Neurology Flashcards

Question

Fluorescein staining

Answer 1

Orange dye that turns green in alkaline conditions Stains corneal stroma green No uptake by intact corneal epithelium or by Descemets membrane Jones test - doe it appear at both nostrils within 3-5 mins

Answer 2

Conjunctival microbiology - sterile swabs Suspect bacterial - charcoal medium - Cats - chlamydophila felis, feline herpes 1 - PCR - dry sterile tube Melting ulcers, or neoplasia - cytology Use local first

Answer 3

End of exam before dilating pupil IF reduced vision, red eye, blue eye (corneal oedema), dilated pupil, buphthalmic globe, exophthalmos, suspect lens luxation Raised IOP - glaucoma Lowered IOP - suspect uveitis Difference >8mmHg between eyes is abnormal

Answer 4

One drop at a time - any more will spill over eyelid margins

Answer 5

Fusidic acid - first line for minor ocular surface imperfections - conjunctivitis Chloramphenicol - prophylaxis for ulcers and ocular surgery, bacterial conjunctivitis - not licenced - not pseudomonas Ofloxacin and ciprofloxaxin - broad spec - infected/melting ulcers , not licenced Gentamycin drops - infected melting - broad spec - licenced - epitheliotoxic to corneal epithelium Chlortetracycline - broad spec - chlamydial conjunctivitis - licenced

Answer 6

Anti-collagenases - serum form same or another animal - leave to clot and spin down - extract plasma - keeps in fridge for one week Stromease

Answer 7

Clindamycin Doxycycline

Answer 8

Sulphonamides - TMPS Enrofloxacin

Answer 9

For feline herpesvirus 1 Ganciclovir or acyclovir ointment Oral - famiciclovir tablets or oral paste

Answer 10

Prednisolone Diclofenac (NSAID)

Answer 11

Reduce aqueous humour production Increase aqueous humour drainage No licenced drugs in dogs/cats Prostaglandin analogues - induce miosis and increase outflow Carbonic anhydrase inhibitors - brinzolamide - reduce formation Beta blockers - timolol - also reduce formation Latanoprost - will reduce IOP - Contraindicated in uveitis and anterior lens luxation

Answer 12

Dilate pupil Examining lens and fundus Treating anterior uveitis and aiding intraocular surgery Atropine - treat anterior uveitis - long duration Tropicamide - much shorter onset and duration of action

Answer 13

Proxymetacaine Rapid onset Lasts 45 mins Repeat application over 2-3 mins increases depth and duration Epitheliotoxic

Answer 14

Two types: Extrusion and protrusion. Onset can be acute, chronic or acute on chronic. Extrusion – when the disc erupts and disc material escapes and compresses the spinal cord. Protrusion – Disc gets compressed and changes shape, compressing spinal cord. Pain on palpation of spinal column. Paralysis of limbs depending on point of compression. Treatment is either conservative or surgical. Conservative cage rest can do well for a lot of dogs and is worth trying unless in emergency cases with severe compression. Severe extrusion would be a case of this. Keeping the dog still is very important to prevent further compression or extrusion of fluids. Breed predisposition: Dachshunds

Answer 15

Microscopic blood clot in the spinal column. Can cause unilateral or bilateral paralysis. Diagnosis is based on exclusion of other differentials. Clinical signs: Acute onset, not painful, paralysis. Absent lower motor neurone signs. Treatment is conservative cage rest. Analgesia where necessary however not painful after 24 hours. Bladder control. Most dogs will recover.

Answer 16

Can pick up in utero so if one puppy presents with condition, be worried about the rest of the litter. Can show signs at around 4 weeks of age but paralysis develops over several weeks as the parasites invade the muscles. Results in lots of scar tissue that causes stiffness and restriction of movement in limbs. Clinical signs: Hindlimb extensor rigidity, inability to walk, difficult to demonstrate reflexes, resents limb flexion. Can turn cases around if caught early enough however delayed treatment means prognosis is poor.

Answer 17

The dry form of the disease causes granuloma formation. These can cause granulomatous change in the spinal cord. Could be multifocal or a singular lesion however rapidly progressive. Clinical signs: paraparesis with increased tone. Uncomfortable on spinal palpation. Reflexes and pain sensation present. Absent tail movement.

