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Flashcards in Neurology Deck (93)
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1

A dog presents with a history paresis of the hind limbs for the past 3 days. Cranial tibial and patellar reflexes are decreased to absent and you note muscle atrophy on the hind limbs. Reflexes are normal on the forelimbs. Where is the lesion located?

L4-S3

2

A dog presents with paresis of the hind limbs and you perform a neuro exam. The cranial tibial reflex is absent and the patellar reflex is slightly exaggerated. Perineal reflex is also absent. Where is the lesion?

~ L6-S3

 

*Since the patellar reflex is present (and pseudo hyper), the femoral nerve is intact and the lesion has to be caudal to L4/L5. 

Absence of cranial tibial and perineal reflexes indicate that the sciatic and pudendal nerves are affected. 

3

A canine patient presents for sudden ataxia after being outside unsupervised. Head tilt is not observed and the pupillary light reflex is present. Percussion of the extensor carpi radialis muscle elicits an exaggerated extension of the carpus. Reflexes on the hind limb are also exaggerated. Where is the SC lesion?

C1-C5

 

*Reflexes exaggerated on all 4 limbs indicates an UMN problem. The lesion will be located cranial to C6. Since the dog is not exhibiting brain signs (circling, seizures, changes in mentation), it is assumed that the lesion is not in the brain.

4

A feline patient presents after inability to walk at home. The extensor carpi radialis reflex is absent, and the patellar and cranial tibial reflexes are exaggerated. The bladder is large and turgid. Toe pinch does not elicit flexion of the forelimb, and the patient does not respond. Toe pinch on the hind limb elicits flexion and a pain response. Crossed extensor reflect of the hind limb is also present. Where is the lesion?

C6-T2

 

*LMN signs to the forelimbs and UMN signs to the pelvic limbs and bladder. 

5

A dog diagnosed with peripheral neuropathy presents for second opinion. If the original diagnosis is correct, what should the patient's reflexes be like?

Areflexia in all 4 limbs

6

A dog presents lame, and on neuro exam exhibits extreme pain with manipulation of the hip joint. What is a possible cause for this reaction?

Nerve root stretching

7

What is axonotmesis?

Tramuatic nerve injury in which the axon dies but the myelin sheath remains intact. The nerve can regrow with the guidance from the myelin sheath at a rate of 1mm per day.

8

Traumatic nerve injury in which loss of the neuron AND myelin sheath results in  NO regrowth of the nerve. 

Neurotmesis

9

What is neuropraxia?

Temporary nerve trauma mainly due to transient loss of blood supply (legs falls asleep).

 

No nerve degeneration occurs, but myelin may degenerate

10

What's likely damaged in this cat?

Radial nerve

11

A cat presents to your clinic with a dropped hock. What nerve do you suspect is damaged?

Sciatic

12

A dog presents dragging his left front limb. The limb has no reflexes or pain response. Neuro exam is normal on all other limbs. What is the likely diagnosis?

Brachial Plexus avulsion

 

*Traumatic injury to nerve roots C6-T2

13

A feline patient presents with miosis and enopthalmus of the right eye. The third eyelid is visible and you note ptosis as well. What is a likely location for the spinal cord lesion?

T1

 

*Horner's Syndrome

14

A dog presents dragging her RF limb. Reflexes are absent in the limb, and toe pinch test elicits no response, however, the dog reacts when the toe is clamped with a hemostat. What is the treatment plan?

Since deep pain is still intact, aggressive physiotherapy 3 times per day and protection of the limb may be indicated. If this is not possible, or the limb is not recovering, amputation is indicated (usually after 6 months).

15

A dog suffering from an abduction injury to the left forelimb is unable to extend or flex his elbow and carpus, but still has movement in his shouler. What area of the spinal cord is likely damaged?

C7 and T1

16

A dog with an abduction injury to the left forelimb is unable to extend or flex his shoulder, but retains ability to move his elbow and carpus. What area of the spinal cord is damaged?

C6  and C7

17

Where do nerve sheath tumors occur 80% of the time?

Caudal cervical area, usually associated with the brachial plexus

18

Nerve sheath tumors usually start ______ and spread proximally into the _____ ____.

