what are the ways of treating hepatic encephalopathy?

Answer 50

lactulose antibiotics diet seizure control

Question 51

why is lactulose used in hepatic encephalopathy cases?

Answer 51

traps ammonia as non-diffusible ammonium in intestines to decrease the absorption into blood

Question 52

what is the aim of altering diet to treat hepatic encephalopathy?

Answer 52

restrict protein and amino acids to reduce ammonia in blood

Question 53

what are the clinical signs of hypoglycaemia?

Answer 53

lethargy, ravenous appetite, anxiety weakness/tremors reduced vision and seizures (all wax and wane)

Question 54

why is hypoglycaemia seen in the brain?

Answer 54

has no storage for glucose

Question 55

why does care need to be taken when correcting hypernatraemia?

Answer 55

do it too rapidly and the cells will burst - permanent brain damage

Question 56

what are the differentials for chronic brain disease?

Answer 56

neoplasia anomalous degenerative

Question 57

what primary neoplasms can be seen in the brain?

Answer 57

intra-axial - glioma extra-axial - meningioma, chord plexus tumour

Question 58

what is the median survival time of infratentorial and supratentorial tumours?

Answer 58

infratentorial - 28 days supratentorial - 178 days

Question 59

what should be done to treat brain neoplasia?

Answer 59

analgesia (paracetamol) anti-inflammatory dose of prednisolone

Question 60

what are the most common anomalous brain diseases?

Answer 60

hydrocephalus hydranencephaly

Question 61

what is storage disease of the brain due to?

Answer 61

lysosomal hydrolase enzyme defect

Question 62

what are the functions of the vestibular system?

Answer 62

maintain balance maintain normal orientation relative to gravitational field maintain position of eyes, neck, trunk, limbs in relation to the head

Question 63

what makes up the peripheral vestibular system?

Answer 63

3 ducts at right angles to each other with endolymph within vestibulocochlear nerve (CN8)

Question 64

what triggers nerve impulses in the vestibulocochlear nerve?

Answer 64

hair bending due to fluid

Question 65

what makes up the central vestibular system?

Answer 65

brainstem - 4 nuclei cerebellum (inhibits nuclei)

Question 66

what are the clinical signs of vestibular disease?

Answer 66

ipsilateral head tilt head sway (both sides of system effected) ataxia and wide base stance leaning/falling nystagmus tight circling (less common) positional strabismus

Question 67

what causes a paradoxical head tilt?

Answer 67

cerebellar disease causes head tilt contralateral to lesion (loss of inhibition)

Question 68

how can the lesion of vestibular disease be localised using nystagmus?

Answer 68

lesion on the slower side

Question 69

what does vertical nystagmus suggest about the location of the lesion?

Answer 69

central vestibular disease

Question 70

what is positional strabismus?

Answer 70

when the head is lifted the eye will drop

Question 71

can paresis be a clinical sign of peripheral or dental vestibular disease?

Answer 71

central - yes peripheral - no

Question 72

can proprioceptive deficits be a clinical sign of peripheral or dental vestibular disease?

Answer 72

central - yes peripheral - no

Question 73

how can mentation be affected by peripheral or central vestibular disease?

Answer 73

central - may be altered peripheral - alert

Question 74

can cranial nerve deficits be a clinical sign of peripheral or dental vestibular disease?

Answer 74

central - V-XII may be affected peripheral - VII may be affected

Question 75

can Horners be a clinical sign of peripheral or dental vestibular disease?

Answer 75

central - rare peripheral - yes

Question 76

how does nystagmus indicate central or peripheral vestibular disease?

Answer 76

vertical is always central horizontal or rotary can be either

Question 77

what are the most common differentials for central vestibular disease?

Answer 77

cerebrovascular disease MUEs, FIP brain tumour

Question 78

what are the most common differentials for peripheral vestibular disease?

Answer 78

otitis media/interna idiopathic

Question 79

what are the two types of strokes?

Answer 79

ischaemic (obstruction) haemorrhagic (rupture)

Question 80

how does cerebrovascular disease present?

Answer 80

stroke or cerebrovascular accident

Question 81

what are the most common underlying diseases causing cerebrovascular disease?

Answer 81

chronic kidney disease hypertension hyperadrenocorticism

Question 82

what does MUO stand for?

Answer 82

meningoencephalomyelitis of unknown origin

Question 83

what type of disease are MUOs?

Answer 83

auto-immune disease of the brain

Question 84

what are the subtypes of MUOs?

Answer 84

granulomatous ME necrotising ME necrotising leukoencephalitis

Question 85

what breeds are granulomatous MEs most common in?

Answer 85

toy/terrier breeds

Question 86

how old are dogs with granulomatous ME?

Answer 86

3-8 years old

Question 86

how are granulomatous MEs distributed?

Answer 86

multifocal distribution

Question 87

what is the prognosis for MUOs?

Answer 87

very poor (progressive chronic disease)

Question 88

how are MUOs treated?

Answer 88

corticosteroids (immunosuppression)

Question 89

what causes CNS involvement of FIP?

Answer 89

immune-complex-mediated vasculitis

Question 90

what are the most common neurological signs of FIP?

Answer 90

tetra paresis, ataxia, nystagmus, loss of balance (cerebellomedullary region)

Question 91

why is FIP causing neurological signs difficult to diagnose?

Answer 91

usually wet form of disease

Question 92

why does otitis media/interna cause peripheral vestibular disease?

Answer 92

CN VII and VIII pass through the middle ear

Question 93

what are some clinical signs of otitis media/interna?

Answer 93

facial paralysis peripheral vestibular signs Horner syndrome pain opening mouth

Question 94

how is idiopathic vestibular disease treated?

Answer 94

spontaneous recovery without treatment

Question 95

what are the clinical signs of idiopathic vestibular disease?

Answer 95

acute onset peripheral signs - rolling, falling, vomiting, ataxia, head tilt, nystagmus

Question 96

what supportive treatment can be given to idiopathic vestibular disease patients?

Answer 96

maropitant (nauseous) reduce stimulation but keep active

Question 97

what are the clinical signs of facial nerve paralysis?

Answer 97

face drooping widening of palpebral fissure food dropping from mouth reduced/absent palpebral relfex

Question 98

what is the most common cause of deafness?

Answer 98

congenital sensorineural deafness

Question 99

what can cause acquired deafness?

Answer 99

chronic otitis interna/media ototoxicity noise trauma anaesthesia associated