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Neuro junior > Approach to neuro patient and dx tools > Flashcards

Approach to neuro patient and dx tools Flashcards

1
Q

Objectives (4)

A
  1. impact signalment on ddx and tests
  2. pros and cons of imaging modalities
  3. indications for electrodiagnostic tests
  4. risk factors and breeds for congenital deafness
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2
Q

Diagnostic modalities (8)

A
  1. Lab work
  2. Radiographs
  3. Ultrasound
  4. Myelography
  5. Computed tomography and CT - myelography
  6. MRI
  7. Cerebrospinal fluid analysis
  8. Electrodiagnostics
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3
Q

Lab testing (5)

A
  1. Fasted pre- and post-prandial bile acids
  2. ACTH stim test
  3. Dexamethasone suppression test
  4. Urine protein:creatinine ratio
  5. Paired insulin and glucose levels
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4
Q

Infectious dz testing (4)

A
  1. Peripheral blood/serum
  2. Cerebrospinal fluid
  3. Regional diseases
  4. PCR panels
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5
Q

Peripheral blood/serum (5)

A
  1. Cryptococcus neoformans
  2. Endemic opportunistic fungus
  3. Respiratory entry, but neurotropic organism
  4. Latex Capsular Agglutination test (LCAT)
    - very sensitive and specific
  5. Leptomeningitis
    - eosinophils on CSF
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6
Q

Cerebrospinal Fluid (4)

A
  1. Toxoplasma gondii
  2. Neospora canis
  3. Cryptococcus neoformans
  4. Distemper virus
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7
Q

Regional diseases (3)

A
  1. Coccidioides
  2. Blastomycoses
  3. Hepatozoon
    …..
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8
Q

PCR panels (2)

A
  1. Respiratory, Neurological

2. Vaccination status or interference

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9
Q

Imaging modalities (5)

A
  1. Radiographs
  2. Ultrasound
  3. Myelography
  4. Computed tomography & CT myelography
  5. Magnetic resonance imaging
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10
Q

Myelography (4)

A
  1. Survey spinal rads
  2. Intrathecal injection
    - Cisternal or lumbar injections (CSF)
    - non-ionic iodinated contrast material
    - Iohexol
  3. repeat rads
  4. can do on any species
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11
Q

Spinal lesion locations

A

Extradural vs
Intradural-extramedullary vs
intramedullary swelling vs
intramedullary opacification

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12
Q

Myelography complications (3)

A
  1. Arrest
  2. Seizures - > 20 kg or cisternal injection
  3. worsening neuro status - chemical meningitis
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13
Q

CT (5)

A
  1. More sensitive than rads
  2. contrast from different degrees attenuation of x-rays
  3. rapid
  4. inexpensive
  5. can do under sedation
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14
Q

MRI (4)

A

signal from protons

  1. H+ in free water
  2. H+ in tissue (interstitial edema)
  3. Tissue with no water
  4. Tissue with metal (Iron in heme)
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15
Q

MRI (4)

A
  1. VERY sensitive for soft tissue resolution
  2. Slow
  3. Requires general anesthesia
  4. CAN’T USE IF IMPLANTS OR PACEMAKER
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16
Q

MRI rando (4)

A
  1. Gadolinium-based contrast
  2. Paramagnetic
  3. Shorten the T1 relaxation of tissues
  4. Shows degradation of blood brain barrier
17
Q

CT VS MRI

A

MRI

  1. Most brain diseases
  2. Intramedullary spinal diseases, tumors
  3. Non-chondrodystrophoid or Type II IVDD

CT

  1. Fractures, boney dz
  2. Mineralized, Type I IVDD
  3. Poor for caudal fossa and lumbosacral area
18
Q

Disk herniations

A

Extrusion vs Protrusion

19
Q

Cerebrospinal fluid (4)

A
  1. Bathes brain and spinal cord
  2. Produced by choroid plexus
    - lateral, 3rd, and 4th ventricles
    - brain capillaries, parenchymal & ependymal cells
  3. Carbonic anhydrase
  4. Drained by arachnoid villi into venous sinuses
20
Q

