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Flashcards in SA Neuro Deck (244)
1

Which diagnostic tests can you use to diagnose neuro conditions?

Blood, urine, faecal, microbiology
Genetic testing
CSF
Imaging (US, radiographs, myelography, CT, MRI)
Electrodiagnostics
Muscle and nerve biopsies

2

What would you look for on a haematology test when diagnosing neuro disease?

Infectious and inflammatory dx
Hyperviscosity (polycythaemia)
Inclusions (lysosomal storage dx)
Thrombocytopenia

3

What would you look for on a biochemistry test when diagnosing neuro disease?

Liver function (bile acid stimulation test, ammonia)
Glucose and fructosamine (weakness, seizures)
Electrolytes (Na, K, Ca-weakness, seizures)
CK, AST (muscle damage)

4

Which endocrine tests may you run when investigating neuro disease (mainly for neuromuscular disease)?

-Thyroid dysfunction
-Adrenal dysfunction
-Insulin

5

Give some markers for immune-mediated diseases

-Acute phase proteins (eg C-reactive protein, good for steroid-responsive meningitis arteritis SRMA)
-Acetylcholine receptor antibodies titres (gold standard for acquired myasthenia gravis)
-Type IIM antibodies titres (gold standard for masticatory muscle myositis)

6

How does immune-mediated acquired myasthenia gravis work?

Forms circulating antibodies against Ach receptors

7

Which test would you use to diagnose myasthenia gravis?

Acetylcholine receptor Ab test= gold standard
Edrophonium test
IV administration of edrophonium chloride (often called tensilon) which is a fast-acting cholinesterase inhibitor
Can have false + and -

8

Give a potential problem with using the edrophonium test to diagnose myasthenia gravis
How would you resolve it?

Can cause a cholinergic crisis: bradycardia, salivation, miosis, dyspnoea, tremors
Give atropine

9

Which infectious diseases could cause neuro conditions in dogs?

Neospora
Toxoplasma
CDV (distemper)
Cryptococcus
Tick-borne diseases

10

Which infectious diseases could cause neuro conditions in cats?

FIV
FeLV
FIP
Toxoplasma
Cryptococcus

11

Why might you carry out metabolic urine screening?

To identify genetic diseases causing errors of metabolism
Most abnormal metabolites are concentrated in urine
Metabolic defects that produce organic acid accumulation often affect neuronal and muscle metabolism

12

Why should you always do a CSF analysis before doing a myelography?

The contrast material in the myelogram is irritable and will cause inflammation, which will affect the results of the CSF analysis

13

Where should you collect a CSF sample from relative to the lesion?

Caudal to lesion

14

When is a CSF analysis contraindicated?

Increased intra-cranial pressure (brain could herniate through skull)
Clotting problems (could cause bleeding into spine -> death)
Chiari-like malformations (syringomyelia)
Atlantoaxial instability or trauma

15

What shoud you never do when taking a CSF sample?

Aspirate

16

How much CSF should you take when obtaining a sample?

1ml/5kg

17

When taking a CSF sample, why should you use a plastic rather than glass tube?

Cells adhere to glass -> may get falsely low counts

18

What should you look at in a CSF analysis?

Differential cell count
Cytology
Protein
PCRs

19

What would you expect in a normal CSF sample?

<5 WBC/ul
No RBC
Protein <30-45mg/dl

20

What are the 2 places you can take a CSF sample from?

Cerebellomedullary cistern (atlanto-occipital joint) or lumbar subarachnoid space (L5-L6)

21

What position should a dog be when you take a CSF sample?

Lateral recumbency
Head 90 degrees, nose parallel to table

22

Where would you take a cervical CSF sample?

Imaginary line between occipital protuberance and wings of atlas (cerebellomedullary cystern)

23

Where would you take a lumbar CSF sample?

L5-L6 in dogs
L6-L7 in cats and small dogs (end of spine) (lumbar subarachnoid space)

24

What size needle should you use when taking a CSF sample?

Cervical: 1.5 inch needle, 21-22G
Lumbar: 1.5-3.5 inch needle, 21-22G

25

What is a pleocytosis?

An increased cel count, usually WBCs

26

For which conditions may you see a neutrophilic pleocytosis in a CSF sample?

(Increased neutrophils)
SRMA (steroid-responsive meningitis arteritis)
Bacerial infection
Granulomatous meningitis
Necrotising encephalitis
Fungal
FIP
Post-myelography, haemorrhage, trauma, neoplasia

27

For which conditions may you see a mononuclear pleocytosis in a CSF sample?

Granulomatous meningitis
Necrotising encephalitis
CNS lymphoma
Viral (distemper)
Bacterial and steroid-responsive meningitis arteritis

28

For which conditions may you see a mixed pleocytosis in a CSF sample?

