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Neuro junior > Encephalopathy/seizures > Flashcards

Encephalopathy/seizures Flashcards

1
Q

Objectives

A
  1. Signs encephalopathy
  2. intracranial vs extracranial ddx
  3. distinguish seizure from non-seizure
  4. indications for anticonvulsant therapy
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2
Q

Encephalopathy (7)

A
  1. hepatic
  2. hypoxic ischemic
  3. uremic
  4. hypertensive
  5. traumatic
  6. toxic
  7. primary CNS
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3
Q

Forebrain (cerebrum + diencephalon) (8)

A
  1. mentation
  2. personality
  3. learned behaviors
  4. olfaction
  5. vision
  6. seizures
  7. compulsion
  8. conscious proprioception
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4
Q

Encephalopathy: Primary CNS (8)

A
  1. neoplasia
  2. epilepsy
  3. inflammatory/infectious
  4. increased ICP
  5. trauma
  6. hemorrhage
  7. vascular
  8. degenerative
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5
Q

Encephalopathy: Metabolic (4)

A
  1. hepatic
  2. hypertensive
  3. toxic
  4. renal/uremic
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6
Q

Hydrocephalus: Congenital (3)

A
  1. malformation of ventricular system
  2. can sometimes prevent deterioration
  3. cannot reverse damage
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7
Q

Hydrocephalus: Acquired (2)

A
  1. Secondary: neoplasia, obstruction, reduced drainage, choroid plexus tumors, FIP
  2. potential to return to normal with treatment
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8
Q

Hydrocephalus treatment (3)

A
  1. Reduce CSF prod
    - pred
    - omeprazole
    - maybes furosemide
  2. Crisis
    - mannitol, hypertonic
  3. Establish drainage
    - ventriculoperitoneal shunt
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9
Q

Seizure classification (3)

A
  1. Generalized - grand mal, tonic-clonic
  2. Partial - focal motor, Jacksonian march
  3. Psychomotor - fly biting, running fits, rage
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10
Q

Petit mal

A
  1. generalized seizure
  2. brief loss muscle tone
  3. sternal, ambulatory, but ataxic
  4. episodic weakness, disorientation
    +/- drooling, vomiting, urination, defecation
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11
Q

Partial seizures (3)

A
  1. Localized to one area of cortex
  2. Does not spread across entire cerebrum
  3. Can generalize at any time
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12
Q

Psychomotor seizures often from

A

temporal lobe and limbic system

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13
Q

Cluster Seizures (3)

A
  1. > 2 seizures in 24 hours or PATTERN
    - normalcy in between events
  2. generalized or partial
  3. usually requires >/= 2 medications for adequate control
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14
Q

Staticus epilepticus (6)

A
  1. rapidly recurring seizures w/ incomplete recovery
  2. more likely in large breed dogs
  3. toxins
  4. metabolic
  5. sudden drug withdrawel; ineffective drugs
  6. progressive dz
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15
Q

Epilepsy is a

A

progressive dz

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16
Q

Things that can be confused with seizures: Dog (4)

A
  1. Hypotensive episodes - HSA bleeds
  2. Cardiogenic events - PH, arrhythmias
  3. Respiratory - BUAS, collapsing trachea
  4. Hypertensive episodes - pheochromocytoma, PLN
17
Q

Things that can be confused with seizures: Cat (4)

A
  1. Hypertensive episodes
  2. 3rd degree A/V block
  3. Behavioral
  4. Movement disorder
18
Q

Hyperthermic cat (3)

A
  1. look for abscess
  2. Could be seizures
  3. idiopathic cats often need > 1 drug at onset
19
Q

DDX: extracranial (4)

A
  1. Metabolic - BG, PSS, Ca, inc PCV
  2. Toxic - EG, Strychnine, Metaldehyde, Pb, OPs, tetanus, bufos
  3. Vascular - Arrythmia, Ischemic & hemorrhagic events
  4. Nutritional - Thiamine def
20
Q

Concurrent dz to consider (4)

A
  1. Pulmonary hypertension
  2. PLN/PLE
  3. Hepatic dz
    - PSS vs acute, fulminating hepatitis vs cirrhosis
    - usually yellow, coagulopathic, cachectic & sick
  4. Known neoplasia
    - nasal tumors, HSA, melanoma, LSA, OSA
21
Q

Shunts

A
  1. young dogs with global signs
  2. atypical stuff - waxing/waning, older dog, assymmetry
  3. resting ammonia-baseline value if patient HE
  4. in doubt run fasted pre- and post-prandial bile acids
22
Q

Shunt breeds (3)

A
  1. pug
  2. yorkie
  3. pom pom
23
Q

Vascular anomalie breeds (3)

A
  1. CKCS
  2. Greyhound
  3. Cats
24
Q

Thaimine deficiency (2)

A
  1. cats fed coldwater fish

2. home-cooked diets

25
Q

DDX: intracranial (8)

A
  1. Idiopathic
  2. Inflammatory - GME, NME, NLE
  3. Neoplastic
    - primary: meningioma, glioma
    - secondary: metastasis, nasal, pituitary
  4. Vascular-ischemic vs hemorrhagic infarct, thromboembolus, hemorrhage
  5. Infectious - crypto, rabies, distemper, toxo, FIP
  6. Anomalous - hydrocephalus, lissencephaly
  7. Traumatic - Acute, chronic
  8. Degenerative - storage disorders
26
Q

Idiopathic epilepsy stereotypes (4)

A
  1. lab
  2. GSD
  3. Aussie
  4. Poodle
27
Q

Inflammatory dz stereotypes (9)

A
  1. Pug
  2. Yorkie
  3. poodle
  4. maltese
  5. chihuahua
  6. pom pom
  7. dachshund
  8. frenchie
  9. boston
28
Q

Primary neoplasia stereotypes (3)

A
  1. dolichephalic breeds - meningioma
  2. brachycephalic breeds - glial tumors
  3. boxers - anything
29
Q

DDX cat

A
  1. Infectious - crypto, toxo, FIP, cuterebra
  2. idiopathic epilepsy
  3. neoplasia - meningioma, lymphoma
  4. vascular
30
Q

Seizure emerg

  • diazepam
  • midazolam
  • lactulose
A
  1. Diazepam
    - 0.5 mg/kg IV up to 3 times
    - 1 mg/kg IN or rectal (last resort)
    - CRI start at 0.2 mg/kg/hr (if responsive to bolus)
    - anticonvulsant effets ~ 20 min
  2. Midazolam
    - can be IM I think
  3. lactulose retention enema
    - 2-30 mg/kg diluted with water wait 10 min….
31
Q

Phenobarb emerg (3)

A
  1. loading dose 16 mg/kg IV over 1-2 min
  2. If geriatric/decrepit give 8-12 mg/kg
  3. cats give ~ 8 mg/kg
32
Q

Keppra (levetiracetam) emerg (2)

A
  1. > 15-20 mg/kg IV q8h

2. May need higher dose if on PB

33
Q

Sodium Bromide emerg (2)

A
  1. 400-600 mg/kg IV over 12-24 hours in sterile water

2. 0.45% NaCl + 2.5% dextrose

34
Q

Indications for anticonvulsants (4)

A
  1. cluster seizures
  2. status epilepticus
  3. neuro defecits/suspicion structural dz
  4. aggression pre/post ictal
35
Q

Mannitol/hypertonic emerg

A
  1. high susp structural dz and vasogenic edema
  2. dying
  3. won’t help with active seizures
  4. mannitol can worsen hemorrhage
  5. hypertonic more effective for hernation

Neuro junior (14 decks)

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