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RUSVM SAM 1 > Brain Conditions > Flashcards

Brain Conditions Flashcards

1
Q

Peripheral vesicular disease results from lesions where??

A

Cranial nerve VIII

Vesicular sensing apparatus in inner ears

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2
Q

Central vestibular disease occurs due to lesions where??

A

Vesicular nuclei in the medulla oblongata

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3
Q

In vesicular disease, is the head tilt and circling toward or away from the side of the lesion?

A

Toward

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4
Q

Dx?

Head tilt 
No CP deficit 
No depression 
Nystagmus - horizontal/rotary 
Eyes move together
A

Peripheral vesicular disease

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5
Q

Dx?

Head tilt 
Tetra/hemiparesis 
Depression 
Cranial nerve deficits 
Nystagmus-horizontal and vertical 
Eyes move in different directions
A

Central vestibular disease

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6
Q

What are causes of peripheral vesicular disease in dogs?

A

Otitis media-interna (antibiotic therapy)
Canine geriatric vestibular disease
Congenital -GSD, Beagle, Doberman

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7
Q

What are causes of peripheral vestibular disease in cats?

A

Otitis media-interna
Congenital - Siamese and Burmese
Feline idiopathic vestibular disease

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8
Q

T/F: In cats with feline idiopathic vestibular disease, with bilateral lesions there may be ataxia but no head tilt or nystagmus

A

True

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9
Q

What is the most common cause of central vestibular disease/

A

Neoplasia

Encephalitis

  • distemper
  • FIP
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10
Q

What are some of the less common causes of central vestibular disease?

A

Hypothyroidism
Toxicity - aminoglycosides or metronidazole

Infections - RMSF, ehrlicichia, cryptococcus, blastomyces, toxoplasma, neosporus

Thiamine deficiency

Granulomatous meningioencephalitis (GME)

Thromboembolism /septic emboli (stroke)

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11
Q

Dx:

Increased extensor muscle tone and proprioceptive deficits on one side of the body with head tilt and circling to the opposite side

A

Paradoxical Central Vestibular Syndrome

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12
Q

In paradoxical central vestibular syndrome, this the head tilt and circling toward or away from the side of the lesion?

A

Away

Cerebellum is involved in modulation or inhibition of vestibular system. A lesion here will lead to increased sensation of falling on the damaged side—> compensate by head tilt and circling to the OPPOSITE side of lesion in cerebellum

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13
Q

What is the normal function of the cerebellum?

A

Coordinate motor activity and help maintain equilibrium and control posture

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14
Q

Dx:

Wide based stance
Truncated ataxia(swaying)
Intention tremor
Dysmetria

A

Cerebellar disease

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15
Q

What is dysmetria ?

A

Improper measurement of distance during movement

  • hypermetria (over-reaching)
  • hypometrria (under-reaching)
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16
Q

What signs do you see in severe cerebellar lesions?

A

Decerebellate rigidity

  • opisthotonos
  • extension of the thoracic limb and flexion of the pelvic limbs
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17
Q

How can you differentiate the signs of cerebellar lesions from midbrain lesions and Schiff-Sherrington?

A

Cerebellar—> opisthotonos + extension of thoracic and FLEXION of the pelvic limbs

Midbrain —> opisthotonos + EXTENSION of BOTH thoracic and pelvic limbs

Schiff-Sherrington —> UMN in hindlimb + EXTENSION of thoracic limbs

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18
Q

What is the cause of cerebellar hypoplasia in cats?

A

Intrauterine infection with panlukopenia parvovirus

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19
Q

6wk old kitten

Truncal ataxia
Tremor
Dysmetria

Non-progressive

A

Cerebellar hypoplasia - pankleukopenia parvovirus

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20
Q

How can you differentiate cerebellar hypoplasia from cerebellar atrophy, storage diseases, and infections?

A

Cerebellar hypoplasia is non progressive

Then rest will be progressive

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21
Q

What breeds of dogs has cerebellar aplasia/hypoplasia been reported in?

A 
Beagles 
St Bernards
Bull terrier
Boston terrier 
Airedale terrier 
Chows
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22
Q

What is abiotrophy?