Answer 18

Cervical pain with non-ambulatory tetraparesis. Treatment: Need to immobilise the neck. Difficult to do. Don’t GA as the neck is being held together by muscle spasm so GA will relax the only support however GA required to fully appreciate problem and position correctly. Breed predisposition: Toy breeds – chihuahuas, Yorkshire terriers

Answer 19

Bacterial infection of the meninges.

Answer 20

Abscess/infection of an intervertebral disc. Treat with antibiotics. Could use a blood culture to try and culture bacteria present but depends on stage of infection. If unable to culture, use broad spectrum - Amoxicillin/TMPS

Answer 21

Non-infectious meningitis. Giving an immunosuppressive course of steroids should treat the meningitis. If no response, see MUO. Diagnosis via a CSF spinal tap BEFORE trialling steroids. High levels of neutrophils in the sample.

Answer 22

Non-infectious meningitis that doesn’t respond to steroid treatment.

Answer 23

Unknown pathology – multiple uncoordinated limbs due to nerve inflammation.

Answer 24

Dirty wound

Answer 25

Ingested toxin

Answer 26

CSF in the spinal cord due to expansion of the central canal. Breed predisposition: Cavalier King Charles Spaniel

Answer 27

Spastic – Abnormal increased muscle tone or stiffness of muscles Ataxia – Uncoordinated movement, can’t position legs underneath body Weakness – Not strong enough to pull legs underneath the body and push to stand up

Answer 28

IVDD Fibrocartilaginous embolism Neospora infection Feline infectious peritonitis Atlantoaxial subluxation Bacterial meningitis Discospondylitis Steroid responsive meningitis arteritis Meningitis of unknown origin Idiopathic polyradiculoneuritis Tetanus Botulism Syringomyelia

Answer 29

Freely mobile apart from attachements at limbus and eyelid margins - free movement of ocular structures Contibutes to tear film - goblet cells produce mucin Provides lymphatic drainage to eye - CALT - conjunctival assocaited lymphoid tissue

Answer 30

Unilateral or bilateral Hyperaemia - redness Chemosis - oedema Swelling/thickness Discharge - lacrimation vs mucoid, purulent, mucopurulent or haemorrhagic Mild irritation/blepharospasm Occasionally pruritis - allergic conjunctivitis

Answer 31

Thickening d/t squamous metaplasia of epithelium Hyperpigmentation Follicular hyperplasia – especially posterior third eyelid and in conjunctival fornices NB follicular conjunctivitis is common in young dogs; may need treatment but often resolves spontaneously

Answer 32

Treatment Treat/remove underlying cause Topical antibiotic therapy Fusidic acid (Isathal®) Licensed product in UK – first choice Treats Gram +ve organisms most commonly found in canine conjunctivitis (Staph spp, Strep spp) Chloramphenicol drops/ointment Other antibiotics based on culture & sensitivity Infectious – primary or secondary Non-infectious – irritants, FBs, allergies Secondary to - Adnexal disease (eyelids, tear film, nasolacrimal duct) - Local ocular disease - corneal ulcers, blepharitis, orbital disease - Other ocular disease – uveitis, glaucoma, episcleritis/scleritis Conjunctival involvement in systemic disease FBs (check under third eyelid!) Important in small furries e.g. GPs Irritants e.g. smoke, sand, neomycin Allergic e.g. atopic dermatitis Adnexal disease Eyelid and eyelash problems Tear film problems e.g. KCS (dry eye) Tear duct infection (dacryocystitis) Entropion: inversion (inward turning) of the eyelid margin Treatment: Hotz-celsus surgery: removal of elliptical piece of skin Ectropion: eversion/outward turning of eyelid margin Treatment: wedge resection Ectopic cilia - surgical excision - eyelash at right angle into cornea KCS - keratoconjunctivitis sicca - local immune mediated destruction of lacrimal gland and third eyelid - WHWT, pug, Shih tzu, bulldog, CKCS, english cocker spaniel - young-middle aged - bilateral Can be congenital, neurogenic (unilateral), toxic (sulphonamide drugs), endocrine (diabetes mellitus, hypothyroid), iatrogenic (removal of third eyelid gland) Schirmer tear test Tear substitutes, stimulants, broad spec abx if secondary infection Epiphora - poor tear drainage - overflow Congenital atresia or obstruction

