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SA DX & TX I > Exam 2 - Vestibular Disease > Flashcards

Exam 2 - Vestibular Disease Flashcards

1
Q

what are the 4 cardinal signs of vestibular disease?

A
  1. head tilt
  2. nystagmus
  3. vestibular ataxia - leaning, falling, rolling to one side
  4. vestibular strabismus - ventrolateral & induced with head elevation
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2
Q

what cranial nerve deficits can be seen in peripheral vestibular disease?

A

VII & horner’s syndrome

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3
Q

are there proprioceptive deficits & mentation changes in peripheral vestibular disease?

A

no

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4
Q

are there proprioceptive deficits & mentation changes in central vestibular disease?

A

yes or no

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5
Q

is the vestibular disease paradoxical in nature in peripheral lesions?

A

no

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6
Q

is the vestibular disease paradoxical in nature in central lesions?

A

yes or no

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7
Q

what cranial nerve deficits can be seen in central vestibular disease?

A

VII, V, IX, X, & XII

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8
Q

if the vestibular disease is paradoxical, what 2 things are true?

A
  1. lesion is ipsilateral to proprioceptive/other CN deficits
  2. it is a central lesion
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9
Q

what are the main differential groups for peripheral vestibular disease?

A
  1. inflammatory
  2. masses
  3. metabolic - including toxic
  4. idiopathic
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10
Q

what are the 2 main inflammatory causes of peripheral vestibular disease?

A

infectious - otitis interna

non-infectious - primary secretory otitis media (PSOM)

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11
Q

what organisms are involved in causing otitis interna?

A

staph, strep, enterics, & anaerobes

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12
Q

what organism typically causes otitis media in cats?

A

pastuerella multocida

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13
Q

what organism typically causes otitis media in dogs with chronic disease?

A

pseudomonas aeruginosa

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14
Q

how is otitis interna definitively diagnosed?

A

identification of the organism on myringotomy

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15
Q

what is the treatment for bacterial otitis interna?

A

antibacterials

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16
Q

what is the treatment for systemic disease caused by otitis interna?

A

targeted is better than empirical!

efficacy of treatment is improved by removal of the gross disease - osteomyelitis minimum of 6-8 weeks

recurrence is likely if underlying cause remains

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17
Q

what is the pathogenesis of primary secretory otitis media?

A

excess mucus builds up in the tympanic bulla cavity

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18
Q

what breed is commonly affected by primary secretory otitis media?

A

cavalier king charles - 3-7 years old

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19
Q

what is the most common clinical sign of primary secretory otitis media?

A

pain - but up to 25% have vestibular signs

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20
Q

what is the treatment for primary secretory otitis media?

A

myringotomy & check for secondary infections to see if antibiotics should be used

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21
Q

T/F: most animals with PSOM only need one treatment to clear the disease and never have other problems

A

false - 50% require more than 1 treatment & 25% have a symptomatic relapse

22
Q

what are examples of non-neoplastic & neoplastic causes of peripheral vestibular disease?

A

non-neoplastic - polyps

neoplastic - ceruminous gland adenocarcinoma/squamous cell carcinoma & peripheral nerve sheath tumor/lymphoma

23
Q

what animals are most commonly affected by nasopharyngeal polyps?

A

young cats - 1-3 years old

24
Q

what clinical signs are seen in cats with nasopharyngeal polyps?

A

horner’s syndrome - CN VII is in the middle ear

vestibular signs - inner ear

25
Q

what is the treatment for nasopharyngeal polyps?

A

traction-avulsion +/- ventral bulla osteotomy & curettage (check for concurrent infection)

post surgical horner’s syndrome may be seen in 50% of cases - should resolve in 2-4 weeks

26
Q

what is the recurrence of nasopharyngeal polyps like?

A

<10% is the osteotomy is done, but 30-60% without

steroids may help reduce recurrence

27
Q

what disease is a metabolic cause of peripheral vestibular disease?

A

hypothyroidism

28
Q

T/F: any topical application that penetrates the tympanic membrane may cause transient vestibular disease

A

true

29
Q

what are examples of 2 topical drugs that can cause peripheral vestibular disease?

A

chlorhexidine

aminoglycosides - especially gentamicin

30
Q

what systemic drugs are known to cause peripheral vestibular disease?

A

aminoglycosides & furosemide

31
Q

why does hypothyroidism cause metabolic peripheral vestibular disease?

A

we don’t know - give them meds for hypothyroidism & they typically get better

32
Q

what is the former name of idiopathic peripheral vestibular disease?

A

old dog vestibular disease

33
Q

how is idiopathic peripheral vestibular disease diagnosed?

A

diagnosis of exclusion

34
Q

what is the treatment for idiopathic peripheral vestibular disease?

A

no treatment - improves on its own in 1-4 weeks

35
Q

what is the onset & progression for idiopathic peripheral vestibular disease?

A

peracute onset & short-term progression

36
Q

idiopathic peripheral vestibular disease affects dogs or cats more?

A

dogs >7 years but still can happen to cats

37
Q

what are the 5 main differentials for central vestibular disease?

A
  1. inflammatory
  2. neoplastic
  3. vascular
  4. metabolic - including nutritional & toxic
  5. secondary to foramen magnum herniation
38
Q

what is the general cause of non-infectious central vestibular disease?

A

immune mediated encephalitis

39
Q

what are the general causes of infectious central vestibular disease?

A

viral - distemper & FIP
protozoal - toxoplasma, neospora
bacterial - extension from otitis interna
fungal
rickettsial

40
Q

how are steroids used as a lifelong therapy in treating meningoencephalitis in central vestibular disease?

A

affect the lymphocytes & macrophages but unacceptable adverse effects are often the limiting factor for use

41
Q

how is cyclosporine used as a lifelong therapy in treating meningoencephalitis in central vestibular disease?

A

blocks the genes for cytokine production & potentially affects many cell types

metabolized by P450

42
Q

how is azathioprine used as a lifelong therapy in treating meningoencephalitis in central vestibular disease?

A

blocks DNA synthesis & primarily acts on lymphocytes with 10-14 days to see a clinical effect

43
Q

how is cytarabine (cytosar) used as a lifelong therapy in treating meningoencephalitis in central vestibular disease?

A

blocks DNA synthesis & affects lymphocytes

crosses the blood brain barrier

44
Q

what is the general treatment for central vestibular disease caused by meningoencephalitis?

A

long-term or lifelong immunosuppressive therapy

45
Q

central vestibular disease caused by bacterial infections often occurs why?

A

as an extension of otitis interna

46
Q

what clinical signs are seen in bacterial infections causing central vestibular disease?

A

may be few to no signs systemically - in chronic infections will see rapid development of neurological signs

47
Q

what 2 forms of vascular events can causes central vestibular disease?

A

ischemic & hemorrhagic

48
Q

how is central vestibular disease caused by a vascular event diagnosed?

A

presumptive diagnosis via MRI - restricted diffusion

49
Q

what is the major differential for central vestibular disease caused by a vascular event?

A

intra-axial neoplasia (glioma)

50
Q

what are the 3 general causes of metabolic central vestibular disease?

A

toxic - metronidazole

nutritional - thiamine deficiency

metabolic - hypothyroidism

SA DX & TX I (59 decks)

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