Neurology Flashcards by AE G

UMN functions

initiate voluntary movement
maintain tone (posture)
inhibit extensor mm (moderate activity)

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LMN functions

link between CNS & effector muscles
direct innervation of effector mm

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efferent motor tracks

brain to muscles
movement

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afferent motor tracks

muscles to brain
coordination

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what happens when something goes wrong with the motor tracts?

weakness, paresis or plegia

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what happens when something goes wrong with the sensory tracts?

ataxia (reduced coordination)

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when can you see both weakness and ataxia together? lesion in the ____

UMN spinal cord region

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UMN signs

Paresis or paralysis of innervated muscles
↑ stride length
Normal to ↑ reflexes “hyperreflexia”
none/mild muscle atrophy, occurs slowly due to “disuse atrophy”
Normal to hypertonic/spastic muscle tone

+ standing/walking on dorsum of foot or dragging/scruffing foot “nail wear”

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LMN signs

Paresis or paralysis of innervated muscles
↓ stride length
↓ to absent reflexes “hyporeflexia”
Severe, rapid muscle atrophy (5-7 days) “denervation atrophy”
hypotonic/atonia/flaccid muscle tone

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paresis localizes to LMN and paralysis localizes to UMN

true or false

false

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intention tremor
no proprioceptive deficits & paresis
wide based stance
irregular foot placement
dysmetria (hypermetria or hypometria)
ipsilateral absent menace

Cerebellar Ataxia

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asymmetric gait
head tilt, circling
spontaneous nystagmus
proprioceptive deficits & paresis

Vestibular Ataxia

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proprioceptive deficits & paresis
knuckling
long overreaching “solider marching”
UMN hypermetria

General Proprioceptive Ataxia
(caudal brainstem and spinal cord lesion)

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Indications of multifocal lesions

LMN signs in both limbs

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what part of the brain does proprioception

cerebellum & brainstem

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what part of the brain does gait

brainstem & cerebrum

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schiff sherington posture
lesion?
signs?

T3-L3 lesion - no prognostic significance
PL flexed, TL extended

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forebrain lesion clinical signs

behavior change
contralateral blindness
ipsilateral head turn, body turn, circling, head press, pacing
deficits in contralateral limbs
contralateral facial hypoalgesia
seizures

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what is the imaging modality of choice for the brain

MRI

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CSF analysis contraindications

in absence of MRI
increased ICP
coagulopathy
cerebellomedullary cistern contraindicated with chiari-like malformation, AA instability or cervical trauma

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cat ddx for forebrain disease of infectious origin

toxoplasma gondii
FIV
FeLV
FCov

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CSF max volume

1ml/5kg

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SRMA does NOT result in forebrain disease but may cause CSF abnormalities

true/false

true – results in neutrophillic, mononuclear or mixed pleocytosis

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function of an EEG

assess forebrain activity
identifies seizures activity

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DDX for forebrain diseases in older animals

intracranial neoplasia (most common is meningioma) canine cognitive dysfunction (degenerative)

Slowly progressive, confusion, anxiety, loss of sleep-wake cycle, decreased pet-owner interaction > 8 yr old dog females & smaller breeds more common disease?

canine cognitive dysfunction

treatment for intracranial neoplasia

prenisolone

treatment for canine cognitive dysfunction

MCT Diet, omega3, carnitoids, vitamin E & A Selegiline cognitive enrichment levetiracetam

what are the DDX for any aged animal with forebrain disease due to metabolic dysfunction?

hypernatremia (>170-175) hyponatremia (<125)

chronic hypernatremia treatment

corrected slowly 48-72 hrs not faster than 0.5 mEq/L/hr half or normal saline then 5% dextrose

acute hypernatremia treatment

5% dextrose

acute hyponatremia treatment

correct quick with normal saline

chronic hyponatremia treatment what is the risk of rapid correction?

corrected slowly 48-72 hrs normal saline not faster than 0..5 mEq/L/hr risk of central myelinolysis with rapid correction

younger animal DDX for forebrain diseases

hepatic encephalopathy hypoglycemia hydrocephalus

treatment for hepatic encephalopathy

IV fluids, enemas, lactulose, diet antibiotics (metronidazole or potentiated amoxicillin) Levetiracetam

small breed, toy breed or brachycephaic dog with domed shape head and fontanelles, obtundation, behavior abnormalities, difficulty training, decreased vision, circling and pacing disease?