Answer 33

Primary infectious conjunctivitis: uncommon in dog Viral infection, e.g. canine herpesvirus-1 Bacterial infection Parasitic infection e.g. Thelazia or Leishmania spp – imported dogs Fungal infection rare in UK Secondary bacterial infection is very common Commensal Gram +ve organisms, e.g. Staphylococcus spp, Streptococcus spp Less commonly: E. coli, Bacillus spp, Proteus spp, Pseudomonas spp

Answer 34

Cause of most conjunctivitis in rabbits Treatment must include nasolacrimal duct flushing (NB single lower nasolacrimal puncta) Underlying cause: overlong molar roots pressing on nasolacrimal duct Often recurrent, aiming to manage rather than cure

Answer 35

Conjunctivitis Uveitis Glaucoma Scleritis/episcleritis Haemorrhage Most commonly due to blunt trauma Check carefully for intraocular damage Other differential diagnoses include coagulopathies, systemic hypertension and vasculitis

Answer 36

Infectious: common Non-infectious: as for dogs but less common E.g. entropion – less common, may be acquired in older cats KCS much less common, hard to diagnose (normal STT values highly variable), can see qualitative tear film problem Extension from local ocular disease Secondary to another ocular disease Conjunctival involvement in systemic disease Primary infectious conjunctivitis is common (unlike in dogs): Chlamydophila felis (bacterium) Feline herpesvirus-1 (FHV-1) (virus) Feline calicivirus (FCV) Mycoplasma felis (bacterium) Bordetella bronchiseptica (bacterium) Secondary bacterial infections common Usually secondary to primary infection (cf dogs – secondary infections also common but usually secondary to underlying problem e.g. adnexa/tear film)

Answer 37

Obligate intracellular bacterium Common cause of feline conjunctivitis Clinical signs Unilateral conjunctivitis, becomes bilateral within a few days Chemosis often marked, hyperaemia No corneal signs Absent or mild upper respiratory disease Diagnosis: clinical signs +/- conjunctival swab for PCR test: Sterile swab rolled in conjunctival sac, placed in sterile, dry tube Systemic treatment indicated as organism affects respiratory tract, GIT and reproductive tract as well as eye Doxycycline antibiotic of choice 10mg/kg daily for 3-4 weeks to eradicate organism (treat in-contacts too) NB may cause teeth discolouration in young animals NB can cause oesophagitis – give with food/syringe water afterwards Amoxycillin-clavulanate in pregnant queen or kittens

Answer 38

Important ocular pathogen Clinical signs vary according to age: Kittens and young cats Bilateral conjunctivitis in conjunction with upper respiratory signs (cat flu) +/- corneal ulceration Adult cats Unilateral ocular discharge with mild conjunctivitis History of previous upper respiratory infection Wide range of other conditions, e.g. corneal ulceration, sequestrum, entropion, eosinophilic keratitis Diagnosis History and clinical signs Conjunctival swab for PCR test Same technique as for C felis Swab site of interest i.e. swab cornea, conjunctiva and/or oropharynx PCR has superseded culture (like C felis) Care with interpretation: False negatives common d/t intermittent shedding False positives common – many cats have been exposed to FHV-1, so positive result could reflect FHV-1 reactivation that is coincidental or secondary to the ocular disease Treatment Nursing Cleaning eyes, nutrition, rehydration Broad-spectrum antibiotic to prevent/treat secondary bacterial infection Topical for eyes (e.g. fusidic acid, chloramphenicol) Systemic for respiratory involvement e.g. amoxycillin-clavulanate Anti-virals Topical e.g. ganciclovir 4x daily Systemic e.g. famcyclovir (expensive) 90mg/kg BID recommended dose

Answer 39

Breach of or dysfunctional barrier layers - epithelium and endothelium - Increased water content - Distorts collagen fibrils - creating opacity

Answer 40

Superficial or deep ingrowth of blood vessels Promotes healing but can increased scarring