Granulomatous meningitis
Bacterial and steroid-responsive meningitis arteritis
Fungal
Protozoal
Non-inflammatory disease (infarction)

29

For which conditions may you see an eosinophilic pleocytosis in a CSF sample?

(Uncommon)
Eosinophilic meningitis
Fungal
Protozoal
Parasitic

30

What is myeography?

Administration of contrast agent to subarachnoid space to outline the spinal cord
Highlights space-occupying lesions as deviations or thinning of contrast column

31

CT is good for diagnosing what?

Trauma
Haemorrhage and middle ear disease
Fair for tumours and IVDD

32

What is electrodiagnostics?

Recording of electrical activity of muscles or neuronal structures
Can be spontaneous or in response to stimulation

33

What is electromyography (EMG)?

Records spontaneous muscle electrical activity
Normal muscle at rest is electrically silent
Destabilisation of the muscle cell membrane results in spontaneous discharge and so identifies damaged or denervated muscles and lesions

34

What do nerve conduction velocities (NCV) do?

Evaluate peripheral nerve function by stimulating a nerve at 2 different locations and recording:
-Amplitude of response (strength)
-Latency of response (how long it takes to get there-to calculate velocity)

35

What do velocities and amplitude represent on an nerve conduction velocity test?

Velocities: myelin
Amplitude: axon

36

What do repetitive nerve stimulation tests do?

Evaluate neuromuscular junctions (eg myasthenia gravis)
If amplitude decreases by >10%, suggestive of disease

37

What do F wave tests do?

Evaluate nerve roots and proximal part of peripheral nerves
(Lost/delayed F waves if nerve roots are damaged)

38

What do electroencephalography (EEG) tests do?

Record spontaneous electrical activity in cerebral cortex. 5-12 electrodes on head.
Good for:
-Detecting seizures
-Localising seizure focus
-Monitoring response to AEDs (automated external defibrillators) in cases with epilepsy
-Brain death

39

What do brainstem auditory evoked response (BAER) tests do?

Screening tool for detection of congenital sensorineural deafness
Determines hearing threshold in adults
Assess neural lesions on CNVIII or brainstem
Assess for brain death

40

Why do we take muscle and nerve biopsies when diagnosing neuro disease?

Mainly to differentiate between inflammatory and non-inflammatory (metabolic, degenerative) disaese

41

How big should a muscle biopsy be?

0.5 x 0.5 x 1.0cm

42

How big should a nerve biopsy be?

1/3 the width for 1cm

43

Which nerve is commonly biopsied?

Peroneal nerve (cranial tibia mucsle) (easily identified, is both motor and sensory)

44

Give some neurological deficits of the forebrain

-Altered mental status (depressed/disorientated)
-Contralateral blindness (decreased menace but normal PLR)
-Normal gait
-Circling (ipsilateral), head turn, head pressing, pacing
-Reduced postural responses in contralateral limb (tells you the lesion is rostral to midbrain)
-Normal to increased spinal reflexes and muscle tone
-Seizures, behavioural changes, hemineglect syndrome

45

How would you identify the location of a lesion using postural reactions?

-Lesions rostral to the midbrain (eg forebrain) -> contralateral reduced responses
-Lesions caudal to the midbrain (eg SC) -> ipsilateral reduced responses

46

Give some neurological deficits of the midbrain

-Depression, stupor, coma
-Cranial nerve deficits, possible vestibular signs
-Paresis of all or ipsilateral limbs
-Possible decerebrate rigidity
-Reduced postural responses in all/ipsilateral limbs
-Normal to increased spinal reflexes and muscle tone
-Resp or cardiac abnormalities

47

Opisthotonus with hyperextension of
all four limbs reflects a lesion where?

Brainstem

48

Give some neurological deficits of the cerebellum

-Normal mentation
-Ipsilateral menace deficit, normal vision, possibly vestibular signs
-Possibly decerebellate rigidity (hyperextended FLs, spastic flexion of hips)
-Intention tremors
-Truncal ataxia, broad-based stance, hypermetria
-Delayed then hypermetric postural responses
-Normal spinal reflexes and muscle tone
-Rarely increased frequency of urination

49

Hyperextension of the forelimbs and spastic flexion of the hips reflects a lesion where?

Cerebellum

50

What is meant by 'white shakers'?

-Idiopathic cerebellitis, idiopathic tremor syndrome
-Mostly small breeds, young dogs
-Fine tremor, worse with stress/excitement
+/- head tilt/decreased menace/ leaning and falling, ataxia

51

How do you diagnose white shakers?

CSF-mildly inflammatory

52

How do you treat white shakers?
What is the prognosis like?

