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Small Animal Medicine > Encephalopathies, Pt. 3 > Flashcards

Encephalopathies, Pt. 3 Flashcards

1
Q

How do infectious encephalopathies typically progress?

A

rapidly!

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2
Q

What is corticosteroid-responsive tremor syndrome? What signalment is most commonly affected?

A

“White Shaker Dog” syndrome with fine whole-body or cerebellovestibular tremors

young adult (< 5 y/o) small breeds, typically Malteses and WHWTs

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3
Q

How do patients with corticosteroid-responsive tremor syndrome appear on diagnostics? How is it treated?

A

typically not done - MRI normal, CSF normal or mild mononuclear pleocytosis

Prednisone —> weaned slowly off

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4
Q

2 y/o MC Chihuahua presents with acute onset of shaking and balance loss. He appears hot, but it is Fall in NY. What is his most likely diagnosis? How would this be treated?

A

corticosteroid-responsive tremor syndrome

  • Prednisone
  • short course of low dose oral Diazepam
  • Pu Ji Xiao Du Yin
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5
Q

What is thought to cause granulomatous meningoencephalomyelitis (GME)? What signalment is most commonly affected? How does it typically present?

A

suspected autoimmune inflammatory CNS disorder

middle-aged, female, small breeds - especially Mini/Toy Poodles

cerebellovestibular dysfunction

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6
Q

What tentative and definitive diagnostics are used for GME?

A

TENTATIVE - CT/MRI, CSF, matching signalment, clinical signs

DEFINITIVE - characteristic histopathological features of lesions predominantly in the white matter, usually at necropsy

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7
Q

How is GME most commonly treated? What are 4 adjunctive treatments recommended?

A

Prednisone 1-2 mg/kg PO BID

  1. Leflunomide - antiinflammatory
  2. Procarbazine - chemo
  3. Cytosine arabinoside - chemo
  4. Cyclosporine - immunosuppressant
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8
Q

What is the prognosis of GME like?

A
  • poor historically, overall median survival of 14 days
  • focal GME more favorable than multifocal
  • prednisone alone is often ineffective
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9
Q

How is Cyclosporine used to treat GME? What side effects may occur?

A

lipophilic peptide that blocks inflammatory cytokines - MST 2.5 yrs

  • vomiting
  • diarrhea
  • alopecia
  • shedding
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10
Q

How is Procarbazine used to treat GME? What side effects may occur?

A

oral antineoplastic - MST 14 months

  • myelosuppression
  • hemorrhagic gastroenteritis
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11
Q

How is Azathioprine used to treat GME? What side effects may occur? How is it unique to other treatments?

A

purine analogue that inhibits DNA synthesis and miosis - MST 5 yrs

  • bone marrow suppression
  • GI signs
  • hepatotoxicity

lag time to clinical effect

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12
Q

How is Cytosine arabinoside used to treat GME? What side effect is of concern?

A

nucleoside analog that is able to cross the BBB - SQ and IV CRI administration most common

myelosuppression

(MST > 1 yr)

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13
Q

How is Leflunomide used to treat GME?

A

pyrimidine analogue - safe in dogs, efficacy questionable

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14
Q

What are the 2 forms of necrotizing encephalitis (NE) of small breeds?

A
  1. PUG/MALTESE - forebrain dysfunction
  2. YORKSHIRE - forebrain and brainstem dysfunction
  • many breeds affected
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15
Q

What imaging is used to diagnose NE of small breeds?

A
  • CT - hypodense lesions
  • T1-weighted MRI - usually not contrast-enhancing
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16
Q

What treatment is recommeded for NE of small breeds? How does it compare to GME?

A

Prednisone + antineoplastics and immunosuppressants

treatment efficacy decreased —> prognosis is poor

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17
Q

What drug has seen some success in treating NE of small breeds?

A

Mycophenolate mofetil (MMF) - immunosuppressant

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18
Q

What are some causes of infectious encephalitides?

A
  • VIRAL: distemper in dogs, coronavirus in cats
  • FUNGAL: crypto in NY
  • Rickettsial
  • Protozoal
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19
Q

What treatment is recommended for bacterial meningoencephalitis?

A

broad-spectrum antibiotics

  • surgery may be requires
  • patients tend to decompensate while DVMs ponder if it is bacterial
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20
Q

What is a common cause of fungal meningoencephalitis? How do patients typically present?

A

Cryptococcus —> bird poop

linger for months, then spiral quickly

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21
Q

What treatment is recommended for fungal meningoencephalitis? What concurrent treatment is recommended temporarily?

A

Fluconazole - kills fungus, but can cause intense inflammatory response

Prednisone

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22
Q

What are 3 common causes of viral meningoencephalitis?

A
  1. canine distemper virus
  2. FIP - coronavirus
  3. rabies virus
23
Q

What are 3 common causes of protozoal meningoencephalitis? What treatments are recommended?

A
  1. Toxoplasma gondii
  2. Neospora caninum
  3. Sarcocystis

Clindamycin or Sulfonamides with Trimethoprim or Pyrimethamine

24
Q

What are 3 other infectious causes of meningoencephalitis?

A
  1. Ricketssial - RMSF, Ehrlichia
  2. parasites - Cuterebra in cats
  3. Prototheca
25
Q

What are 3 origins of primary brain tumors?

A
  1. brain parenchyma - glial cells and neurons
  2. meninges and ependyma
  3. vascular
26
Q

What are the 3 most common primary brain tumors?