Answer 41

Non specific response to corneal insult

Answer 42

Proliferation at basal epithelial cells at limbus - mitosis Movement of peripheral cells towards centre of cornea Epithelial cells lost from corneal surface into tear film

Answer 43

Stromal wound healing Starts once re-epithelialisation is complete Fibroblasts migrate in & lay down new collagen Requires vascularisation Results in scar tissue: remodelling over time

Answer 44

Many possible causes Trauma Tear film problem – KCS Adnexal conditions i.e. involving eyelids, eyelashes and conformation Primary corneal disease – SCCEDs – more on later Infection - bacterial keratitis/feline herpes virus 1 Neurological disease - neuroparalytic keratitis - facial nerve paralysis - unable to blink Careful eye examination necessary – examine both eyes for clues as many conditions are bilateral

Answer 45

Pain - classic TRIAD of ocular pain Increased lacrimation (high STT) Blepharospasm - closing eye Photophobia - avoiding bright light Conjunctival hyperaemia - a “red eye” Ocular discharge Corneal oedema Reflex uveitis

Answer 46

SCCED: spontaneous chronic corneal epithelial defect Aka non-healing ulcer, indolent ulcer, ‘Boxer ulcer’ Superficial ulcer that affects middle-aged dogs (>7 years old) Can affect any breed (esp Boxers and corgis) Usually unilateral (but can be bilateral, recurrent) Epithelium loss only NO stromal involvement Characterised by lip of loose epithelium – epithelium grows across but cannot adhere to underlying stroma SCCED: Indistinct, irregular border which under-runs with fluorescein Variable inflammatory response – from no neovascularisation to granulation tissue ++ Diagnosis based on Signalment: older dogs Clinical appearance: superficial, non-adherent epithelium Ruling out other underlying causes e.g. ectopic cilium, foreign body, eyelid mass, KCS… Treatment Debride, keratotomy, medical treatment - local drops, cotton bud Chloramphenicol Systemic NSAIDs Treat reflex uveitis - atropine Bandage contacct lens Check weekly

Answer 47

Loss of epithelium and stroma Acute or chronic Fluorescein stains walls and floor of ulcer Superficial stromal or deep stromal Anterior uveitis common Loss of stroma will distort contours of cornea – visible crater

Answer 48

Epithelial loss only Acute onset Painful (higher density of nerve endings in superficial layers of cornea) Sharp distinct borders Minimal corneal inflammatory response +/- Reflex uveitis Treatment Identify and treat underlying cuase Prevent secondary infection - chloramphenicol drops Systemic NSAIDs Treat any reflex uveitis - atropine Recheck 3-5 days

Answer 49

Acute or chronic Complete stromal loss - defect down to Descemet’s membrane Walls of ulcer/crater usually obvious Descemet’s membrane is 10-15μm – similar to cling film Walls stain positive (exposed stroma) Descemet’s membrane does not stain with fluorescein Floor/base of ulcer looks black or clear Make sure to flush fluorescein - false negative as base will stain until flushed

Answer 50

Beware the animal with an acute closed painful eye with copious discharge – probably “melting” Acute, painful Lots of gelatinous “gloopy” discharge Ill-defined, rounded, soft edges – like melting butter/candle wax… Variable appearance – varying amounts of stromal involvement Ill-defined, rounded, soft edges Marked corneal oedema Marked anterior uveitis (pain, miosis, hypopyon, low IOP) Can progress rapidly and perforate within hours: ophthalmic emergency Enzymes (proteinases and collagenases) break down or ‘digest’ corneal stroma Two origins Cornea itself: epithelial cells, stromal fibroblasts, WBCs Bacterial infection, e.g. Pseudomonas sp, β-hemolytic Streptococcus sp Topical steroids cause local immune suppression and potentiate collagenase activity Corneal cytology Gently scrape margin of ulcer (not base) Corneal swab Bacterial culture and sensitivity Swab margin of ulcer (not base) Care with very deep lesions – procedure can cause corneal perforation! Treat as infected Ideally C&S - enrofloxacin Anticollagenase - serum every 1-2 hours Systemic antibiotics Systemic NSAIDs and opiates Atropine to effect May need surgery - monitor closely/hospitalise