Corticosteroids for 4-6 months +/- other immunosuppressive drugs
Good prognosis, may relapse

53

What are the 3 main methods of infection of bacterial meningitis?

-Haematogenous
-CSF
-Direct invasion (eg inner ear, eyes, bite wounds)

54

Give some clinical signs of bacterial meningitis

Usually acute:
-Obtundation and cranial nerve deficits
-Neck pain
-Pyrexia
-Neutrophilia (50% of cases)

55

How would CSF be affected by bacterial meningitis?

-Increased protein concentration
-Pleocytosis (increased lymphocytes)
-Phagocytosed organisms (rare)

56

How do you treat bacterial meningitis?

-Antibiotics
-Surgical drainage
-Guarded prognosis

57

Give some clinical signs of increased intracranial pressure

-Altered mental status: obtunded, stupor, coma
-Altered pupil function: anisocoria, miosis, mydriasis
-Posture: decerebrate or decerebellate
-Bradycardia and hypertension (Cushing's reflex)
-Physiological nystagmus

58

What is the oculocephalic reflex?

-When you move head, eyes should follow
-May be absent in comatose patients with brainstem dysfunction eg head trauma

59

How should you treat a patient with head trauma?

-ABC
-Oxygenation
-Restore blood pressure
-Fluid therapy (avoid glucose)
-Analgesia

60

How would you treat raised intracranial pressure?

-Mannitol (decreases blood viscosity) followed by crystalloid fluid therapy to prevent dehydration eg normal 0.9% saline (CI in hypovolaemia)
-Or hypertonic saline (4mg/kg 7.5% as slow bolus) (CI in hyponatremia)

61

Give some general care you should consider when treating a patient with head trauma

-Keep head elevated
-Avoid jugular compression
-Turn every 4-6 hours
-Catheterise bladder
-Nutritional support (tube feeding)

62

What should you not give to patients with head trauma?

Corticosteroids

63

What is hydrocephalus?

Abnormal dilation of the ventricular system within the cranium

64

Which kinds of dogs are affected by hydrocephalus?

Toy breeds, young age

65

Give some clinical signs of hydrocephalus

-Domed head
-Persistent fontanellae
-Abnormal behaviour
-Cognitive dysfunction
-Seizures
-Obtundation
-Circling/pacing
-Vestibular signs

66

How do you treat hydrocephalus?

-Medical: corticosteroids, furosemide, anti-epileptic drugs
-Surgical: ventriculoperitoneal shunt (drains fluid from ventricles into abdomen)

67

What is lissencephaly?
Which breeds are predisposed to it?

-No development of gyri and sulci
-Llasa apso, Korat cats

68

Give some clinical signs of lissencephaly

-Seizures and behavioural changes

69

What are hydronencephaly and porencephaly?

Presence of cerebral cavities, usually communicating with subarachnoid space and/or lateral ventricles

70

Give the clinical signs of hydronencephaly and porencephaly

-1st few months: circling, abnormal behaviour
-Up to a few years: seizures

71

What is hepatic encephalopathy?

Liver dysfunction -> toxins in blood -> brain dysfunction
-Caused by acute liver failure or congenital portosystemic shunt

72

Give some clinical signs of hepatic encephalopathy

Mostly signs of forebrain dysfunction:
-Seizures
-Circling, head-pressing
-Abnormal behaviour
-Mentation changes (obtundation)

73

How do you diagnose hepatic encephalopathy?

-Blood ammonia levels
-Bile acids
-Liver US or CT

74

How do you treat hepatic encephalopathy?

-Lactulose (reduces absorption of ammonia from gut)
-Antibiotics
-Restricted protein diet
-Anti-epileptic drugs
-Surgery

75

Give the clinical signs of hypocalcaemia

-Muscle spasm and cramping
-Muscle twitching, trembling, stiffness
-Mental depression
-Tonic-clonic spasm
-Episodic rigidity
-Tetraparesis
-Seizures

76

Give the clinical signs of hypercalcaemia

-Muscle spasm and cramping, muscle twitching -Trembling
-Mental depression
-PU/PD
-Constipation

77

Give some causes of hypernatremia (high blood sodium)

-Excess water loss
-Excess salt intake
-Insufficient water intake
-Brain abnormalities

78

Give the clinical signs of hypernatremia (high blood sodium)

-Changes in mentation and seizures

79

How do you treat hypernatremia (high blood sodium)?

Correct sodium levels slowly over 48-72 hours

80

What is a storage disease?

-Defect of a lysosomal hydrolase enzyme
-Accumulation of storage substrates within the cytoplasm (mainly of neurons) -> cellular dysfunction -> diffuse neurological dysfunction -> progressive -> death

81

How do you manage storage diseases?