CSF collection considerations (6)

A
  1. Competency
  2. Requires general anesthesia
  3. Rapid degradation of cells
  4. greater meningeal or ependymal involvement more abnormal CSF
    - deep parenchymal dz may not show
  5. Often helpful to rule out other dzs
  6. VERY SENSITIVE, not specific
21
Q

CSF collection contraindications (2)

A
  1. Inc intracranial pressure

2. Lack of comfort/competency wit procedure

22
Q

CSF Collection (4)

A
  1. Cisternal puncture (dog, cat, horse)
    - cerebellomedullary cistern, cisterna magna
  2. Landmarks
    - Occiput
    - Spine of C2
    - Wings of C1
  3. Spinal needle
    - stylet
  4. Lumbar puncture
    - subarachnoid space: L5-6 in dog/ L6-7 or L7-S1 cat
    - higher rate of blood contamination
    - indicated if closer to lesion
23
Q

CSF evaluation (5)

A
  1. Ultrafiltrate of plasma (almost water)
  2. Color and clarity
  3. Total nucleated cell count
  4. RBC count
  5. Protein conc
24
Q

Xanthochromia

A
  1. Yellow CSF
  2. Usually from prior hemorrhage (>10hrs)
  3. Can last up to 4 weeks
25
Q

Inc CS turbidity

A

usually from increased cellularity

26
Q

Pleocytosis

A

Too many cells

27
Q

Protein level

A
  1. Cisternal < 25 mg/dL
  2. Lumbar < 40 mg/dL
    * Serum protein is g/dL
28
Q

Albuminocytologic dissociation

A

Elevated CSF protein conc in face of normal CSF cell count

29
Q

Neuromuscular testing (4)

A
  1. 2-M antibody titer
    - masticatory myositis
    - serum sample
  2. Acetylcholine receptor antibody titer
    - myasthenia gravis
    - serum sample
  3. Electrodiagnostic testing
  4. Muscle and nerve biopsies
30
Q

Electrodiagnostic testing (6)

A
  1. Electromyography
  2. Nerve Conduction Velocity
  3. Repetitive Nerve Stimulation - MG suspect
  4. F-Waves - nerve root
  5. Brainstem Auditory Evoked Response
  6. Electroencephalography
31
Q

Electromyography (5)

A
  1. Healthy m. normally silent
  2. Abnormal discharges can occur from metabolic m. or n. dz
  3. When denervated, muscle becomes very sensitive to circulating acetylcholine
  4. Insertional activity
  5. Spontaneous discharges
32
Q

Nerve Conduction Studies (3)

A
  1. Evaluate conduction
  2. M. Wave
  3. Affected by age, limb temp, limb length
33
Q

Conduction (4)

A
  1. Motor and Sensory
  2. Latency
  3. Amplitude
    - Proportional to number of axons
  4. Velocity
    - reflects degree of myelination
34
Q

F wave

A
  1. Eval n. root, only motor
  2. Orthodromic and antidromic stimulus
  3. Orthodromic stim reaches m. fiber, elicits strong response indicatavie of muscle contraction (M wave)
  4. Antidromic stim evokes small proportion of m. fibers causing small, second CMAP called F wave
35
Q

About BAER (3)

A

Brainstem Auditory Evoked Response

  1. Measure of conductive, sensorineural hearing and brainstem fxn
  2. up to 7 waves
    - cochlear nerve, cochlear nucleus, dorsal nucleus of trapezoid body, and brainstem (lateral lemniscus, medial geniculate, auditory radiations)
  3. Skull thickness and m. mass reduce amplitudes
36
Q

Breeds prone to congenital deafness (7)

A
  1. Australian cattle dog
  2. Australian shepherd
  3. Bull terrier
  4. Catahoula
  5. Dalmation
  6. English cocker spaniel
  7. English setter

Neuro junior (14 decks)

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