Peripherally

Spinal Cord

19

A 9 year old dog presents to your clinic with paresis of the right front limb. You note muscle atrophy of the affected limb, and upon manual flexion, the dog cries out in pain. The owner states that the limb has been slowly getting worse, and that the dog seems to be in pain more recently. What is a probable diagnosis?

Nerve sheath tumor

 

*CS: slowly progressive monoparesis and "root signs" are suggestive of neoplasia. 

20

A dog presents with monoparesis and "root signs", suggesting neoplasia of the peripheral nerves. What tests can you use to localize the tumor and confirm your diagnosis?

Localize: Myelogram, CT, MRI

 

Confirm diagnosis with histopath collected during surgery

21

You diagnose a nerve sheath tumor in a cat. What is the best treatment plan?

Surgery (complete removal is highly unlikely and the tumor will grow back within a few months)

Radiation and chemo post surgery will delay regrowth by another month

22

A client brings in her Great Dane who suddenly collapsed after going for a run, and is now unable to walk. Reflexes are exaggerated on all 4 limbs, but paresis seems worse on the left side. There is no pain on palpation of the spine. Radiographs and myelography are normal. MRI is performed and you see a lighter area, as pictured. What is the most likely diagnosis?

Fibrocartilagenous embolus

 

*Peracute, non-painful, many times after exercise. Large breeds most susceptible, and Schnauzers.

 

*Non-progressive! Pain/paresis will NOT get worse in the hours after the event as it would with a traumatic injury due to inflammation. etc.

23

Now that you've diagnosed the Great Dane with a fibrocartilagenous embolus, what is your treatment plan?

TIME (very slow recovery, if the patient recovers at all)

Supportive care, physiotherapy, turning to avoid sores

 

*Can medically treat bladder problems with prazosin/phenoxybenzamine (UMN) or Bethanecol/PPA (LMN).

24

Regarding fibrocartilagenous emboli, which patient has a better chance of recovery; one with UMN signs or one with LMN signs?

Patients with UMN signs have a better chance of recovery than patients with LMN signs. 

With LMN signs, the entire cell (body and axon) is damaged.

25

A German Shepherd presents for increasing weakness of the hind limbs over the past year. The dog is knuckling while walking, and has difficulty turning without crossing his legs. The muscles of the hind limbs are atrophied and reflexes are exaggerated. Palpation of the spine and flexion/stretching of the hind limbs are performed without eliciting pain, however, toe pinch still elicits a response. The thoracic limbs are normal. What is the likely diagnosis?

Degenerative Myelopathy

 

*Degeneration of axons and myeline sheaths in thoracolumbar spinal cord. Genetic! Retain superficial and deep pain, and urinary/fecal incontinence usually intact. 

26

The owners of the dog with degenerative myelopathy want to know if there are any diagnostics we can use to confirm the disease, since they discovered there is no treatment besides physiotherapy. 

pNF-H (phosphorylated neurofilament heavy)

and

myelin basic protein are elevated in the CSF of these patients. (But it still isn't specific for this disease)

 

*Imaging will be normal in these patients

27

In degenerative lumbosacral stenosis, or cauda equina syndrome, the spinal cord between L7 and S1 becomes compressed. What type of disc degeneration is the cause?

Hansen type II

 

*slowly pushes dorsally over time

28

In a patient with degenerative lumbosacral stenosis, instability at L7/S1 can cause spinal cord compression as the vertebrae move relative to one another, in a step-like formation. What is this called?

Spondylolisthesis

29

How does proliferation of the interarcuate ligaments make degenerative lumbosacral stenosis worse?

Compresses the spinal cord dorsally, so now it's being compressed ventrally and dorsally. 

30

An 8 year old Viszla presents for progressive weakness and pain in the hind limbs. The dog has recently been dribbling urine while sleeping. On exam, the dog is hunched over. Patellar reflexes are present to exaggerated on the hind limbs, but you are not able to elicit a cranial tibial reflex. What is a likely diagnosis in this patient?

Degenerative lumbosacral stenosis

 

*LMN signs to the pelvic limbs and bladder. Patellar reflexes remain because the femoral nerve exits at L4/L5. Patellar reflex may be exaggerated due to lack of tone in the hamstrings, not an UMN problem.