Cerebral Diseases Flashcards
1
Q
What is the Functional Anatomy of Cerebral Syndrome?
A
- Cerebrum
- Consciousness, processing of sensory information (touch, pain, proprioception), skilled responses and motor function
- Facilitates the function of all cranial nerves
- Thalamus
- The relay center for all anatomic divisions of the brain
- Other subcortical brain structures
- Internal capsule, basal ganglia (caudate, putamen, globus pallidus)
- Movement, cognition, emotion
2
Q
What are the clinical signs of cerebral syndrome?
A
- Gait abnormalities
- Weakness w/out ataxia
- Weakness w/ ataxia and deficits
- Proprioceptive deficits w/ normal strength
- Conformation
- Circling (“Big” circles) and compulsive pacing)
- Head turn, body turn
- Seizures
- Contralateral limb and vision deficits
- Behavior changes (obtundation, head pressing, aggression)
3
Q
What are some diseases of the Cerebrum?
A
- Brain tumors
- primary or metastatic
- Meningoencephalitis of unknown etiology
- Granulomatous meningoencephalitis (MUE)
- Necrotizing meningoencephalitis
- Steroid-responsive meningitis-arteritis
- Cerebral vascular accident (stroke)
- Head trauma
- Infectious disease
- Young dogs/cats
- Lysosomal storage diseases
- Congenital hydrocephalus
- Older dogs/cats
- Senile atrophy
- Cognitive dysfunction
- Hypertensive encephalopathy
- Metabolic - hepatic, renal, hypoglycemic, hypothyroid, hypernatremic
4
Q
What is Canine Distemper Encephalitis? Signs? Diganostics?
A
- Affects the Cerebrum, cerebellum, optic tracts, spinal cord
- Hx - Upper respiratory and GI signs preceding neuro signs
- Causes:
- blindness
- seizures
- central vestibular
- cerebellar
- spinal cord
- myoclonus
- Hyperkeratosis of foot pads
- Gold-medallion lesions of retina
- Dx:
- PCR - urine, conjunctival, pharyngeal, nasal, blood
- CSF - mononuclear pleocytosis and increased CDV IgG
5
Q
What is Steroid-Responsive Meningitis arteritis (SRMA)?
A
- “aseptic meningitis”
- # 2 inflammatory CNS disease
- Young 8-18mo, large breed dogs
- Signs:
- neck pain
- fever
- stiffness
- ataxia
- Diagnostics:
- CBC - leukocytosis with left shift
- CSF - marked neutorphilic pleocytosis
- Positive response to steroids
- Tx - immunosuppressive prednisone (2mg/kg/day)
- going to be 4 - 5 months
- Beagle Pain syndrome
- Necrotizing polyarteritis
- Frequently recurrent
6
Q
What is Bacterial Meningitis / Encephalitis? Signs? etiology?
A
- Peracute, acute or gradual onset (2-3wks)
- Peracute - deteriorate so quickly referral is generally recommended and survival is low
- Signs:
- Lethargy
- reluctance to walk
- anorexia
- neck pain
- hyperthermia
- bradycardia
- depression
- seizures
- Dx:
- Fundic exam (optic neuritis)
- elevated WBC
- CSF tap + culture - neutrophilic pleocytosis
- Tx:
- Antibiotics that cross BBB (fluoroquinolones, 3rd gen cephalosporins, trimethoprim0sulfa, chloramphenicol, doxy, macrolides)
- Steroids for first 24-48hr at anti-inflammatory dose
7
Q
What is Fungal Meningoencephalitis? Causes? signs? Dx?
A
- Causes:
- Cryptococcus
- Histoplasmosis
- Blastomycosis
- Signs consistent with bacterial meningitis
- Often a component of systemic disease
- Dx:
- CSF
- Urine antigen testing
- serology
- Fundic exam - fungal plaques
- Tx:
- Fluconazole, Itraconazole
- Amphotericin B
- Posaconazole, Voriconazole (cats)
8
Q
What is Meningoencephalitis of unknown etiology (MUE or MUO)?
A
- Granulomatous Meningoencephalitis (GME)
- Ocular - acute or subacute vision loss
- focal - mass lesion
- disseminated - multifocal signs
- Necrotizing Meningoencephalitides (NME)
- Pug dog encephalitis - uncommon
- acute and cronic forms
- seizures, abnormal behavior, gait, posture, circling, head tilt, head pressing, and blindness
- yorkshire terrier necrotizing encephalitis
- Pug dog encephalitis - uncommon
- Nonsuppurative, inflammatory disease
- Affects the cerebrum, cerebellum, Ponse, Medulla, and spinal cord
- Diffuse of coalescing lesions
- Common etiology:
- toy breeds
- females
- 1-8yrs
9
Q
How is MUO (GME/NME/PDE) diagnosed? Tx?
A
- Dx:
- Suspicion based on clinical signs and signalment
- CT, MI
- CSF - mononuclear to mixed pleocytosis, elevated protein
- Tx:
- Prednisone
- Cyclosporine
- Cytosine arabinoside
- Leflunomide, Mycophenolate
- Antiepileptics (PDE)
10
Q
What are strokes?
A
- Cerebrovascular accident
- Peracute to acute onset with nonprogressive signs after 24 hours
- May be primary or secondary
- Hyperadrenocorticism, Protein-losing nephropathy, Feline cardiomyopathies, Immune mediated hemolytic anemia
- thrombocytopenia, coagulopathy
- Tumors
- Types: Ischemic (most common) and hemorhagic (<20)
- Locations: Cerbral, thalamic, Cerebellar (~50%), Brainstem
11
Q
What is the prognosis of a stroke? management?
A
- Outcome dependent on etiology
- 50 - 75% have good long-term outcomes
- Recurrent events in up to 30%
- Management:
- Mannitol or hypertonic saline in acute phase if high intracranial pressure
- Anti-epileptic drugs if seizures
- Treat underlying disease
- Supportive
12
Q
What is a transient ischemic attack
A
brief loss of function but with recovery in <24hrs
13
Q
What is Chiari-like Malformation? Clinical signs? Tx?
A
- Caudal Occipital Malformation Syndrome (COMS)
- Syringohydromyelia
- abnormal spinal cord fluid accumulation
- complex pathogenesis
- Clinical signs
- Spinal pain, paresis, ataxia
- facial scratching or rubbing
- Resentment of touching, grooming
- LMN signs to thoracic limbs
- Tx:
- Medical - corticosteroids, carbonic anhydrase inhibitors, analgesics
- Surgery - enlargement of foramen magnum and caudal fossa
14
Q
What findings are seen in an MRI on a patient with Chiari-like malformation?
A
- Small foramen magnum
- Small caudal fossa volume
- Cerebellar herniation
- Hydrocephalus
- Syringohyromyelia
15
Q
What are some Metabolic Encephalopathies? what neurological issues do they cause?
A
- Uremic encephalopathy
- Long-standing chronic renal failure
- Hypertension (common in CKD), hyperparathyroidism, acidemia
- Hepatic encephalopathy
- Acute or chronic liver disease
- Neurodepressive
- Ammonia, Benzodiazepine-like substances, GABA (Portosystemic shunts)
- Hypothyroidism
- Myxedema stupor or coma
