Brain Diseases

Question 1

How does idiopathic cerebelitis (white shakers) present?

Answer 1

Small breed, young dogs
Presenting with a fine tremor
+/- another cerebellar sign eg ataxia

Question 2

How can you diagnose idiopathic cerebellitis?

Answer 2

Exclusion
CSF - mildly inflammatory
MRI

Question 3

How should you treat idiopathic cerebellitis?

Answer 3

4-6 months of corticosteroids

Question 4

What is the common presentation of bacterial meningitis?

Answer 4

Obtundation and cranial nerve deficits
Neck pain
Pyrexia

Question 5

How can you diagnose bacterial meningoencephalitis?

Answer 5

Bloods - neutrophillia
CSF analysis - pleocytosis, high protein, occ engulfed bacteria
CSF / blood culture - positive in only 15-30%

Question 6

How should you treat bacterial meningioecephalitis?

Answer 6

Antibiotics eg: Fluoroquinolones
Surgical drainage
Poor px

Question 7

How should you manage a head trauma patient?

Answer 7

Try to reduce the severity of the contre-coup lesion
O2
Initial assessment
ICP management
Isotonic or hypertonic IVFT - maintain cerebral perfusion
Surgical drainage
Maintain a normal temperature and blood pressure
- 90-140 mmHg
Pain management

Question 8

Where is the brain at the highest risk of herniation with increased ICP?

Answer 8

Forebrain – tentorium cerebelli = compresses brainstem

Cerebellum – foramen magnum

Question 9

What are the clinical signs of increased ICP?

Answer 9

Obtunded, comatose, stupor
Anisocoria, mydriasis, miosis
Cushings reflex - bradycardia and hypertension 
Absent physiological nystagmus 
Decerebrate or decerebellate rigidity

Question 10

What signs would make you concerned about forebrain herniation through the tentorium cerebelli?

Answer 10

Anioscoria and absent PLR

Question 11

How can you reduce CSF volume in a case of increased ICP?

Answer 11

Diuretics - Mannitol

• increases cerebral perfusion, decreases CSF volume
• follow by crystallised fluids to prevent dehydration

Hypertonic saline - hyperosmotic agent

Question 12

What opioid would be best to use in increased ICP?

Answer 12

Methadone

Less likely to cause emesis than morphine

Question 13

What nursing care should you provide to a patient with increased ICP?

Answer 13

Keep the head elevated
Turn q 4-6h
Nutritional support - feeding tube 
Keep at a stable temperature 
Catheterise the bladder

Question 14

What breed is predisposed to hydrocephalus? How does it present and how should it be treated?

Answer 14

Chihuahua - persistent fontanelle and domed head

CP: circling, pacing, abnormal behaviour, seizures, obtundation

Treatment: corticosteroids, furosemide, AEDs
Surgical - ventriculoperitoneal shunt

Question 15

What is the most common cause of hepatic encephalopathy and how does it present?,

Answer 15

Congenital PSS

Seen in young dogs with stunted growth and forebrain signs

• bilaterally symmetrical
• head pressing, seizures, circling

Question 16

How can you diagnose hepatic encephalopathy due to PSS?

Answer 16

Dynamic bile acid stimulation test
Ammonia assay
Liver US
CT angiography

Question 17

How should you medically manage / surgically manage PSS?

Answer 17

Medical 
Low protein diet
Lactulose
Amoxi-clav, metronidazole
AEDs

Surgically close PSS

Question 18

How can hypernatraemia present and how should you treat it?

Answer 18

Seizures, changes in mentation

Slowly correct sodium imbalance over 48-72h

Question 19

How do lysosomal storage disease present and how can they be diagnosed?

Answer 19

Early onset, diffuse neurological signs - bilaterally symmetrical
Progressive until death

Dx: DNA test, blood and urine screening, MRI brain

Question 20

How can you manage lysosomal storage disease?

Answer 20

AEDs

Anti-anxiety drugs

Question 21

What are some common differentials for patients with forebrain disease over 6yo?

Answer 21

Cerebrovascular accident
Bacterial meningoencephalitis 
Hepatic encephalopathy 
Hypoglycaemia
Electrolyte imbalances - addisons
Idiopathic vestibular syndrome 
Degenerative - lysosomal storage diseases
Neoplasia - meningioma, glial cell tumours

Question 22

How does hypoglycaemia present, and what are some common underlying causes?

Answer 22

Anxiety, lethargy, depression
Ravenous appetite
Tremors, visual deficits
Seizures

Young puppies that haven’t eaten enough
Insulinoma
Liver disease

Question 23

How can you diagnose and treat hypoglycaemia?

Answer 23

Blood glucose <3 mmol/L

Tx: IV Glucose, frequent feeding, underlying cause

Question 24

Name some brain tumours that are seen.

Answer 24

Intra-axial - glioma
Extra-axial - meningioma, choroid plexus tumours

Metastasis - haemangiosarcoma
Direct extension - nasal tumour, pituitary tumour

Question 25

How can you treat brain tumours?

Answer 25

Corticosteroids to reduce cerebral oedema
AEDs
Surgery
RT

Question 26

What is the common clinical presentation of laforas disease?

Answer 26

Miniature wire haired daschund

Myoclonus jerking, progressive

Question 27

How can you manage laforas?

Answer 27

KBr / levetricetam

Antioxidant rich diet with low starch and sugar

Question 28

What is the clinical presentation of canine cognitive dysfunction?

Answer 28

Sleep disturbances 
Loss of learnt behaviour 
House soiling
Aggression
Getting stuck in corners

Question 29

How can you manage canine cognitive dysfunction?

Answer 29

Selegilline- MAO inhibitor

Antioxidant rich diet