coma and seizures exam 2

Question 1

normal Intracranial pressure

Answer 1

5-10 mmHg

Question 2

ICP regulation, what is altered first when trying to decrease pressure. what is second?

Answer 2

shunt CSF to the spinal subarachnoid space, then decrease csf production. finally decrease cerebral blood flow

Question 3

decrease in cerebral blood flow is detremental to brain health. what happens if intracranial pressure is high while mean art BP is low.

Answer 3

mABP-ICP. if ICP is higher than mABP then the cerebral blood flow will be very low.

Question 4

transtentorial herniations caudal and rostral cause what compression?

Answer 4

midbrain compression

Question 5

which herniation has RAS system affected, cranial nerves IX-XII, and death

Answer 5

foramen magnum herniation. puts pressure on medulla

Question 6

what is a clinically detrimental ICP?

Answer 6

greater than 30 mmHg will decrease cerebral blood flow

Question 7

difference between decerebellate and decerebrate

Answer 7

decerebellate is opisthcontus with twisted torso, pelvic limbs flexed.

decerebrate: opisthcontus, extension of all four limbs, the fronts are rigid and the back are not flexed

Question 8

what does the occulocephalic reflex test

Answer 8

interruption between vestibular and the nuclei because the CN for eye movement are not recieving messages from VIII

Question 9

what do we try and treat in a TBI

Answer 9

secondary brain injuries. inflam, ischemia,

Question 10

when do we do a CT:MRI on TBI patients

Answer 10

if we plan on doing surgery on the thing we find. if we dont plan on doing surgery, it really isnt indicated.

Question 11

forebrain, midbrain, cerebellar, medulla. which are better prog than other areas for TBI

Answer 11

forebrain and cerebellar injury have better prog

Question 12

SACS score of _____ has a 50% survival in first 48 ours

Answer 12

8

Question 13

what is the first goal when treating a TBI

Answer 13

restoration of vital parameters. normovolemic, normotensive and ventilating. use what ever fluid you have.

Question 14

goal 2 of treating TBI

Answer 14

after restoration of vitals, reduce ICP.

Question 15

what pharma method is used to decrease ICP

Answer 15

mannitol diuretic.. draws water into circulation

Question 16

what meds are commonly used to induce a coma

Answer 16

phenobarbital and NMDA agonists (ketamine)

Question 17

difference between reactive seizure ad epilepsy

Answer 17

reactive seizures are a response from a normal brain to a disturbance or toxin

epilepsy is a disease of the brain

Question 18

three types of epilepsy?

Answer 18

idiopathic structural and epilepsy of unknown cause

Question 19

what can occur in the pre-ictal period

Answer 19

prodrome; marked abnormal behavior days prior to the seizure (dog stops herding)
aura: abnormal sensation seconds prior to the seizure.

Question 20

what is the difference between syncope and a epileptic seizure

Answer 20

syncope lasts for seconds and is a sudden collapse. triggered by excitement

Question 21

how to differentiate epileptic seizure from narcolepsy

Answer 21

excitement stimulates narcolepsy, it is sudden collapse, can last minutes.

Question 22

myotonia, MG vs epilepsy

Answer 22

mytonia has a stiff gait, very long lasting, either stiff or flaccid collapse

Question 23

paroxysmal dyskinesia

Answer 23

episodic movement disorder from a gluten synstitvity. normal consciousness, hyper muscle tone.

Question 24

three ways we have reactive epileptic seizures

Answer 24

changes in resting membrane potential, too much excitation, too little inhibition

Question 25

how does hyponatremia cause seizure

Answer 25

increase in NA compared to the environment out side of the cell. this changes the resting membrane potential, water follows sodium into the neuron, leading to axonal swelling

Question 26

how does hypocalcemia cause seizure

Answer 26

less calcium means theres a dissociation from the Na channel. this makes the channels easier to open. more calcium moves into the cell changing the membrane potential

Question 27

most reliable way to differentiate between structural epilepsy and idiopathic

Answer 27

structural occurs in less than 6mo and older than 6 years. there is usually drug resistance if you try and treat

Question 28

most common chronic neurological disease in dogs?

Answer 28

idiopathic epilepsy (IE)

Question 29

there are three tiers of Idiopathic epilepsy. what are the general characteristics needed to have tier one confidence level of IE

Answer 29

2 unprovoked seizures, known breed, normal tests between 6mo to 6years of age

Question 30

tier 2 characteristics

Answer 30

normal pre and post bile acids, normal MRI, normal CSF,

Question 31

tier 3s difference

Answer 31

EEG abnormalities

Question 32

what are first line ASDs? for long acting drugs

Answer 32

phenobarbital and KBr, imepitoin is not used.

Question 33

fast acting anti-seizure drugs

Answer 33

diazepam, midazolam, propofol

Question 34

what is the theraputic ranges for phenobarbital

Answer 34

25-35.

Question 35

superficial necrolytic dermatitis

Answer 35

chronic history of phenobarb administration 6 years. erosive dermatopathy, nonreversible. if you see skin lesions in your patient, do US an look for nodules.

Question 36

there is only one FDA approved antiseizure drug. promidone. Why dont we use it

Answer 36

we do not use this because it is severely liver toxic.

Question 37

what are the two uses for levetiracetam

Answer 37

add on med on top of daily med, and for structural epilepsy.