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Neurology (Spring 2015) > L02: Forebrain Disease in the Vet Patient (Seneca) > Flashcards

L02: Forebrain Disease in the Vet Patient (Seneca) Flashcards

1
Q

What does forebrain include?

A

Cerebrum (telencephalon)

Thalamus, Hypothalamus (diencephalon)

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2
Q

5 lobes of cerebrum and functions

A

1) frontal - motor cortex
2) parietal - somatosensory cortex
3) temporal - auditory complex
4) occipital - visual cortex
5) piriform - olfactory complex

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3
Q

blood supply to brain (5 arteries)

A 
From Circle of Willis:
-Rostral cerebral
-Middle cerebral
-Caudal cerebral
-Rostral cerebellar
From basilar artery:
-Caudal cerebellar
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4
Q

Species variation in blood supply to brain: DOG

A
  • blood to rostral half (FOREBRAIN) supplied by internal carotid a.
  • caudal half supplied by vertebral a.
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5
Q

Species variation in blood supply to brain: CAT/SHEEP

A

entire brain supplied by maxillary a.

cats: basilar a. carries arterial blood AWAY

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6
Q

Species variation in blood supply to brain: BOVINE

A

entire brain supplied by a mixture of maxillary and vertebral blood.

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7
Q

6 categories of lesions**

A

1) intracranial
2) C1-C5
3) C6-T2
4) C6-T2
5) L4-S3
6) Lower motor neuron (diffuse)

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8
Q

where do seizures come from?**

A

forebrain ONLY

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9
Q

CS of forebrain disease

A
  • Seizure
  • altered mentation/behavior change/dementia/loss of training
  • pacing, wandering, wide circles (typically to SAME side as lesion)
  • head turn to SAME side as lesion
  • postural reaction deficits (OPPOSITE side as lesion)
  • visual impairment, cortical blindness (OPPOSITE side)
  • head pressing, star-gazing, fly-biting
  • hemiparesis (OPPOSITE side)
  • NORMAL gait (but may have proprioceptive ataxia)
  • hemi-inattention, hemi-neglect
  • brain pain (flinches when clamp on head or neck)
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10
Q

CS NOT assoc. with forebrain disease

A
  • head tilt
  • nystagmus
  • stupor, coma (typically comes from brainstem)
  • ataxia
  • abnormal spinal reflexes
  • significant cranial n. deficits
  • intention tremors (come from cerebellum)
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11
Q

where does coma come from?

A

brainstem

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12
Q

where do intention tremors come from?

A

cerebellum

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13
Q

why are postural reaction deficits on the CONTRALATERAL side in forebrain disease?

A

crossing over occurs in the medulla oblongata

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14
Q

where does crossing over (decussation) of proprioceptive tracts occur?

A

medulla oblongata

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15
Q

proprioceptive information remains ipsilateral to level of:____

A

midbrain

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16
Q

diagnostic work-up for forebrain disease

A
  • Hx, neuro exam
  • minimum database
  • MRI (superior to CT)
  • CSF analysis
  • infectious disease testing if indicated
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17
Q

DAMNITV

A 
acronym for common forebrain diseases and their clinical presentations. Stands for:
Degenerative
Anomalous
Metabolic
Neoplasia/Nutritional
Inflammatory/Infectious
Toxin/Trauma
Vascular
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18
Q

why are visual deficits on contralateral side in forebrain disease?

A

because of crossover at optic chiasm

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19
Q

DEGENERATIVE includes:

A

Lysosomal storage diseases
Leukodystrophy
Cognitive Dysfunction

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20
Q

chars. of lysosomal storage diseases

A
  • rare
  • usually autosomal recessive
  • accumulation of metabolic by-products usually due to a defective enzyme
  • leads to cellular dysfunction
  • usually develop progressive encephalopathy soon after birth
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21
Q

chars. of cognitive dysfunction

A
  • mostly older dogs
  • similar to human Alzheimer’s
  • accumulation of beta-amyloid in the brain, which coalesce to form neuritic plaques
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22
Q

CS of cognitive dysfunction

A
  • progressive cognitive impairment
  • inactivity, abnormal sleep/wake cycle
  • wandering/pacing
  • dementia, incontinence
  • anxiety
  • failure to recognize people
  • dec. interaction
  • hearing loss, vocalization
  • cats can develop aggression
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23
Q

Dx of cognitive dysfunction

A

-Hx, CS

+/- abnormal MRI (cerebral atrophy, ventricular enlargement, microhemorrhage, infarct, interthalamic adhesion)

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24
Q

Tx of cognitive dysfunction

A
  • no known cure

- Optional: Selegiline, SAM-e, acupuncture

25
Q

ANOMALOUS includes:

A

Congenital Hydrocephalus

Primary Epilepsy

26
Q

chars. of Congenital Hydrocephalus

A
  • toy/brachiocephalics
  • excess CSF
  • destruction of ependymal lining of ventricles
  • neuronal injury in the cerebral cortex and compromise of cerebral vasculature
  • damage to periventricular white matter
  • can be asymptomatic
  • can cause dysfunction from compression and stretching of brain parenchyma
27
Q

General Exam findings of Congenital Hydrocephalus

A
  • dome-shaped head
  • open fontanelle or larger calvarial defect
  • ventrolateral strabismus (due to orbital malform.)
28
Q

Neuro Exam findings of Congenital Hydrocephalus

A
  • typically apparent by 6mo

- behavior change, obtundation, dementia, circling, pacing, restlessness (uncommonly seizures)