-No treatment
-Symptomatic treatment eg anti-epileptic drugs, anti-anxiety drugs

82

Give some causes of hypoglycaemia

Insulinoma, hepatic dysfunction

83

Give some clinical signs of hypoglycaemia

-Anxiety, lethargy, depression
-Ravenous appetite, exercise intolerance
-Tremors, visual deficit, seizures, coma

84

How do you diagnose hypoglycaemia?

Blood glucose <3mmol/L and clinical signs

85

How do you treat hypoglycaemia?

-Direct administration of glucose in emergency
-Frequent feeding in chronic cases
-Treat underlying cause

86

Give some primary neoplasms of the brain

-Intra-axial glial cell tumours
-Extra-axial meningiomas, choroid plexus tumours

87

How do you diagnose brain tumours?

-MRI (sometimes CT)
-CSF analysis (to rule out inflammatory disease)

88

How do you treat brain tumours?

-AEDs (anti-epileptic drugs)
-Anti-inflammatory dose of corticosteroids to reduce cerebral oedema
-Surgery +/- radiotherapy

89

What is Lafora's disease?

-Neuronal glycoproteinosis
-Progressive myoclonic epilepsy
-Jerking (myoclonic) which is induced by flashing lights, sudden sounds and movements
-Wire-haired Dachshund and Basset Hound; rare

90

How do you treat Lafora's disease?

-Antioxidant-rich diet
-Avoid starchy/sugary treats
-Treat epilepsy symptomatically (eg KBr)

91

Give some clinical signs of vestibular disease

-Head tilt (ipsilateral)
-Vestibular ataxia and wide-based stance
-Nystagmus
-Leaning and falling, sometimes tight circling
-Positional strabismus

92

Is a vertical nystagmus normally caused by a defect in the central or peripheral vestubular system?

Central

93

What is a cerebrovascular accident?

-Stroke
-Rapid loss of brain function due to a disturbance in blood supply to the brain

94

What are the 2 types of cerebrovascular accident (stroke)?

-Ischaemic (majority; results from aterial/venous obstruction)
-Haemorrhagic (results from rupture of blood vessels)

95

How do you diagnose a cerebrovascular accident (stroke)?

MRI

96

Give some concurrent medical conditions that could lead to a cerebrovascular accident (stroke)?

-CKD
-Hypertension
-Hyperadrenocorticism (Cushings)

97

What is an MUO?

Meningoencephalomyelitis of unknown origin

98

What are the 3 types of MUO?

-GME= granulomatous meningoencephalomyeitis
-NME= necrotising meningoencephalomyelitis
-NLE= necrotising leucoencephalomyelitis

99

Which kind of dogs are more affected by GME (granulomatous meningoencephalomyelitis)?

Young adults, toy and terrier breeds

100

What are the 3 forms of GME (granulomatous meningoencephalomyelitis)?

-Disseminated: multifocal signs involving forebrain, cerebellum, brainstem, spinal cord
-Focal
-Ocular: acute onset visual impairment, papillary changes, optic disc oedema

101

Which dog breeds are prone to NE (necrotising meningoencephalitis and leucoencephalitis)?

Toy breeds eg pugs, maltese, chihuahua, pekinese

102

How do you treat MUOs?

-Immunosuppression: corticosteroids, cytosine arabinoside, cyclosporin, lomustine

103

Neurological signs associated with FIP are usually localised to which brain region?

Cerebellomedullary

104

Give some neurological clinical signs that can be associated with FIP

Tetraparesis, ataxia, nystagmus, loss of balance, sometimes behavioural changes or seizures +/- iritis/anterior uveitis/chorioretinitis

105

Which cranial nerves pass by the middle ear?

-CNVII (facial)
-CNVIII (vestibulocochlear)

106

Give some clinical signs of otitis media/interna

-Pain opening the mouth
-Horners syndrome
-Facial paralysis

107

Give some examples of ototoxic drugs

-Antibiotics (aminoglycosides, tetracyclines)
-Chemotherapy agents (vincristine, cisplatin)
-Chlorhexidine -> perforated ear drum

108

What is the only thing you should lavage the middle ear with?

Warm saline

109

How can you investigate peripheral vestibular disease?

-Examine ear canal
-If tympanic membrane broken -> swabs, C&S
-Myringotomy if indicated (small hole in tympanic membrane)
-Lavage if indicated (warm saline)
-MRI/CT

110

How can you investigate central vestibular disease?

-MRI
-CSF analysis
-Blood pressure/urine analysis/caogulation profile
-Abdominal US/thoracic radiographs
-Serology for infectious diseases

111

What is the difference between sensorineural and conductive deafness?