Answer 51

Deep stromal Descemetocoele Perforated ulcer Melting ulcer Intensive treatment +- surgery All good referral options Grafting surgery Provide immediate tectonic support Provide blood supply Enucleation

Answer 52

Common causes are: Infection: feline herpesvirus infection (FHV-1) Trauma (cat fight injuries, FB) Corneal sequestrum Gentle debridement with cotton bud and contact lens fine Keratotomy techniques for SCCEDs predispose to sequestrum formation

Answer 53

Remove the primary cuase Treat the rest of the brain to isolate it from the effects of the primary cause Control not cure! 1st line - phenobarbital, imepitoin KBr or Levetiracetam Gabapentin Zonisamide

Answer 54

Seizure of more than 5 minutes Or More than 1 seizure in 5 minute period Treat with IV diazepam IV phenobarbital IV propofol Rectal diazepam IV levetiracetam Intranasal midazolam IV pentobarbital

Answer 55

Condition that threatens vision and/or the globe itself Traumatic globe prolapse Retrobulbar abscess Acute glaucoma Anterior lens luxation Corneal emergencies Sudden onset blindness

Answer 56

Acutely displaced beyond plane of eyelids Immediate oedema of conjunctiva and orbital soft tissue – further exacerbated by the eyelid spasm (obstructs venous drainage leading to more swelling…) Traction on optic nerve likely to result in permanent blindness Desiccation of ocular surface – potential for corneal ulceration Rupture of extraocular muscles Brachycephalic - Shallow orbits impart very little protection for eye Very little force required to cause prolapse Easy to replace, better prognosis Feline Cats have deeper orbits and therefore better protection Large amount of force required to prolapse globe Head trauma in an RTA In theory, better prognosis if: Brachycephalic Positive PLR Eye that attempts to move Worse prognosis if: Cat or dolicocephalic breed Hyphaema Corneal/scleral rupture If in doubt, attempt replacement – can enucleate later if needed Enucleate immediately if attachments almost all severed or if optic nerve is severed Needs treating immediately: by you rather than by referral Rapid treatment will improve prognosis for vision and globe Distressing to animal and owner Painful Keep globe moist – lubricating ointment (if animal allows) Prevent self-trauma with buster collar Provide analgesia/sedation GA for globe replacement once stable +/- clip hair Prepare area with aqueous povidine-iodine solution or sterile saline Lateral canthotomy Make eyelid opening larger by cutting skin at lateral canthus Reduces pressure on globe and makes replacement much easier Wrap eyelids back around and push globe in with swab Repair lateral canthotomy Double layer closure with figure of 8 at eyelid margin 4/0 – 6/0 polyglactin (Vicryl) Temporary tarsorraphy (suture eyelids together) To prevent re-prolapse and tamponade haematoma and oedema within orbit 5/0 vicryl 3-4 simple interrupted or mattress sutures +/- stents Systemic antibiotics and anti-inflammatories Broad spectrum topical antibiotic Buster collar Re-evaluate after 10-15 days to remove sutures and decide if enucleation required