A

Premature death of neurons due to disruption o the metabolic processes in the cells

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23
Q

T/F: cerebellar abiotrophy occurs in almost every breed of dog

A

True

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24
Q

In what breeds of dogs are cerebellar abiotrophies an inherited autosomal recessive trait?

A 
Kerry blue terrier 
Gordon setter 
Rough coated collies 
Boarder collies 
Brittany spaniel 
Bernese mountain dogs 
Old English sheepdogs
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25
Q

What is generally the progression of cerebellar abiotrophy?

A

Animals are normal at birth and when they begin to walk there is degeneration of Purkinje fibers followed by neuronal loss in the brain stem because of loss of the trophic influence of Purkinje fibers

Progressive cerebellar dysfunction and brain stem lesions

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26
Q

What infectious agents can cause cerebellar signs?

A

Distemper (paramyxovirus)
Canine herpesvirus
FIP (coronavirus)

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27
Q

What primary tumors occur in the cerebellum?

A

Meddullablastoma

Glioma

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28
Q

What is corticosteroid responsive tremor syndrome?

A

AKA shaker dog disease

Tremors in all 4 limbs and head —> get worse with excitement/exercise

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29
Q

What breeds is shaker dog syndrome most common in?

A

Maltese

West highland white terriers

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30
Q

What would you your other DDX if you suspect shaker dog syndrome?

A 
Fear 
Hypomyelintion 
Tremorgens 
Toxins 
Orthostatic tremor 
Head bobbing 
Old dog hindlimb tremors
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31
Q

Treatment for shaker dog disease ?

A

Prednisone

—> response to glucocorticoids suggests there is an autoimmune disorder

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32
Q

What is Scotty cramp?

A

Hypertoncitiy syndrome caused by a deficit of serotonin inhibitory neurotransmitter and prostaglandin abnormality

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33
Q

Dog at 10months
With exercise there is abduction of the thoracic limbs and pelvic limb stiffness, falling and curling into a ball with limbs tightly flexed against the body.
No loss of consciousness

DX?
Rx?

A

Scotty cramp - episodic muscle hypertonicity

Prozac (fluoxetine) —> selective serotonin reuptake inhibitor

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34
Q

King Charles spaniel 5months
After exercise there is pelvic and thoracic limb hypertonicity
Consciousness is maintained

Dx?
Rx?

A

Episodic falling

Clonazepam - muscle relaxant can stop clinical signs
Usually resolves over a few years

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35
Q

Conditions of the brainstem or cerebral cortex can present as…

A

Depression -decreased responsiveness
Stupor-animals are unresponsive but can be aroused by painful stimuli
Coma- unresponsive and unarousable

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36
Q

What is hydrocephalus?

A

Dilation of the ventricular system of the brain
—> reduced absorption (congenital or acquired blockage of drainage)
—> excessive secretion of CSF (choroid plexus tumor)

37
Q

What breeds are congenial hydrocephalus seen in?

A

Toy/small breed and Brachycephalic

Bulls dog, Pomeranian, chihuahua, Maltese, poodle, pug, Yorkshire terrier, Lhasa apso

38
Q

Toy breed puppy

Altered mental attitude 
Slow learner 
Seizures
Dilated pupils
Auditory impairment 
Tetraparesis 
Ventrolateral strabismus 
Domeshaped skull

Dx/?

A

Hydrocephalus

39
Q

What are acquired causes of hydrocephalus ?

A 
Meningitis 
FIP
Cryptococcus
Toxoplasma  
Neoplasia
40
Q

How can you diagnose hydrocephalus?

A

CSF sampling —> can result in herniation because of incresed ICP

Ultrasound if fontanelles are open

CT/MRI

41
Q

How do you treat hydrocephalus?

A

Shunts to drain CSF into the abdominal/peritoneal/jugular vein (80% successful)

Prednisone, dexamethasone, omeprazole, acetazolamide, and furosemide can decreased CSF (temporary)

42
Q

What are the most common brain neoplasms?

A

Meningioma

Glioma

  • astrocytoma
  • oligodendrocytes
  • glioblastoma
43
Q

What breeds of dogs are more predisposed to glioma?

A

Brachycephalic breeds

44
Q

What breeds are more predisposed to meningiomas?

A

German shepherds and golden retrievers

45
Q

About _______ of meningiomas in dogs are invasive?

A

1/3

46
Q

What are the most common primary brain tumors seen in cats?