-Sensorineural: failure to conduct sound from cochlea to auditory cortex of brain
-Conductive: failure to conduct sound from outer ear to inner ear

112

Which dogs and cats are affected by sensorineural deafness?

Breeds with white pigmentation and blue eyes eg dalmation

113

How can you assess hearing in dalmation puppies?

-BAER test (brainstem auditory evoked response)
-Done at 8 weeks old

114

Which cranial nerve does a BAER test assess?

Vestibulocochlear

115

Which nerve plexus supplies the HLs?

L4-S1

116

Which nerve plexus supplies the FLs?

C6-T2

117

Which nerve plexus supplies the neck?

C1-C5

118

What is discospondylitis?

Infection and inflammation of intervertebral disc and adjacent vertebrae

119

Give the clinical signs of discospondylitis

Significant spinal pain, may have systemic signs of illness

120

Discospondylitis is most likely to occur where along the spinal cord?

L7-S1

121

Discospondylitis is most commonly caused by which infectious agent?

Staph intermedius

122

How do you diagnose discospondylitis?

-Imaging: radiographs, MRI or CT (narrowing of IVD space, roughening of endplates, proliferation of adjacent bone)
-Bacteriology: blood, urine, CSF

123

How do you treat discospondylitis?

-Long-term antibiotics (based on sensitivity)
-NSAIDs initially when painful

124

What is chiari-like malformation?

-Malformation of the skull- cerebellum protrudes through foramen magnum
-CKCS

125

How do ischaemic myelopathies usually occur?

-Fibrocartilage from nucleus pulposus embolises in spinal cardvasculature- fibrocartilagenous embolism
-Hypertension in cats

126

Which dog breed is more affected by ischaemic myelopathies?

Miniature schnauzer

127

How do you diagnose an ischaemic myelopathy?

MRI

128

How do you treat an ischaemic myelopathy?

-Supportive care, physio
-Usually takes 10 days to walk again (max. 3-4 months)

129

What is SRMA?

-Steroid-responsive meningitis-arteritis
-Immune-mediated inflammation of the blood vessels in the meninges lining the spine

130

What are the clinical signs of SRMA?

-Spinal pain, pyrexia, lethargy
-Occasionally neurological deficits

131

Which dog breeds are more affected by SRMA?

-Boxers, Beagles
-6-18 months old

132

How do you treat SRMA?

-Corticosteroids for 4-6 months +/- other immunosuppressive drugs (azathioprine)

133

How do you diagnose SRMA?

-Leucocytosis with neutrophilia
-CSF analysis: increased neutrophils and protein
-Increased IgA in CSF and serum

134

Atlanto-axial (AA) instability occurs in which dog breeds?
Why?

-Young dogs, toy breeds
-Failure of ligamentous support between the two vertebrae, usually asociated with aplasia/hypoplasia of the dens

135

Give some clinical signs of atlanto-axial intability

-Neck pain
-Ataxia or tetraplegia

136

How do you treat atlanto-axial instability?

-Conservative splint for 6-12 weeks
-Surgery

137

Give some clinical signs of chiari-like malformation

-Neck pain
-Neck scratching
-Torticollis/scoliosis
-Thoracic limb weakness and atrophy

138

How do you treat chiari-like malformation?

-Medical: NSAIDs, furosemide, gabapentin, corticosteroids, amantadine
-Surgery

139

What is the difference between Hansens type I and II IVDD (intervertebral disc disease)?

-Type I: herniation of nucleus pulposus through annular fibres and extrusion into the spinal canal (chondrodystrophic breeds)
-Type II: annular protrusion but no extrusion of nuclear material (large breed dogs)

140

Intervertebral disc disease typically affects which vertebrae?

T12-L2

141

How would you diagnose IVDD?

-Radiography: narrowed IVD space (spondylosis with type II)
-Myelography
-CT, MRI

142

How would you treat IVDD?

-Conservative: strict rest for 6-8 weeks for type I, 4-6 weeks for type II, NSAIDs
-Surgical: if neurological deficits/ severe or recurrent pain

143

Give some clinical signs of cervical spondylomyopathy ('Wobbly dog')

-Large breeds and Basset hounds
-Progressive ataxia, tetraparesis, sometimes pain
-Signs worse in the pelvic limbs (paresis, ataxia)
-Short stilted gait and muscle atrophy in thoracic limbs

144

What might hyperviscosity of blood indicate?

Polycytaemia

145

What might inclusion bodies indicate on a haematology?

Lysosomal storage disease

146

What is the gold standard diagnostic tool for the acquired form of Myasthenia Gravis?

Acetylcholine receptor antibodies titres

147

What is the gold standard diagnostic tool for masticatory muscle myositis?

