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LA DX & TX I > Exam 1 - Equine Neurology - Cervical Lesions, EPM, & Trauma > Flashcards

Exam 1 - Equine Neurology - Cervical Lesions, EPM, & Trauma Flashcards

1
Q

what are the 2 fundamental objectives of a neurological exam?

A
  • neurologic or not neurologic
  • localize the lesion
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2
Q

ataxia is best defined as what?

A

inability to coordinate muscle activity during voluntary movement

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3
Q

T/F: cervical vertebral myelopathy & equine protozoal myeloencephalitis are associated with ataxia

A

true - usually but not always for equine protozoal myelitis

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4
Q

how is ataxia graded?

A

on a scale from 1-5

imprecise - subjective

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5
Q

what is the most common synonym for cervical vertebral myelopathy?

A

wobblers disease

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6
Q

what is cervical vertebral myelopathy?

A

abnormalities of the cervical vertebral body, processes, or foramina that cause compression of the cervical spinal cord at the level of 2 adjacent vertebrae

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7
Q

what is the most common form of cervical vertebral myelopathy? what animals does it affect?

A

dynamic - compression with neck movement

younger horses

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8
Q

where is the most common site of cervical vertebral myelopathy?

A

C3-C4 is most common followed by C6-C7

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9
Q

what is static cervical vertebral myelopathy?

A

osseous or soft tissue changes that compress the cord regardless of movement

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10
Q

what animals are affected by static cervical vertebral myelopathy?

A

typically older horses

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11
Q

where is the common site of static cervical vertebral myelopathy?

A

C5-C6

C6-C7

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12
Q

T/F: horses can have both dynamic & static forms of cervical vertebral myelopathy

A

true

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13
Q

what causes cervical vertebral myelopathy?

A

spinal cord compression from instability or malformation

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14
Q

what is the pathogenesis of cervical vertebral myelopathy?

A

unknown - probably multifactorial

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15
Q

what breeds may be predisposed to cervical vertebral myelopathy because of rapid growth?

A

thoroughbreds & warm bloods

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16
Q

T/F: cervical vertebral myelopathy is very similar to degenerative osseous diseae

A

True

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17
Q

what is the typical signalment of cervical vertebral myelopathy?

A

usually 6 months to < 3 years, quarter horses, thoroughbreds, warm bloods, & Tennessee walkers, maybe males

animals affected can be any age or breed

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18
Q

what is the common history in a patient with suspected cervical vertebral myelopathy?

A

can be acute - consider trauma

or can be subtle, slowly progressive

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19
Q

what are the clinical signs seen with cervical vertebral myelopathy?

A

bilateral symmetrical ataxia, paresis, & spasticity

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20
Q

what limbs are more severely affected by cervical vertebral myelopathy?

A

hindlimbs - usually at least 1 grade more severe

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21
Q

T/F: signs of cervical vertebral myelopathy tend to be stable but can be progressive, wax, or wane

A

true

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22
Q

what clinical signs will you see upon walking in a patient with suspected cervical vertebral myelopathy?

A

toe dragging, bunny hopping at canter, floating their front feet (can exacerbate this by elevating head), & a base wide stance at rest

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23
Q

how is cervical vertebral myelopathy diagnosed?

A

signalment/history, neuro exam, & radiographs

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24
Q

why can radiographs be useless in diagnosing cervical vertebral myelopathy?

A

cervical spine will often be normal in appearance

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25
Q

how is myelography used in diagnosing cervical vertebral myelopathy?

A

neutral & flexed views, 50% reduction in dorsal contrast column, but not perfect

26
Q

what complications can occur with a myelogram?

A

poor recovery, worsening of signs after the procedure, seizures, & meningitis

27
Q

what is the best treatment option for cervical vertebral myelopathy?

A

interbody fusion to stabilize the vertebrae & decompress the cord - patient selection is important

28
Q

what are the limitations of using interbody fusion to treat cervical vertebral myelopathy?

A

complications, costs, missed sites

~70% of horses improve 1 grade of ataxia

29
Q

what are the treatment options using dietary restrictions for cervical vertebral myelopathy?

A

decrease carbs & proteins to 66-75% of NRC requirements, add vitamins & minerals, stall rest

30
Q

what is equine protozoal myeloencephalitis?

A

disease of horses in the americas associated with invasion of the central nervous system by apicomplexan protozoa

31
Q

what is likely the most common neurological disease of horses in texas?

A

equine protozoal myeloencephalitis

32
Q

what is the primary cause of equine protozoal myeloencephalitis?

A

sarcocytis neurona - vast majority

n. hughesii - some cases

33
Q

what is the definitive host of sarcocystis neurona?

