Clinical Neurology Approach to the Dog and Cat

Question 1

Define ‘Syndrome’

Answer 1

A group of clinical signs that are usually observed together and are representative of a specific disease

Question 2

How do we generate a Differential Diagnosis list?

Answer 2

D: Degenerative
A: Anomalous
M: Metabolic
N: Neoplastic
I: Idiopathic, Inflammatory, Immune-mediated
T: Toxic, Trauma
V: Vascular

Question 3

Define ‘Seizure’

Answer 3

A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness

Question 4

What is a Tonic-Clonic Seizure?

Answer 4

A seizure where the animal has a Tonic phase (intense muscle rigidity) followed by a Clonic phase (uncontrolled jerking or limb paddling)

Question 5

What can Owners misinterpret a Seizure for?

Answer 5

Syncope event: complete loss of consciousness aka fainting

Question 6

Describe a Generalized Seizure

Answer 6

Most frequently recognized in vet medicine
A generalized seizure starts when all areas of the brain are affected by an abnormal electrical impulse
- 80% of seizures in dogs are a Generalized tonic-clonic seizure

Question 7

Describe a Focal/ Partial Seizure

Answer 7

A focal seizure is where one hemisphere of the brain is affected by an abnormal electrical impulse
- Most common in cats

Question 8

Describe a Focal progressing to a Generalized seizure

Answer 8

A seizure where one hemisphere of the brain is affected and it progresses to all areas of the brain

Question 9

What are the stages of a Seizure?

Answer 9

1) Pro-dromal Phase: alteration of behaviour
2) Aura: initial manifestation of the seizure
3) Seizure or Ictus: actual seizure
4) Post-ictal Phase: hunger, thirst, behavioural, impaired vision, proprioceptive decline

Question 10

What are the 3 main differential diagnosis for a seizure?

Answer 10

Reactive Seizure: brain reacting to an extra-cranial cause
Structural Seizure: intra-cranial lesion
Idiopathic Epilepsy

Question 11

What are some Metabolic causes to a Reactive Seizure?

Answer 11

• Hepatic encephalopathy
• Hypoglycemia
• Hypocalcemia
• Hypokalemia
• Uremia
• Hyperlipoproteinemia
• Hypothyroidism

Question 12

What are the Nutritional causes to a Reactive Seizure?

Answer 12

Thiamine deficiency (Vit B1)

Question 13

What are the Toxic causes to a Reactive Seizure?

Answer 13

• Lead
• Strychnine (used in pesticides)
• Organophosphates
• Xanthine derivatives
• Chocolate

Question 14

What are some differential diagnosis for a Structural Seizure?

Answer 14

• Degenerative: Storage diseases
• Anomalous: Hydrocephalus, Lissencephaly
• Neoplastic: primary, metastatic
• Inflammatory: distemper, rabies, bacterial, toxoplasmosis, neosporosis, rickettsial, granulomatous meningoencephalomyelitis, meningitis of unknown origin
• Idiopathic: idiopathic epilepsy
• Trauma: head trauma, cerebral hypoxia/ anoxia
• Vascular: Infarction, Haemorrhage

Question 15

What are the potential diagnostic tests available to us for a neurological patient?

Answer 15

• Hematology/ Biochemistry: glucose, bile acids/ liver enzymes, urea/ creatinine, electrolytes, lead
• Serology: Toxoplasma/ Neospora, Distemper
• Radiography
• Advanced Imaging: CT, MRI
• CSF tap + Cytology