Type 2M antibody titres

148

Seizures occur due to a change in activity where?

Forebrain

149

Give some deficits associated with a forebrain lesion

Seizures
Circling
Behaviour change
Head turn (to side of lesion)

150

Give the 4 stages of a seizure

1. Prodrome (any predicting events)
2. Aura (initial manifestation of seizure)
3. Ictal (seizure event- involuntary muscle tone or movement +/- abnormal sensations or behaviour)
4. Post-ictal (can have unusual behaviour or neurological deficits for minutes to days after)

151

How long does the ictal stage of a seizure normally last?

60-90 seconds
Occurs most commonly at sleep or rest

152

What are the 2 major categories of seizure?

Generalised (involvement of both cerebral hemispheres simultaneously; consciousness is impaired)
Focal (activation of one part of one cerebral hemisphere)

153

What are the phases of a generalised seizure?

Tonic-clonic (most common)
Tonic (conraction of all skeletal muscles, legs out, head back)
Clonic (rhythmic movements eg jerking, clamping jaw, paddling of legs)
Myoclonic (sudden jerking motions
Atonic (sudden and general loss of muscle tone -> collapse)

154

What are the forms of a focal seizure?

Motor
Autonomic
Behavioural

155

What are audiogenic reflex seizures?

Cats, late onset (15yrs)
Myoclonic seizures caused by high-pitched sounds (can progress to tonic-clonic)

156

How do you control audiogenic reflex seizures?

Levetiracetam

157

What are the criteria for a diagnosis of idiopathic epilepsy?

2 or more seizures (24 hours apart)
Age of onset 6m to 6y
Unremarkable inter-ictal examination (period between seizures)
No clinically significant abnormalities on minimum database (haem/biochem/fasting bile acids/urinalysis)
Unremarkable MRI and CSF analysis

158

When should you start treatment for epilepsy?

Structural/metabolic epilepsy
Status elipticus or cluster seizures
6 months or less between seizures
Post-ictal signs are severe or last longer than 24 hours
Seizure frequency and/or duration is increasing
1st seizure is within 1 month of a traumatic event

159

Are any seizure medications licensed in cats?

No

160

Which are the 3 licensed seizure medications?

Phenobarbitone
Bromide (Potassium or sodium bromide salts)
Imepitoin

161

What is the mechanism of action of phenobarbitone?

Enhances GABA (inhibitory neurotransmitter of CNS)

162

What are the initial doses for phenobarbitone in cats and dogs?

Dogs: 3mg/kg BID
Cats: 2mg/kg BID

163

Give some side effects of phenobarbitone

Sedation, ataxia
PUPD, polyphagia
Hepatotoxicity
Haematological abnormalities (anaemia, neutropenia, thrombocytopenia)

164

When is phenobarbitone contra-indicated?

Dogs with hepatic dysfunction

165

What is the mechanism of action of bromide (anti-seizure medication)?

Raises the seizure threshold by inhibiting transport of Na+

166

What are the initial doses for bromide in cats and dogs?

Dogs: 30mg/kg SID
DON'T USE IN CATS

167

Give some side effects of bromide

Sedation
Ataxia and HL weakness

168

What is the dose for imepitoin in dogs?

10-30mg/kg BID

169

What is status elipticus?

Seizure lasting >5 mins, or >2 seizures without full recovery
Emergency

170

What are cluster seizures?

2 or more seizures within 24 hours
Emergency

171

Give some causes of status elipticus seizures in dogs

Neoplasia
CNS inflammatory disease
Trauma
Metabolic disorders
Toxicities
Idiopathic epilepsy

172

Why are status elipticus and cluster seizures an emergency?

Stage 1: increased autonomic activity (tachycardia, hypertension, hyperglycaemia)
Stage 2: irreversible neuronal damage (after 30 mins; hypotension, hypoglycaemia, hyperthermia, hypoxia, brain damage)

173

How do you stop a seizure?

Diazepam 1mg/kg per rectum

174

What is meant by 'breakthrough seizures'?

When an epileptic dog is medicated and still has seizures, we call them “breakthrough seizures”

175

How would you begin medicating a dog that is experiencing cluster seizures/status elipticus?

Place iv catheter
Phenobarbital 3mg/kg BID
If seizures don't stop/there are further seizures over the next 1-3 hours: phenobarbital iv loading (boluses)
If further seizures: levetiracetam loading

176

Give a side effect of using potassium bromide as an anti-seizure medication in cats

Eosinophilic bronchitis

177

Give a side effect of using diazepam as an anti-seizure medication in cats

Hepatic necrosis (oral administration)

178

Give some differentials for acute onset non-ambulatory tetraparesis

Neuropathy: polyradiculoneuritis
Junctionopathy: myasthenia gravis, botulism, organophosphate toxicity
Myopathy: severe polymyositis, electrolyte abnormalities eg Addisons

179

Which markers do we use for acquired myasthenia gravis?