A

opossum

34
Q

T/F: EPM is transmitted horse to horse

A

false - horses are the dead end host

35
Q

how is EPM transmitted?

A

ingestion of food or water contaminated directly or indirectly with sporocysts from opossum feces

36
Q

what horses are affected by EPM?

A

any breed, age, sex!! only in north & south america!

37
Q

T/F: EPM is not reported in donkeys, mules, or non-horse equids

A

True

38
Q

what is the classical presentation of EPM?

A

progressive, asymmetrical, multifocal, ataxia, & muscle atrophy

39
Q

Why is equine protozoal myeloencephalitis the great imitator?

A

its clinical signs can represent a multitude of neurologic diseases

40
Q

how is equine protozoal myeloencephalitis diagnosed postmortem?

A

looking for presence of protozoa - can be difficult if animal received treatment

41
Q

which is more accurate in diagnosing equine protozoal myeloencephalitis, antemortem or postmortem?

A

post mortem

42
Q

how is equine protozoal myeloencephalitis diagnosed antemortem?

A

use clinical signs, CBC, & CSF analysis to help rule-in or rule-out other causes

immunodiagnostic testing - serum or CSF

response to treatment - this can be misleading

43
Q

what is an antemortem immunodiagnostic test for equine protozoal myeloencephalitis that is semi-quantitative?

A

western blot - looks for s. neurona specific antibodies

44
Q

what is an antemortem immunodiagnostic test for equine protozoal myeloencephalitis that is quantitative & looks for s. neurona & s. hughesii?

A

indirect fluorescent antibody test

45
Q

what is an antemortem immunodiagnostic test for equine protozoal myeloencephalitis that is quantitative & looks for s. neurona surface antigens?

A

ELISA

46
Q

why is it best to test both serum & CSF for equine protozoal myeloencephalitis?

A

exposure is widespread so the seroprevalence is high

false negatives can occur in serum & CSF

negative results can make EPM less likely while positive results can be harder to interpret

47
Q

what is the treatment for equine protozoal myeloencephalitis?

A

anti-protozoals, anti-inflammatory drugs, & other supportive care

48
Q

what drug is used to treat equine protozoal myeloencephalitis once daily for a minimum of 3-4 months?

A

pyrimethamine (1mg/kg) & sulfonamide (25mg/kg) - ReBalance

49
Q

what are the side effects/toxicities of pyrimethamine (1mg/kg) & sulfonamide (25mg/kg) - ReBalance?

A

diarrhea & bone marrow suppression (neutropenia & anemia)

50
Q

what anti-protozoal treatment is used once daily for a duration of 28 days for equine protozoal myeloencephalitis?

A

Ponazuril

51
Q

what are the benefits to using ponazuril for equine protozoal myeloencephalitis? cons?

A

corn oil may enhance intestinal absorption & side effects appear to be limited

expensive!!!

52
Q

what drug is used to treat equine protozoal myeloencephalitis that has the same minimum treatment duration as ponazuril?

A

diclazuril

53
Q

why are corticosteroids controversial for treating equine protozoal myeloencephalitis?

A

they may promote parasite proliferation by immunosuppression

54
Q

what are the proposed benefits for using steroids for equine protozoal myeloencephalitis?

A

signs are largely attributed to inflammation associated with response to parasites - highly effective for acute CNS inflammation

55
Q

what is the treatment outcome for equine protozoal myeloencephalitis?

A

1/3 recover

1/3 have no response to treatment

1/3 have deficits after treatment

10-30% relapse

56
Q

how is equine protozoal myeloencephalitis prevented?

A

no vaccine!!!

opossum proof pastures & barns, store feed & hay in a secured manner, minimize stress

57
Q

T/F: equine protozoal myeloencephalitis affects both gray & white matter (upper & lower motor neurons)

A

True

58
Q

T/F: geographic distribution of equine protozoal myeloencephalitis appears to largely be attributed to the range of the opossum

A

true

59
Q

T/F: sagittal ratios & using inter/intra vertebral measurements are believed to be helpful in making the diagnosis for cervical vertebral myelopathy - but don’t always identify the specific site of compression

A

true

60
Q

if a horse with EPM has a subtle, slowly progressive onset of the disease, how do you expect the animal to present?

A

may appear to have a lameness problem initially

61
Q

if a horse with EPM has an acute onset of the disease, how do you expect the animal to present?

A

sometimes associated with trauma & neurologic signs are errantly attributed to trauma

62
Q

T/F: EPM can cause cranial nerve deficits

A

true

LA DX & TX I (45 decks)

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