Encephalopathy/seizures

Question 1

Objectives

Answer 1

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

Question 2

Encephalopathy (7)

Answer 2

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

Question 3

Forebrain (cerebrum + diencephalon) (8)

Answer 3

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

Question 4

Encephalopathy: Primary CNS (8)

Answer 4

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

Question 5

Encephalopathy: Metabolic (4)

Answer 5

1. hepatic
2. hypertensive
3. toxic
4. renal/uremic

Question 6

Hydrocephalus: Congenital (3)

Answer 6

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

Question 7

Hydrocephalus: Acquired (2)

Answer 7

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

Question 8

Hydrocephalus treatment (3)

Answer 8

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

Question 9

Seizure classification (3)

Answer 9

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

Question 10

Petit mal

Answer 10

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

Question 11

Partial seizures (3)

Answer 11

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

Question 12

Psychomotor seizures often from

Answer 12

temporal lobe and limbic system

Question 13

Cluster Seizures (3)

Answer 13

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

Question 14

Staticus epilepticus (6)

Answer 14

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

Question 15

Epilepsy is a

Answer 15

progressive dz

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

Hyperthermic cat (3)

Answer 18

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

Question 19

DDX: extracranial (4)

Answer 19

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

Question 20

Concurrent dz to consider (4)

Answer 20

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

Question 21

Shunts

Answer 21

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

Question 22

Shunt breeds (3)

Answer 22

1. pug
2. yorkie
3. pom pom

Question 23

Vascular anomalie breeds (3)

Answer 23

1. CKCS
2. Greyhound
3. Cats

Question 24

Thaimine deficiency (2)

Answer 24

1. cats fed coldwater fish

2. home-cooked diets

Question 25

DDX: intracranial (8)

Answer 25

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

Question 26

Idiopathic epilepsy stereotypes (4)

Answer 26

1. lab 2. GSD 3. Aussie 4. Poodle

Question 27

Inflammatory dz stereotypes (9)

Answer 27

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

Question 28

Primary neoplasia stereotypes (3)

Answer 28

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

Question 29

DDX cat

Answer 29

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

Question 30

Seizure emerg - diazepam - midazolam - lactulose

Answer 30

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....

Question 31

Phenobarb emerg (3)

Answer 31

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

Question 32

Keppra (levetiracetam) emerg (2)

Answer 32

1. > 15-20 mg/kg IV q8h | 2. May need higher dose if on PB

Question 33

Sodium Bromide emerg (2)

Answer 33

1. 400-600 mg/kg IV over 12-24 hours in sterile water | 2. 0.45% NaCl + 2.5% dextrose

Question 34

Indications for anticonvulsants (4)

Answer 34

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

Question 35

Mannitol/hypertonic emerg

Answer 35

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