A
  1. meningioma
  2. glioma - astrocytoma, oligodendroglioma
  3. choroid plexus tumors
27
Q

What are some other primary brain tumors?

A
  • ependymoma
  • olfactory neuroblastoma
  • gliomatosis cerebri
  • primary histiocytic sarcoma
  • PNET
  • medulloblastoma
  • microglial tumors
28
Q

What is the most common signalment affected by primary brain tumors? What is the most common complaints in dogs and cats?

A

9 y/o dogs, >10 y/o cats

  • DOGS = seizures
  • CATS = behavior changes
29
Q

What are the most common primary brain tumors in dogs and cats?

A

DOGS = meningiomas and gliomas

CATS = meningiomas

30
Q

What is important to consider when diagnosing primary brain tumors?

A

often occupy more than one anatomic regions of the brain —> nearly 1/4 have another tumor type elsewhere

31
Q

What are the most common sites of astrocytomas?

A

diencephalon* and cerebellum

32
Q

How do canine meningiomas compare to feline ones? What are all gliomas considered?

A

canine meningiomas are much more aggressive - 80% are atypical histologically

aggressive!

33
Q

What is the most common site for choroid plexus tumors in dogs? What are the 2 most common types?

A

4th ventricle

  1. choroid plexus papilloma (CPP)
  2. choroid plexus carcinoma (CPC) - lateral ventricle most common, exhibit intraventricular or subarachnoid (drop) metastasis
34
Q

What are important aspects of diagnosing primary brain tumors in dogs and cats?

A
  • signalment
  • history
  • neuro exam
  • advanced imaging (MRI, CT)
  • histopathological confirmation
35
Q

What are the 2 most common breeds of dogs affected by primary brain tumors? What tumors do these breeds tend to get? What age is most commonly affected?

A
  1. GOLDEN RETRIEVERS and other dolicephalics - meningiomas, choroid plexus tumors (GR)
  2. BOXERS and other brachycephalics - gliomas

older - 9 y/o

36
Q

What primary brain tumor are Pembroke Welsh Corgis predisposed to?

A

intracranial histiocytic sarcoma

37
Q

What is the most common signalment in cats affected by primary brain tumors? What type of tumor is most common?

A
  • > 10 y/o
  • male predilection
  • no breed predilection

meningiomas

38
Q

What is the most common historical feature in patients with primary brain tumors? What tends to cause rapid development?

A

progressive neurologic dysfunction over weeks to months, especially with meningioma

hemorrhage, exhaustion of compliance mechanisms, herniation

39
Q

What is the top complaint in dogs and cats with primary brain tumors?

A

DOGS = seizure activity

CATS = behavior change

40
Q

What cat-specific historical features are common with primary brain tumors?

A

NON-SPECIFIC - lethargy, inappetence, anorexia

  • no obvious attributable clinical signs - incidental finding on necropsy
41
Q

How is tumor location determined? Where are most found? What do all patients typically show on physical exam?

A

neurologic exam findings

forebrain - markedly asymmetric

neck and head pain on palpation

42
Q

What is the most common advanced imaging used to diagnose primary bone tumors? What is required for definitive diagnosis?

A

MRI* or CT

histopathology

43
Q

Why isn’t CSF analysis commonly used to diagnose primary brain tumors? When can it be used?

A

usually of no benefit and present potential danger

CPP/CPC differentiation

44
Q

What are 4 common MRI appearances of intracranial meningiomas?

A
  1. broad-based, extra-axial attachment with distinct tumor margins
  2. uniform contract enhancement, unless there is a cystic component
  3. displace tissue - expansile
  4. “dural tail” - thickening and enhancement of the dura
45
Q

What are 4 common MRI appearances of intracranial gliomas?

A
  1. intra-axial location with indistinct tumor margins
  2. infiltrative
  3. non-uniform and often poor contrast enhancement
  4. areas of hemorrhage and ring enhancement
46
Q

What are 2 common MRI appearances of intracranial choroid plexus tumors? What is common with CPCs?

A
  1. intraventricular location
  2. uniform contrast enhancement

intraventricular metastases

47
Q

What supportive therapies are recommended for brain tumors?

A
  • Prednisone
  • anticonvulsants if seizing
  • additional pain medications as needed
48
Q

What is the survival time like for patients with primary brain tumors on supportive therapy? How does location affect this?

A

typically 1-6 months —> avg 2 moths

  • SUPRATENTORIAL = 6 months
  • INFRATENTORIAL = 1 month
49
Q

What are the 3 options for definitive treatments of brain tumors?

A
  1. surgery
  2. radiation
  3. chemotherapy
50
Q

What tumors are typically removed surgically?

A

surface-oriented masses over the serebral or cerebellar convexities —> usually feline meningiomas (only treatment!)

  • not performed as frequently for canine meningiomas
51
Q

What is radiation therapy for brain tumors like?

A
  • total administration of 50 Gy
  • typically administered over 4 weeks in fractions, M-F
52
Q

What “new-school” type of radiation therapy is used for brain tumors? How does this compare to old-school radiation therapy?

A

stereotactic radiosurgery with cyberknife or gamma knife

  • more precise
  • fewer treatments (2-5)
  • more favorable results!
53
Q

What 2 chemotherapies are used for brain tumors?

A
  1. oral Lomustine - canine gliomas
  2. oral Hydroxyurea - meningiomas
54
Q

What kind of substance is Lomustine? What side effects are associated?

A

nitrosourea compound able to cross the BBB to treat canine gliomas

  • bone marrow suppression
  • hepatotoxicity

Small Animal Medicine (52 decks)

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