A

Meningioma
Lymphoma
Pituitary tumor
Glioma

47
Q

What signs are often seen with brain neoplasia in the cortex?

A

Change in behavior

  • inactivity
  • decreased purring
  • irritability
  • compulsive pacing
  • altered level consciousness
  • head pressing
  • circling
  • seizure
48
Q

With cerebrocortical tumors, where would you see visual deficits or postural reaction deficits?

A

Contralateral side

49
Q

What signs would you see with a brainstem neoplasia ?

A

Hemiparesis or lateralizing tetraparesis
Depression
Cranial nerve deficits

50
Q

What methods can be used to diagnose a brain neoplasia ?

A

CT/MRI

CSF if tumor cells are in contact with ventricles (risk hernia if tumor causes increase ICP)

51
Q

What is the treatment of brain neoplasias?

A

Benign superficial tumors can be removed

Dexamethasone/mannitol may reduce edema, and temporarily reduced tumor size
Radiation

Overall prognosis is poor, treatment only expends life for months, maybe years (meningiomas longer than glioma)

52
Q

What is the cause of brain herniation ?

A

Usually space occupying lessons - decrease CSF flow —> increase ICP

Displacement of tentorium cerebellum through foramen magnum

53
Q

What procedures than increase risk of brain herniation ?

A

Volatile anesthetics (cerebral vasodilation and increase brain blood volume and pressure)

CSF taps (increase pressure gradient)

54
Q

What are signs of increased ICP that may lead to brain herniation?

A

Depressed/stuporous
Miotic and non responsive/slow PLR (loss of SNS input)

Higher ICP: 
Breathing pattern abnormalities 
Strabismus 
Facial nerve dysfunction 
Weak jaw tone 
Dilated pupils (loss of both SNS and PSNS input)
55
Q

What are signs of brain herniation?

A

Rapid progressive

Tetraparesis
Coma —> respiratory arrest (RAS and resp centers compression)

56
Q

What is the treatment of brain herniation?

A

Remove underlying cause

Dex-> decrease edema and herniation
Mannitol

57
Q

What is a concussion?

A

No morphological lesions
Transient unconsciousness
Confusion/ataxia for a few days

58
Q

What is a contusion?

A

Focal hemorrhage and edema
More confused and ataxic than concussion
CP deficits
Unconsciousness

59
Q

What is the primary and secondary damages caused by cranial traumas?

A

Primary: brain parenchyma and blood vessel damage resulting in edema and hemorrhage

Secondary: hypotension and hypoxemia activating metabolic pathways —> free radicals and damage neuronal membranes

60
Q

An (intra/extra-cerebral)? hematoma causes progressive neurological dysfunctions hours after the injury, whereas (intra/extra-cerebral)?result in acute dysfunction

A

An EXTRAcerebral hematoma causes PROGRESSIVE neurological dysfunctions hours after the injury, whereas INTRAcerebral hematomas result in ACUTE dysfunction

61
Q

What signs would you see if the cranial trauma caused a lesion in the cortex?

A

Decreased consciousness
Normal cranial nerves
Seizure
Contralateral hemiparesis

62
Q

What signs would you see if cranial trauma caused lesions in the brain stem?

A 
Decreased consciousness  
Abnormal cranial nerves 
Irregular respiration 
Bradycardia 
Mydriasis 
UMN signs - extensor rigidity
63
Q

How can you localize a crainial trauma injury?

A

Decreased level of consciousness -> brainstem or cortex involved

Asymmetry of menace response and nostril stimulation/limb proprioceptive without other cranial nerve deficits —> cortex in contralateral side

Stupendous patient with multiple cranial nerve deficits —> brainstem

64
Q

T/F: a lesion in the cortex due to trauma has a worse prognosis than a lesion in the brainstem

A

False

Brainstem lesions have more guarded prognosis

65
Q

With history of trauma, what would you suspect within PLR are abnormal, there is deterioration of consciousness, extensor rigidity and abnormal respiratory patterns?

A

Increased ICP

PLR-> increased pressure on oculomotor nerves

66
Q

How do you treat cranial trauma injuries?