Acetylcholine receptor antibodies

180

Which markers do we use for masticatory myositis?

2M antibodies

181

What is polyradiculoneuritis?

Inflammation of nerve and roots
Fairly common

182

Give some causes of polyradiculoneuritis

Idiopathic/rabies vaccine, immune-mediated?
Breed predisposition in Bengal cats
Demyelination

183

Give some clinical signs of polyradiculoneuritis

Acute onset, rapidly progressive (days)
Tetra/paraparesis -> non-ambulatory tetraparesis/plegia
Flaccid, reduced motor fuction (inc absent reflexes)
Can affect respiratory muscles

184

How do you diagnose polyradiculoneuritis?

Electrophysiology (f waves will be lost/delayed) and CSF analysis (lumbar)

185

How do you treat polyradiculoneuritis?

Supportive: nursing, physio, ventilatory support if necessary
Fair prognosis

186

What is myasthenia gravis?

Muscle weakness due to reduced neuromuscular transmission

187

What causes the 2 forms of myasthenia gravis?

Acquired: immune-mediated; Ab-mediated destruction of acetylcholine receptors
Congenital: deficiency of acetylcholine receptors

188

>80% of dogs with myasthenia gravis also have what?

Megaoesophagus (only 15% in cats)

189

Which cat breed is predisposed to myasthenia gravis?

Abysinnian

190

25% of cats with myasthenia gravis also have what?

Thymoma

191

How do you treat myasthenia gravis?

Anti-cholinesterase (pyridostigmine po)
Immunosuppression?
Postural feeding if mega-oesophagus

192

What is meant by the 'fulminant' form of myasthenia gravis?

Sudden onset of megaesophagus and frequent regurgitation of large volumes of fluid

193

How does botulism affect nerves?

Toxins prevent acetylchline release at nerve junctions

194

Give some clinical signs of botulism

Acute onset rapidly-progressing tetraparesis
Cranial nerves may be affected: facial paralysis, megaoesophagus, altered jaw tone
Respiratory muscles may be affected
Urinary dysfunction, GI dysmotility, mydriasis, reduced tear production

195

How do you treat botulism?

Supportive care
Physiotherapy

196

Give some clinical signs of immune-mediated polymyositis

Exercise intolerance, generalised weakness, muscle atrophy
Pyrexia, stiffness, non-ambulatory tetraparesis, reluctance to move, lowered head carriage, myalgia (muscle pain)

197

How do you diagnose immune-mediated polymyositis?

Inflammatory leucogram, elevated CK/AST
Muscle biopsies

198

How do you treat immune-mediated polymyositis?

Prednisolome +/- other immunosuppressives

199

Are cats or dogs affeced by masticatory myositis?

Dogs only

200

Why does masticatory myositis occur?

Antibodies to 2M myosin -> myositis

201

Give some clinical signs of acute and chroninc masticatory myositis

Acute: swollen/painful masticatory muscles, exophthalmos
Chronic: trismus (pain/fibrosis), mastictory muscle atrophy

202

How do you diagnose mastictory myositis?

Imaging
CK (may be slightly elevated)
2M antibodies

203

How do you treat masticatory myositis?

Prednisolone +/- other immunosuppressive drugs
Physio

204

What is the most likely cause of an infectious myositis?

Protozoa eg Toxoplasma, Neospora

205

Give some clinical signs of Neosporosis in puppies

Radiculoneuritis and polymyositis
Pelvic limb hyperextension
Ascending paralysis of pelvic limbs with muscle contracture and arthrogryposis

206

How do you diagnose Neosporosis in puppies?

Clinical signs, biopsy, CK/AST. serology

207

How do you treat Neosporosis in puppies?

Clindamycin/TMPS and pyrimethamine

208

What is neuropraxia?

Temporary nerve damage but no disruption of the nerve or myelin sheath
Good prognosis, will return to normal function in a few days

209

What is axonotmesis?

Disruption of the axon but intact myelin sheath
Good prognosis but slow recovery

210

What is neurotmesis?

Partial/complete transection of the nerve
Partial recovery is possible

211

Give some clinical signs of brachial plexus avulsion

Monoparesis, cutaneous trunci absent ipsilaterally, Horner's syndrome

212

Give some clinical signs of a brachial plexus tumour?

Malignant peripheral nerve sheath tumour
Chronic progressive thoracic limb lameness, pain, muscle atrophy
Neurological deficits

213

How do you diagnose a brachial plexus tumour?