hydrocephalus

hydrocephalus diagnostic modality of choice & treatment

MRI glucocorticoids furosemide omeprazole acetazolamide surgery

type of seizure: sustained increase in muscle contraction followed by repetitive involuntary muscle contractions at a frequency of 2-3 seconds

tonic-clonic (most common)

type of seizure: sudden brief involuntary contraction of a muscle or group of muscles

myoclonic

type of seizure: sustained increase in muscle contraction lasting a few seconds-minutes

tonic

type of seizure: regular repetitive myoclonus, involving the same muscle groups, freq 2-3 sec

clonic

type of seizure: sudden loss of muscle tone

atonic

what are 3 forms of focal seizure

motor autonomic behavioral

idiopathic head tremor syndrome is found in what breeds

dobermans english bull dogs boxers

episodic falling due to paroxysmal hypertonicity is found in what breed

calvalier king charles spaniels

paroxysmal gluten sensitive dyskinesia (canine epileptoid cramping) is found in what breed

border terrier

causes of reactive seizures

metabolic or toxic

causes of structural epilepsy

inflammatory, neoplastic, traumatic

causes of idiopathic epilepsy

genetics - diagnosis of exclusion - dogs 6 mo - 6 yr

most common cause of reactive seizures in cats

hypoglycemia, hepatic encephalopathy and intoxication

most common cause of structural epilepsy in cats

hippocampal necrosis

criteria for starting treatment for seizures

structural epilepsy or reactive seizures status epilepticus or cluster seizures 2+ seizures in 6 month period post-ictal signs are severe or last longer than 24 hours

type of seizure: seizure lasting > 5 min or >2 seizures without full recovery of consciousness

status epilepticus

type of seizure: 2 or more seizures within 24 hours

cluster seizures

only antiepileptic that is FDA approved in dogs? cats?

primidone none in cats

phenobarbital MOA: steady state reached: metabolism:

increased inhibitory effect of GABA 2-3 weeks induces cytochrome P450 (contraindicated in dogs with hepatic dysfunction)

Potassium Bromide (KBr) MOA: steady state reached: contraindications:

competes with Cl transporter, inhibits Na, membrane hyperpolarization 12 weeks not used in cats due to eosinophillic bronchitis must be given along consistent diet don't use in patients with kidney disease

Levetiracetam (keppra) MOA: indications:

unknown AED of choice in PSS/liver disease

Zonisamide MOA: metabolism: dose:

blocks propagation of epileptic discharges metabolized by liver, use in dogs and cats dose increased when used with phenobarbital

treatment for stopping seizures immediately

diazepam per rectum midazolam intranasal

treatment if the patient is still seizing

phenobarbital then levetiracetam

treatment for breakthrough seizures

infusion of diazepam, midazolam, propofol

after 30 min of sustained seizure activity (prolonged status epilepticus) what drug do you use

NMDA receptor antagonists = Ketamine + dexmedetomidine

Hansen type I IVDD

chondroid degeneration nucleus pulposus extrusion young/middle aged chondrodystrophic breeds (dachunds) acute, painful

Hansen type II IVDD

fibroid degeneration annulus fibrosus protrusion older large breed (GSD) chronic, painful

gold standard diagnostic for IVDD

MRI

treatment for IVDD

crate rest 4-8 weeks medical management (pain) surgery recurrent/persistent pain or unresp to conservative therapy

young, middle aged, active dog that is acutely (hours) painful, non-progressive clinical signs

fibrocartilaginous embolism (FCE)

DDX for a FCE

acute non compressive nucleus pulposus etrusion (ANNPE) type I IVDD

young-middle aged, medium-giant breed dogs that have severe pain (spinal hyperesthesia), fever, inappetance, decreased mentation and reluctance to move

diskospondylitis

diskospondylitis diagnosis and treatment

radiographs (at 3 weeks) or MRI (right away) cephalosporins

> 7 yr old german shepherd, boxer or corgi with insidious onset, slowly progressive, non-painful T3-L3 signs

degenerative myelopathy

middle aged-older german shepherd with DJD at L7-S2

lumbosacral syndrome - bony proliferation = stenosis + type II disc protrusion

lumbosacral syndrome treatment

dorsal laminectomy conservation therapy

2 types of caudal cervical spondylomyelopathy "wobbelers"?

1. young great danes and mastiffs - degeneration/thickening of articular processes, dorsolateral compression 2. older dobermans - hypertrophy of articular processes, dorsal and ventral compression

what breeds are predisposed to atlantoaxial instability and what are the 2 causes

toy breeds, < 1 yr 1. congenital malformation of C2 2. trauma of dens