A

Treat shock/life threatening injuries -ABC
Maintain cerebral perfusion and O2 delivery —> hetastarch/hypertonic —> increase BP and decrease
ICP

Stable:

  • maintain ICP (normal 5-12mmHg)
  • avoid hypercapnia and hypoxia—> vasodilation (increased ICP)
  • head slanted up

Mannitol in severe/deteriorating condition, only if CVS in good health (and free radical scavenger)

67
Q

What should you do if your trauma patient is having seizures?

A

Aggressive seizure treatment
—> increases ICP

Diazepam
Midazolam
Phenobarbital

They can also act as brain protectants by decreasing O2 consumption and metabolic rate

68
Q

Hematomas, penetrating wounds, or unstable depressed fractures need to be treated surgically. What is your best choice for induction an maintenance of anesthesia ?

A

Barbiturates/propofol -induction
Isoflurane

Do not increase ICP

69
Q

What can indicate poor prognosis of patients with cranial traumas?

A

Coma for over 2 days

Irregular respiratory rate and unresponsive bilateral mydriasis indicate poor prognosis

Euthanatize - intractable seizures/respiratory failure

70
Q

What is narcolepsy ?

A

Sudden recurring attacks of sleep

Usually accompanied by cataplexy-> loss/reduction of muscle tone and signs of weakness, head drop/collapse for seconds to minutes

71
Q

When do episodes of narcolepsy usually occur?

A

With excitement, especially during eating

72
Q

How can you definitively diagnose narcolepsy?

A

EEG during an episode —> classical sleep patterns

73
Q

What is the cause of narcolepsy?

A

Mutation in orexin gene —> normally keeps animals awake and stop REM sleep

74
Q

How can you control narcolepsy?

A

Amphetamine (Ritalin)

Antidepressants (imipramine)

75
Q

What are DDX for narcolepsy?

A

Syncope

76
Q

What is feline ischemic encephalopathy ? What is the cause?

A

Ischemic necrosis in a cerebrum or the brainstem occurs sporadically in young to middle aged cats

Cuterebra larva migrans —> from nasal cavity through cribriform plate —> cause vasospam in the brain arteries

77
Q

What clinical signs are associated with feline ischemic encephalopathy ?

A 
History of upper respiratory signs 
Neurological signs have sudden onset 
-> seizures and abnormal behavior 
—> unilateral blindness
—> circling/head tilt 
—> hemiparesis
78
Q

What are the inflammatory disease that can affect the brain?

A 
Rabies 
Distemper 
Toxoplasma 
Canine herpesvirus encephalitis 
Parvovirus 
Canine granulomatous meningoencephalitis
Feline immunodeficiency virus 
Feline infectious peritonitis 
Feline leukemia virus 
Feline polioencephalomalacia 
Bacterial meningitis  
 Steroid responsive meningitis-arteries 
Mycotic meningioencephalitis
Parasitic 
Protothecosis 
Feline non-FIP encephalitis
79
Q

What is dysautonomia?

A

Degeneration of neurons in the SNS and PSNS ganglia and dysfunction of the autonomic nervous system

Seen in cats and dogs

80
Q

What bacteria has been associated with dysautonomia ?

A

C botulinum

Autoimmune disorder

81
Q

What are the main signs seen with dysautonomia ?

A

PSNS dysfunction

  • mydriasis
  • prolapsed third eyelid
  • reduced lacrimal secretions
  • regurgitation
  • constipation
82
Q

What are the three types of deafness?

A

Conductive
Central
Sensorineural

83
Q

What is conducive deafness?

A

Results from chronic otitis externa/media —> prevents sound from being transmitted to inner ear

84
Q

What is central deafness?

A

Damage to central auditory pathways which is associated with other brain stem signs

85
Q

What is sensorineural deafness?

A

Congenital or acquired abnormalities of the cochlear.

86
Q

What breeds of dogs is congenital sensorineural deafness most common in/

A

Dalmatian
English cocker spaniel
English setter
Bull terrier

87
Q

What can cause an acquired sensorineural deafness?

A 
Noise trauma 
Otitis interna 
Exposure to ototoxicity agents 
-aminoglycosides 
-polymyxin B and chloramphenicol 
-antiseptic solutions 
-furosemide and cisplatin
88
Q

T/F: acquired sensioneural deafness can be associated with normal aging resulting in atrophy of the cochlear neurons

A

True

RUSVM SAM 1 (26 decks)

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