Answer 57

Acutely displaced beyond plane of eyelids Immediate oedema of conjunctiva and orbital soft tissue – further exacerbated by the eyelid spasm (obstructs venous drainage leading to more swelling…) Traction on optic nerve likely to result in permanent blindness Desiccation of ocular surface – potential for corneal ulceration Rupture of extraocular muscles Brachycephalic - Shallow orbits impart very little protection for eye Very little force required to cause prolapse Easy to replace, better prognosis Feline Cats have deeper orbits and therefore better protection Large amount of force required to prolapse globe Head trauma in an RTA In theory, better prognosis if: Brachycephalic Positive PLR Eye that attempts to move Worse prognosis if: Cat or dolicocephalic breed Hyphaema Corneal/scleral rupture If in doubt, attempt replacement – can enucleate later if needed Enucleate immediately if attachments almost all severed or if optic nerve is severed Needs treating immediately: by you rather than by referral Rapid treatment will improve prognosis for vision and globe Distressing to animal and owner Painful Keep globe moist – lubricating ointment (if animal allows) Prevent self-trauma with buster collar Provide analgesia/sedation GA for globe replacement once stable +/- clip hair Prepare area with aqueous povidine-iodine solution or sterile saline Lateral canthotomy Make eyelid opening larger by cutting skin at lateral canthus Reduces pressure on globe and makes replacement much easier Wrap eyelids back around and push globe in with swab Repair lateral canthotomy Double layer closure with figure of 8 at eyelid margin 4/0 – 6/0 polyglactin (Vicryl) Temporary tarsorraphy (suture eyelids together) To prevent re-prolapse and tamponade haematoma and oedema within orbit 5/0 vicryl 3-4 simple interrupted or mattress sutures +/- stents Systemic antibiotics and anti-inflammatories Broad spectrum topical antibiotic Buster collar Re-evaluate after 10-15 days to remove sutures and decide if enucleation required Must manage owner expectations Prognosis for vision: Guarded Most eyes are blind (80% dogs, ?100% cats) Prognosis for retaining globe Reasonable (most owners prefer blind eye to no eye) Other complications: lagophthalmos, neurotrophic keratitis, dry eye, permanent strabismus…

Answer 58

Abscess or cellulitis behind globe Clinical signs Acute onset Unilateral Exophthalmos (proptosis) Pain, especially on opening the mouth Third eyelid protrusion and swelling Ocular discharge Pyrexia, lethargy Ultrasound: look for fluid-filled cavity Look in mouth (recall close proximity of upper dental arcade to soft tissue floor of orbit) Drain abscess under GA Access to soft tissue floor of orbit via mouth Scalpel incision, insert artery forceps blindly into retrobulbar space Recall that most eyes are 2cm from cornea to sclera Release pus… Pressure around and traction on optic nerve can cause temporary blindness and, if not treated urgently, permanent blindness Medical management Systemic NSAIDS Systemic antibiotics May need IV fluids and injectable medications if not eating Topical lubricants until normal blinking returns

Answer 59

Ocular pain (classic triad): Blepharospasm Increased lacrimation Photophobia Head shy, yelping, dull/quiet Vision loss Change in appearance… Two groups of dogs predisposed to acute glaucoma: Purebreed dogs with hereditary primary glaucoma (Spaniels, retrievers, Bassets, huskies…) Terrier breeds with acute lens luxation and secondary glaucoma How to differentiate? Is it a predisposed breed? Can you see an underlying cause? (Uveitis, lens luxation) Tonometry Normal range in dogs and cats: 10-25mmHg Acute glaucoma: Often >40mmHg May see IOPs of 60-80mmHg Reduce IOP – choice of medications depends on underlying cause Prostaglandin analogue (latanoprost) if suspect primary Carbonic anhydrase inhibitors (brinzolamide, dorzolamide) always ok IV mannitol if not responding to drops Analgesia Seek referral advice/offer referral ASAP Primary glaucoma is a bilateral condition Consider referral assessment of other eye

Answer 60

Acutely painful eye Glaucoma (episcleral injection, raised IOP, diffuse oedema, vision loss) Focal corneal oedema Lens outline may be visible in anterior chamber Is it a predisposed breed? If a terrier, assume anterior lens luxation until proven otherwise! Lens luxation or primary glaucoma? Does the dog have a history of either problem? If very cloudy Take a photo with a flash Consider ultrasound Look at the other eye for clues – bilateral condition Offer referral: emergency surgical removal of lens or “couching” to push lens backwards Analgesia e.g. oral NSAID and opioid Bilateral condition: contralateral eye likely to be affected but at an earlier stage i.e. subluxation Consider referral assessment/prophylactic treatment If eye is enucleated, send for histopathology

