Horner's and Cranial Neuropathies Flashcards
1
Q
Objectives (2)
A
- Recognize peripheral neuropathy from central disease
- Identify cranial nerve deficits and appropriate differential diagnoses for each
- List diagnostic procedures for each neuropathy
2
Q
Trigeminal Sensory Branches (2)
A
- Ophthalmic nerve (V1)
- Orbital fissure
- A brance innervates indside of nose - Maxillary nerve (V2)
- Round foramen
- Sensation to entire face
3
Q
Trigeminal Motor Branch (2)
A
- Mandibular nerve (V3)
- oval foramen - Muscles of mastication
- Pterygoid mm
- Digastricus m
- Temporalis m
- Masseter m
- Tensor veli palatini m-innervates tympanic membrane
4
Q
Trigeminal Neuropathy DDX (4)
Dropped Jaw
A
- Idiopathic
- Lymphoma
- Neospora
- Trauma
5
Q
Trigeminal Neuropathy DX (2)
A
- MRI brain
2. CSF-inflammation, blasts, organisms
6
Q
Trigeminal Neuropathy TX (4)
A
- Neospora: Clindamycin/TMS
- LSA: chemo that penetrates BBB
- Idiopathic/Traumatic: supportive
- feeding tube (nutrition/water) - Improvement takes weeks to months
7
Q
Trigeminal Nerve Tumor (4)
A
- Nerve Sheath Tumor - CN V most common CN affected
- Diagnose by MRI & CSF analysis
- Surgical resection not an option
- Can consider radiation
8
Q
Facial Nerve (2)
A
- Resting tone to muscles
- If acutely lose tone, muscles become flaccid
- No facial expression, inability to respond, twitch or blink
- Midline shifts AWAY from affected side (philtrum)-contralateral side still has tone
9
Q
Chronic facial paralysis
A
- If chronic denervation to the muscles they become fibrotic due to loss of input
-no facial expression, inability to respond, twitch or blink
-Narrowing on the palpebral fissure (cornea better protected)
~affected side has contracted
10
Q
CN VII DDX (4)
A
- Neoplasia-nerve or surrounding tissue
- Idiopathic (75% of dogs and 25% of cats)
- Infectious (Otitis media/interna)
- Trauma (Iatrogenic post TECA) trauma
11
Q
CN VIII: Vestibular (6)
A
- Sensory for orientation of head w/respect to gravity
- Physiologic nystagmus (Doll’s eye, vestibulo-ocular)
- Pathologic nystagmus
- Strabismus
- Head tilt
- Ataxia
12
Q
CN VIII: Cochlear
A
Sensory for hearing-difficult to test
-BAER
13
Q
Idiopathic Geriatric about (3)
A
- Old dog vestibular dz
- Large breed
- Peripheral signs
- head tilt
- Nystagmus
- Ataxia, if ambulatory; alligator rolling
- INTACT postural reactions
14
Q
Idiopathic Geriatric TX (5)
A
- Supportive care - maybes MDB
- Thoracic rads
- MRI head (ears and brain)
- Anxiolytics if severely vestibular (plus fluids and antiemetics)
- Good prog
- nystagmus and ataxia resolve
- head tilt often persists
15
Q
Signs that something isn’t Geriatric Idiopathic vest dz (4)
A
- Facial paresis to paralysis
- Horner’s syndrome
- Any other CN deficit
- CP deficits
16
Q
Other DDX for vestibular dz (4)
A
- Otitis media/interna
- Neoplasia
- Trauma
- Intracranial dz
17
Q
Idiopathic VII & VIII (5)
A
- Not well understood
- Peripheral vestibular signs (head tilt, nystagmus, +/- ataxia)
- Facial paresis to paralysis
- All dxstics normal
- Usually resolves on own
18
Q
Horner’s (4)
A
Loss of sympathetic input to eye and local mm
- Ptosis
- Miosis
- Enophthalmos
- Protrusion of nictitans
19
Q
Horner’s syndrome neurons and orders (3)
A
- 1st order neuron
- cell body in hypothalamus
- projects to spinal cord T1-T3 - 2nd order neuron (Pre-ganglionic)
- Thoracic sympathetic trunk to cranial cervical ganglion - 3rd order neuron (Post-ganglionic)
- cranial cervical ganglion to target structures
20
Q
Horner’s Lesion Localization (5)
A
- Brainstem
- Cervical spinal cord
- Axilla/brachial plexus-sympathetics exit at T1-T3 and synapse
- Cervical area
- ascend with the vagosympathetic trunk - Tympanic bulla
- dog vs cat
21
Q
Horner’s ddx
A
- Neoplasia
- Idiopathic-Golden retrievers and preganglionic dz
- Infectious-otitis
- Inflammatory polyp
- Iatrogenic-bulla osteotomy
- Trauma
22
Q
Horner’s tx
A
- None
- Lessens/resolves on its own
- Rarely affect QOL only aesthetic