29
Q

Tx of Congenital Hydrocephalus

A 
Reduce CSF production with:
-Prednisone
-Omeprazole (proton pump inhibitor)
-Furosemide
Surgery: ventriculoperitoneal shunt (shunts extra fluid to abdomen)
*Can NOT address cerebrocortical damage*
30
Q

chars. of Primary Epilepsy***

A
  • no identifiable brain abnormality
  • usually younger pure-bred dogs
  • usually generalized seizures during rest/sleep
  • highly variable seizure frequency
  • more common in dogs
31
Q

most commonly used drugs to tx primary epilepsy***

A 
Phenobarbital
Potassium Bromide (KBr)
Levetiraceta
Zonisamide
Emergency: Diazepam IV
32
Q

METABOLIC includes:

A

Hepatic encephalopathy

Hypoglycemia

33
Q

2 causes of hepatic encephalopathy

A

liver failure

portosystemic shunt

34
Q

CS of hepatic encephalopathy

A 
obtundation (altered consciousness)
pacing
head pressing
visual deficits
head pressing
seizures (infrequent)
*may be assoc. with feeding*
copper colored eyes in cats
35
Q

Dx of hepatic encephalopathy

A 
Hx
Pre and post-prandial bile acids***
inc. ALT/ALP, NH3
ammonium biurate crystals in urine
scintigraphy
36
Q

Tx of hepatic encephalopathy

A

Sx shunt attenuation
low protein diet
lactulose (binds NH3)
abx

37
Q

causes of hypoglycemia

A
  • glycogen depletion in very young, small puppies/kittens
  • excess insulin secretion (insulinoma)
  • insulin overdose in diabetic animals
  • Addison’s disease
  • Liver failure
  • Toxin (ie. xylitol)
38
Q

CS of hypoglycemia

A
  • tremor
  • vocalization
  • altered mental status
  • seizure
  • visual dysfunction
    etc. ..
39
Q

Most common primary forebrain neoplasms

A 
Meningioma (most common in dogs and cats!)
Glioma
Choroid plexus tumors
Lymphosarcoma
Histiocytic sarcoma
40
Q

what produces CSF?

A

choroid plexus

41
Q

most common secondary forebrain neoplasms

A 
hemangiosarcoma
adenocarcinoma
lymphoma
melanoma
nasal/frontal sinus carcinoma
calvarial tumor
pituitary tumor
peripheral nerve sheath tumor
42
Q

CS of neoplasm effecting forebrain

A

(highly variable)

  • behavior change, circling, head press, visual deficits, hemi-inattention
  • proprioceptive deficits
  • gradual development
  • endocrine signs w/ pituitary tumors
43
Q

Tx of neoplasm effecting forebrain

A

sx, radiation, chemo

44
Q

NUTRITIONAL causes of forebrain dz

A

thiamine deficiency (all fish diet in cats)
hypoglycemia
hypocalcemia

45
Q

INFLAMMATORY causes of forebrain dz

A

Immune-mediated:

  • Necrotizing Leukoencephalitis (NLE)
  • Necrotizing Meningoencephalitis (NME)
  • Granulomatous Meningoencephalitis (GME)
  • Meningoencephalitis of unknown cause
46
Q

INFECTIOUS causes of forebrain dz

A

More common in cats, pigs

  • Bacterial
  • Protozoal
  • Viral (ie. West Nile Virus Encephalomyelitis, Equine Herpes virus myeloencephalopathy, Rabies)
  • Fungal
  • Rickettsia
  • Parasitic
  • Equine infectious encephalitidies (including EEE, WEE, VEE)
47
Q

Ex. of protozoal cause of infectious forebrain dz

A

Equine Protozoal Myeloencephalitis (EPM)

-Apicomplexan protozoa (Sarcocystis neurona**)

48
Q

Dx of infectious forebrain dz

A

CSF analysis: inc. WBCs, elevated protein lvls

Serology

49
Q

Tx of infectious forebrain dz

A

Drugs that cross BBB:

  • Abx: doxy, clindamycin, sulfas
  • Immune suppression: pred, cyclosporine, etc.
50
Q

TOXIN-related causes of forebrain dz

A
  • xylitol
  • narcotics
  • ivermectin
  • rodenticide
  • methylxanthines
  • lead
  • strychnine
  • organophosphates
  • pyrethrins
  • ethylene glycol
51
Q

TRAUMA-related causes of forebrain disease in NEONATES

A

narrow birth canal
oversized cranium
forced whelping/fetal extraction

52
Q

TRAUMA-related causes of forebrain disease in SMALL BREEDS

A
  • mishandling
  • Hit by car
  • blunt or penetrating trauma
53
Q

TRAUMA-related causes of forebrain disease in LARGE BREEDS

A

HBC

blunt or penetrating trauma

54
Q

TRAUMA-related causes of forebrain disease in FELINES

A

High rise fall
HBC
blunt or penetrating trauma

55
Q

Why are felines more at rick for penetrating skull injury compared to dogs?

A

thinner calvarium, reduced muscle mass

56
Q

VASCULAR-related causes of forebrain dz

A 
Brain infarct (stroke) (non-hemorrhagic or hemorrhagic)
Hypercoagulability
Hyperviscosity
IV neoplasia
Atherosclerosis
57
Q

causes of brain infarct

A

Hypertension (1ary or 2ary to hyperadrenocorticism, renal dz, pheochromocytoma)
Cardiac dz

58
Q

Atherosclerosis most common in what breed?**

A

Schnauzer

Neurology (Spring 2015) (7 decks)

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