Answer 61

Chemical injury FB Melting ulcer Severe lacerations Acid and alkali injuries cause immediate loss of epithelium Cornea and eyelids Acid injuries Bleach, toilet cleaner Spirit-based skin preparation Alkali injuries Caustic solutions Lime burns (e.g. cement, plaster) Washing detergents IMMEDIATE irrigation of ocular surface If at home, tap water is fine Tap water or saline or Hartmann’s solution if animal in the practice Flush copiously e.g. 500ml to 1 litre until pH normal (7.5); sedation likely to be necessary Test pH of conjunctival sac to determine nature of chemical e.g. urine dipstick Early specialist advice Medical management for corneal ulceration Alkalis may induce ‘melting’ or liquefactive necrosis, intensive medical management indicated Urgent attention indicated for all FB but most are not true emergencies Emergency only if large and painful The following require urgent treatment but are not true emergencies Deep corneal ulcers Descemetocoeles Perforated corneal ulcer +/- iris prolapse ‘Melting’ ulcer is however a true emergency Crater appearance: loss of stroma Descemetocoele: dark/clear base is hallmark sign Perforated ulcer with iris involvement – site of perforation “plugged” by iris tissue, anterior chamber has re-formed Corneal lacerations Sharp corneal trauma carries better prognosis than blunt trauma

Answer 62

Acute glaucoma Acute uveitis Intraocular haemorrhage Retinal detachment Optic neuritis SARD (Sudden Acquired Retinal Degeneration) Toxicity (ivermectin, enrofloxacin in cats) Intracranial lesion

Answer 63

Idiopathic vestibular disease Otitis interna Oto-toxic drugs Inflammatory polyp Trigeminal neuritis Trigeminal nerve sheath tumour Brucellosis Rabies

Answer 64

Treat with time. May need antiemetics to deal with nausea. Can also get Horner’s syndrome as can affect sympathetic pathway. Clinical signs: Sudden onset, head tilt, stumbling, circling, nystagmus, nausea. More commonly affects the older animal. Occurs alongside idiopathic facial paralysis as inflammation through the foreman so multiple nerves effects. Prognosis: good to excellent

Answer 65

Involves fluid in the inner ear: Vestibular cochlear organ – can be secondary to otitis media or tympanic rupture. Can be sterile or infectious. Use otoscope to check for inflammation through the tympanic membrane. Clinical signs: Head tilt, spontaneous horizontal or rotary nystagmus, circling Most common bacteria are pseudomonas spp and staphylococcus spp. . Oblique skyline and lateral oblique radiograph can be used to view tympanic bullae and to check for fluid however difficult. Can use MRI or CT. Treatment – otitis media: Broad spectrum

Answer 66

Anything administered local has the risk of rupturing the tympanic membrane. Metronidazole -> OD or abnormal reactions can cause vestibular syndrome. Aminoglycosides (gentamicin, amikacin) and cisplatin are of the highest concern for ototoxicity.

Answer 67

Benign growths mainly seen in cats. Develop in the middle ear and Eustachian tubes. Depending on which path the polyps take, patients may present with otitis, nasopharyngeal signs or both. Condition may be acute or chronic. May be related to the inflammation caused by a respiratory virus however polyp signs often don’t appear until months after infection. Clinical signs if in middle ear: Abnormal balance, changes in pupil sizes, head tilt, nystagmus. Treatment: Ventral bulla osteotomy/ removal by traction. Can cause nerve damage.

Answer 68

Sudden onset dropped jaw. Mickey muzzle and analgesia. Diagnosis by exclusion. Ability to manually shut jaw. Clinical signs: Inability to close jaw, difficulty taking food into mouth, may have difficulty swallowing. Idiopathic, bilateral, non-suppurative and affects all motor branches of the trigeminal nerve. Can be accompanied by Horner’s syndrome and/or sensory disturbances to some regions of the head.

Answer 69

Chronic slow growth of tumour. Causes progressive atrophy. Many dogs outlive tumours. Risk of going into brain and cause neurological signs. One side of the head is sunken in, atrophy to muscles of mastication. Clinical signs: Facial asymmetry, reduced facial sensation, absent palpebral reflex with normal menace response. Reduced unilateral corneal sensation and enophthalmos. Horner’s syndrome. As it progresses, signs of brainstem compression develop.

Answer 70

Not in the UK however being brought in from Romania. Zoonotic. CSF culture and sensitivity. Can cause discospondylitis.

Answer 71

Has the dog been abroad – if suspicious, call for help and get advice. Don’t perform neurological exam for risk of getting bitten. Isolate and keep behind bars.

Neurology Flashcards

(96 cards)