Feline Neurology

Question 1

You’re performing a neuro exam on a cat and are struggling to observe a cutaneous trunci reflex and menace response. Is this abnormal?

Answer 1

No, 1/3 of cats will not show a cutaneous trunci reflex. As for the menace, cats are harder to elicit this with, you may need to do a sneak attack or lay them on their back.

Question 2

Briefly describe feline hyperesthesia syndrome. What happens in severe cases?

Answer 2

Typically cats are ~ year old and seemingly have hallucinations, twitching with head involvement and in severe cases will self mutilate their tail. Their labs will come back normal, making us think its caused by vaculolar myopathy or a seizure. GABAPENTIN is a good starting point for 2/3 of patients

Question 3

Briefly describe idiopathic epilepsy in cats.

Answer 3

Idiopathic epilepsy can occur at any age but typically affects cats over 7 years old. The seizures occur during resting conditions with rapid running being common during and then the cat will be normal during interictal states. These cats should be treated with phenobarbital or levetiracetam.

Question 4

In healthy cats with no hx of liver dz that have idiopathic epilepsy __ is the most appropriate choice

Answer 4

Phenobarbital

Question 5

What 2 drugs should not be used to treat idiopathic epilepsy in cats?

Answer 5

Potassium bromide and diazepam

Question 6

Idiopathic epilepsy has a __ prognosis for older patients but a __ response rate to anti seizure drugs and a __ complete remission of seizures

Answer 6

Poor, 70%, 40%

Question 7

Audiogenic Reflex Seizures is in __ cats and associated with ___ sounds. Avoiding these sounds can eliminate seizures in __ of cases while __ is the go to drug

Answer 7

Older Birman, high pitched, 75%, Keppra

Question 8

The drug of choice for idiopathic epilepsy is __ while the drug of choice for audiogenic reflex seizures is __

Answer 8

Phenobarbital , Keppra (levitiracetam)

Question 9

Hippocampal Necrosis is __ and cats will have what clinical signs? What treatment is used

Answer 9

Hippocampal necrosis is focal and cats will show aggressive behavior, hyper salivation, vocalization, and facial twitching. What’s interesting about this condition is the animals don’t response to conventional treatment so a combo therapy of pheno + Keppra with prednisolone is used

Question 10

Name 6 common CNS infections in cats

Answer 10

FIP
Toxoplasmosis
Cryptococcus
FeLV
FIV
Panleukopenia

Question 11

What is the most common diagnosis of cats with CNS inflammation/infection?

Answer 11

FIP

Question 12

What are exam findings of a cat with FIP? What is pathopneumonic?

Answer 12

Anterior chamber hemorrhage and Iris vasculitis because this is a CNS disease and the optic nerve is an extension of the brain. On MRI, we should see ventricular dilation and periventricular contrast enhancement which is pathopneumonic for FIP

Question 13

FIP is diagnosed by high ___ titers and treated with ___ which has a ___ response to treatment. The virus will come back eventually but you can retreat, however developing resistance is possible.

Answer 13

CSF coronavirus, remdesevir, 80-85%

Question 14

Toxoplasmosis causes CNS disease when __ become __ and is more common in __ animals.

Answer 14

Bradyzoites become tachyzoites and immunocompromised

Question 15

How do you DX toxoplasmosis?

Answer 15

IgG positive -> exposure
IgG neg, IgM positive -> more likely recent exposure
PCR may be helpful

The more definitive diagnoses is doing a CSF tap and seeing the Protozoal cysts with inflammation

Question 16

Toxoplasmosis treatment

Answer 16

Clindamycin, or TMS

Prognosis is good if caught early

Question 17

Cryptococcus is the most common fungus causing __ signs in cats and is more common with abundant __ in the environment. The gold standard of dx is __ while serology and CSF may also be helpful.

Answer 17

Cryptococcus is the most common fungus causing neurological signs in cats and is more common with abundant bird feces in the environment. The gold standard of dx is fungal culture while serology and CSF may also be helpful.

Question 18

How would you treat cryptococcus? Prognosis?

Answer 18

Fluconazole for life
Prednisolone for 3-5 days
Amphotericin B and flucytosine combo

Prognosis is good so long as patient is not obtunded

Question 19

FeLV has a predisposition to other __ infections and __

Answer 19

CNS, lymphoma

Question 20

FIV is a __ virus that on cytology will show __ and __ but CNS signs are only reported in ___ of cases

Answer 20

Neurotropic, perivascular cuffing, glial nodules, 1-5%

Question 21

Feline Panleukopenia Virus causes ___ when infected in utero, perinatally or by a __ vaccine in a pregnant queen. It is a non-progressive disorder with no inflammatory changes within the brain

Answer 21

Feline Panleukopenia Virus causes cerebellar hypoplasia when infected in utero, perinatally or by a live vaccine in a pregnant queen. It is a non-progressive disorder with no inflammatory changes within the brain

Question 22

A cat comes into your clinic acutely blind but with a normal ocular exam in august, what is your top differential?

Answer 22

Feline ischemic encephalopathy

Question 23

Feline ischemic encephalopathy treatment

Answer 23

Ivermectin (effective against cuterebra) , Prednisolone once, and Premed with diphenhydramine may work but Shinn recommends a craniotomy

Question 24

briefly describe global cerebral ischemia

Answer 24

The maxillary artery supplies the brain cerebellum and forebrain but can be occluded if the cats jaw is open for an extended period of time (ex. Dental). This results in the cat waking up with blindness and seizures that are irreversible. They can be treated with anti seizure meds but prognosis is poor.

Question 25

Cervical ventroflexion is most commonly caused by __ and is more common in cats because of the lack of a __. __ and __ are also common causes

Answer 25

Hypokalemia, nuchal ligament, thiamine deficiency and myasthenia gravis

Question 26

Cervical ventroflexion is most commonly caused by __ and is more common in cats because of the lack of a __. __ and __ are also common causes

Answer 26

Hypokalemia, nuchal ligament, thiamine deficiency and myasthenia gravis

Question 27

Brief description of Thiamine Deficiency

Answer 27

In cats this vitamin is needed for carb metabolism so a lack of it would cause vestibular signs, vision loss, mydriasis without pupil light reflexes, ataxia and seizures. Some signs may persist once you catch it but it can be ok if you catch it

Question 28

Meningiomas account for __ of primary brain tumors. What are the clinical signs? MST?

Answer 28

57%

Behavioral change, seizures, ataxia, visual impairment

18 day MST with medical therapy but 37 months with surgery

Question 29

What is the most common neoplasm affecting the spinal cord and second most common intracranial tumor in cats?

Answer 29

Lymphosarcoma