Electrodiagnostics
Imaging (MRI best)

214

How do you treat a brachial plexus tumour?

Surgery

215

How do you differentiate central from peripheral vestibular disease?

Central: may have paresis and prorioceptive deficits, nystagmus may be vertical, horizontal or rotatory
Peripheral: may have Horner's syndrome, nystagmus may be horizontal or rotatory

216

Give some causes of acute onset vestibular disease

Idiopathic vestibular dz
Cerebrovascular dz
Head trauma
Trauma to middle/inner ear

217

Give some causes of chronic onset vestibular disease

Otitis media/interna
Brain and middle ear tumours
Thiamine deficiency
Lysosomal storage dz
MUO, FIP
Degenerative dz
Brain malformation
Congenital vestibular dz

218

Give some causes of vestibular disease that can be acute or chronic onset

Metronidazole toxicity
Ototoxic drugs
Hypothyroidism

219

How do you diagnose MUOs?

MRI

220

How do you diagnose FIP in cats?

Clinical signs
Lymphopenia, neutrophilia, non-regenerative anaemia
Increased serum alpha-1-acid glycoprotein
High serum titres of feline coronavirus Ab
MRI: ventricular dilation

221

Give some signs of metronidazole toxicity
When does it occur?

Seizures, tremors, rigidity, hypermetria
Usually when doses are >60mg/kg/day

222

How do you treat metronidazole toxicity?

Discontinue drug
Give diazepam

223

Give some clinical signs of a thiamine deficiency

Bilateral central vestibular signs, seizures

224

Give some clinical signs of bilateral vestibular disease

Crouching low to the ground
May fall to both sides
Wide lateral excursions of the head

225

What age of dogs are affected by idiopathic vestibular disease?

Adult to geriatric

226

How do you treat idiopathic vestibular disease?

No tx needed-will resolve spontaneously

227

How do you diagnose idiopathic vestibular disease in dogs?

Diagnosis of exclusion

228

What are the 2 forms of feline idiopathic vestibular disease?

Acute onset, non-progressive, improves over 2-4 weeks
Atypical form: acute onset but clinical signs progress over 3 weeks; recover after 3 months but milk residual head tilt may remain

229

How do ischaemic myelopathies occur?

Fibrocartilage from nucleus pulposus embolises in the spinal cord vasculature -> fibrocartilagenous embolism -> blocks off blood supply to part of spinal cord

230

When do clinical signs of ischaemic myelopathies occur?
What signs do you see?

Exercise
Vary from mild weakness or incoordination, to inability to walk

231

What is chiari-like malformation?

Mismatch between caudal fossa volume and its contents, with caudal displacement of the cerebellum through foramen magnum
Can develop syringomyelia (fluid-filled 'cyst' in spinal cord)

232

How do you diagnose cervical spondylomyelopathy?

Myelography +/- CT, MRI

233

How do you treat cervical spondylomyelopathy?

Anti-inflammatories, rest
Surgery

234

What is 'cauda equina' syndrome?

Degenerative lumbosacral stenosis
Arthritis of the joint between the last lumbar vertebra and the sacrum -> narrowing of spinal canal -> pressure on nerves coming off spinal cord

235

Give some clinical signs of 'cauda equina' syndrome?

Reluctance to exercise, rise, jump into car, do stairs
Proprioceptive deficits, reduced withdrawal reflex, muscle atrophy
Lameness
Lumbosacral/hip pain
Mono/paraparesis
Urinary and/or faecal incontinence

236

How do you treat cauda equina syndrome?

Conservative: rest and NSAIDs
Surgery: dorsal laminectomy/ dorsal fusion-fixation/ foraminotomy

237

Give some clinical signs of degenerative myelopathy

Insidious, progressive ataxia and paresis of pelvic limbs -> paralysis
Not painful
Age of onset: 5-9y

238

Are there any treatment options for degenerative myelopathy?

No therapeutical options
Physio

239

How do you perform a hemilaminectomy?

Remove one half of the vertebral arch (lamina, articular process and pedicle) and expose spinal cord -> remove ruptured disc material
Used to correct slipped or herniated discs in the thoracolumbar spine

240

How do you perform a dorsal laminectomy?

Remove dorsal spinous process and laminae -> access to spinal cord

241

Which drug can you give to dogs with canine cognitive dysfunction?

Selegiline

242

Give some clinical signs of canine cognitive dysfunction?

Disturbances in sleeping; pacing/vocalising at night
Getting stuck in corners, staring into space
Loss of house-training ability
New behavioural problems

243

What is myelography?

Injection of positive contrast into subarachnoid space

244

Where should you inject when doing a myelography?

Cistern puncture (easier)
Lumbar puncture (safer, more difficult)