encephalopathy and seizures Flashcards
1
Q
encephalopathy
A
- syndrome of brain dysfuction
- usually forebrain signs
- non-specific
2
Q
primary CNS causes of encephalopathy
A
- neoplasia
- epilepsy
- inflammatory/infectious
- increased ICP
- trauma
- hemorrhage
- vascular
- degenerative
3
Q
metabolic causes of encephalopathy
A
- hepatic
- hypertensive
- toxic
- renal/uremic
4
Q
diagnostics for hepatic encephalopathy
A
- CBC, serum chem panel, UA
- fasted pre- and post-prandial bile acids, ammonia
- AUS, portal/rectal scintigraphy
5
Q
hepatic encephalopathy treatment
A
- low-protein diet
- ion-trapping (lactulose PO or enema)
- antibiotics (metronidazole, neomycin)
6
Q
congenital vs acquired hydrocephalus
A
- congenital
- malformation of ventricular system
- can sometimes prevent deterioration
- cannot reverse damage
- acquired
- secondary
- neoplasia, obstruction, reduced drainage
- choroid plexus tumors
- FIP
- potential to return to normal with treatment
- secondary
7
Q
hydrocephalus treatment
A
- reduce CSF production
- prednisone
- omeprazole
- furosemide, acetazolamide
- crisis: mannitol, hypertonic saline
- establish drainage
- ventriculoperitoneal shunt
8
Q
seizures
A
- forebrain: cerebrum and diencephalon
- etiology
- primary CNS disturbance
- neurologic manifestation of systemic disease
9
Q
classification of seizures
A
- generalized (grand mal, tonic-clonic)
- partial (focal motor seizures, Jacksonian march)
- psychomotor (fly biting, running fits, rage)
10
Q
generalized seizures “petit mal”
A
- mild generalized seizures
- brief loss of muscle tone
- may remain sternal or ambulatory, but ataxic
- episodic weakness, disorientation
- +/- drooling, vomiting, urination, defecation
11
Q
partial seizures
A
- head turning, tonus of one limb, altered behavior, licking, fly biting…
- seizure focus
- localized to one area of the cortex
- does not spread across entire cerebrum, can generalize at any time
12
Q
psychomotor seizures
A
- complex partial seizures, behavioral seizures
- running fits, fly biting, episodic rage, hissing, drooling
- sensory and motor components
- may have autonomic manifestations
- often from the temporal lobe and limbic system
13
Q
cluster seizures
A
- >2 seizures in 24 hours
- period of normalcy in between episodes
- reliable pattern of multiple seizures at each event
- does not matter if generalized or partial seizures
- usually require > 2 meds for adequate control
14
Q
status epilepticus
A
- rapidly recurring seizures with incomplete recovery between episodes
- more likely in large breed dogs
- toxins
- metabolic
- sudden drug withdrawal; ineffective drugs
- progressive disease
15
Q
ddx for possible seizures in dogs
A
- hypotensive episodes (HSA bleeds)
- cardiogenic events (PH, arrhythmias)
- respiratory (BUAS, collapsing trachea)
- hypertensive episodes (pheochromocytoma, PLN)
16
Q
ddx for possible seizures in cats
A
- hypertensive episodes
- 3rd degree AV block
- behavioral
- movement disorder
17
Q
cat seizures
A
- keep checking body temp
- idiopathic cats often require multiple drugs at the onset
18
Q
signalment and history
A
- age: 1-5 yrs
- breed:
- small, terrier type vs large, dolichocephalic
- cat
- chronicity & progression
- acute onset vs long-standing
- seizures along vs other neuro deficits
- concurrent diseases
19
Q
extracranial seizure differentials-metabolic
A
- BG
- PSS
- Ca
- increased PCV
20
Q
extracranial seizure differentials-toxic
A
- EG
- strychnine
- metaldehyde
- Pb
- OPs
- tetanus
- Bufos
21
Q
extracranial seizure ddx-vascular
A
- arrythmia
- ischemic and hemorrhagic events
22
Q
extracranial seizure ddx-nutritional
A
- thiamine deficiency
23
Q
concurrent disease to consider
A
- pulmonary hypertension
- PLN/PLE
- hepatic disease
- known neoplasia
24
Q
PSS
A
- typically young dogs with global signs
- BUT
- wax and wane
- older dogs
- asymmetrical signs
- resting ammonia
- useful to know if the current episode is due to HE, so you need a sample when animal is abnormal
- when in doubt, run fasted pre- and post-prandial bile acids
25
Q
shunt breed predisposition
A
- pug
- yorkie
- pom
26
Q
vascular breed predisposition
A
- CKCS
- greyhound
- cats
27
Q
thiamine deficiency
A
- cats fed coldwater fish-thiaminase
- non-traditional home-cooked diets
28
Q
intracranial ddx-inflammatory
A
- GME
- NME
- NLE
- …
29
Q
intracranial ddx-neoplasia
A
- primary
- meningioma, glioma
- secondary
- metastasis, nasal, pituitary
30
Q
intracranial ddx-vascular
A
- ischemic vs hemorrhagic infarction
- thromboembolus
- hemorrhage
31
Q
intracranial ddx-infectious
A
- crypto, rabies
- distemper
- toxo, FIP
32
Q
intracranial ddx-anomalous
A
- hydrocephalus
- lissencephaly
33
Q
intracranial ddx-traumatic
A
- acute (immediate)
- chronic (weeks to years)
34
Q
intracranial ddx-degenerative
A
- storage disorders
35
Q
stereotypes for idiopathy epilepsy
A
- lab
- germand shepherd
- australian shepherd
- poodle
36
Q
stereotypes for inflammatory disease
A
- pug
- yorkie
- poodle
- maltese
- chihuahua
- pomeranian
- dachshund
- frenchie
- boston
37
Q
stereotypes for primary neoplasia
A
- dolichocephalic breeds with meningioma
- brachycephalic breeds with glial tumors
- boxers with anything
38
Q
ddx for dog <1 yr
A
- extracranial: PSS, BG, toxin
- intracranial: malformation, storage disease, infectious (distemper vs sepsis), IE
39
Q
ddx for dog 1-5 yrs
A
- IE, inflammatory, infectious, neoplasia
40
Q
ddx for dogs >5 yrs
A
- neoplasia, inflammatory, IE, vascular
41
Q
ddx for cat
A
- infectious (crypto, toxoplasma, FIP, cuterebra)
- suspect idiopathic epilepsy
- neoplasia (meningioma, lymphoma)
- vascular
42
Q
emergency management
A
- triage
- body temp
- hydration status
- BP mgmt
- BG, iCa, PCV/TS
- caution with bolusing fluids if structural IC disease or disrupted BBB
43
Q
stopping the seizure
A
- diazepam
- PR or IN
- 20-30 min effect
- phenobarb
- loading dose
- keppra (levetiracetam)
- may need higher dose if on PB
- sodium bromide
44
Q
indications for anticonvulsants
A
- absolute
- cluster seizures
- status epilepticus
- neuro deficits or suspicion of structural dz
- aggression pre- or post-ictal
45
Q
A
46
Q
mannitol or hypertonic saline
A
- high suspicion of structural dz and vasogenic edema
- they’re dying
- not going to help with active seizures
- mannitol can worsen hemorrhage
- hypertonic saline has been shown to be more effective than mannitol for herniation
47
Q
corticosteroids
A
- known history of brain tumor or inflammatory disease
- they’re dying
- not going to help with active seizures
- will reduce vasogenic edema and decrease ICP
- don’t give if we don’t have a dx as it may hide nay inflam dz
