Midterm #1 - Neurology Portion Flashcards
This syndrome can progress to a cat mutilating its tail (pictured below)
Feline Hyperesthesia Syndrome
Which drug is one of the main forms of treatment for Feline Hyperesthesia Syndrome (example pictured below)?
Gabapentin
What is the mean age for Feline Hyperesthesia Syndrome?
1 year
This feline neurology condition has the following characteristics:
- Can occur at any age (more common in patients <7 years)
- Often occurs during resting conditions
- Rapid running in common!!
- Status epilepticus is uncommon!!
- Normal during Interictal states
Feline Idiopathic Epilepsy
What two drugs are used to treat Feline Idiopathic Epilepsy? Which of the two is better tolerated?
Phenobarbital and Levetiracetam (Keppra)
This type of seizure is defined as a seizure that is objectively and consistently precipitated by environmental or internal stimuli
Reflex seizure (audiogenic)
These type of seizures are caused by high pitched sounds and can be eliminated in 75% of cases by avoiding the noise
Audiogenic Reflex Seizures
You will see focal facial seizures and aggression in cats who have this part of their brain affected? Hint: affected cars are frequently refractory to conventional anti-seizure treatment
Hippocampal Necrosis
How is hippocampal necrosis usually treated in cats?
Anti-epileptic therapy (Phenobarbital and Levetiracetam)
What are 6 common CNS infections in cats?
FIP, FeLV, FIV, Toxoplasmosis, Cryptococcus, and Panleukopenia
What is the most common cause of CNS disease in cats (both brain AND spinal cord)?
Feline Infectious Peritonitis
How is Feline Infectious Peritonitis diagnosed and treated?
Diagnosed by high CSF coronaviral titers; Treated by antiviral adenosine nucleoside analogue
When you have encephalitis and granulomas caused by toxoplasmosis, what feline neurological signs will you see?
Seizures, Vestibular signs, Cerebellar signs, and Obtunded
When you see segmental myelitis caused by toxoplasmosis, what feline neurological signs will you see?
Proprioceptive ataxia, weakness, and incontinence
What other kind of signs aside from neurological can manifest from toxoplasmosis infection?
Ocular signs
How do you diagnose Toxoplasmosis?
Serology +/- PCR
How do you treat Toxoplasmosis?
Clindamycin or Trimethoprim sulphonamide
How is Cryptococcus transmitted?
Via inhalation
What is the most common neurological sign seen in cats with Cryptococcus?
Gait Abnormalities
How do you diagnose Cryptococcus and which one is the gold standard?
Serology, CSF, Fungal culture; the gold standard is a fungal culture
How do you treat Cryptococcus?
Fluconazole, Prednisolone, Combination of Amphotericin B and Flucytosine
What viral infections predisposes cats to other CNS infections?
FeLV
If a cat infected with Feline Panleukopenia has Cerebellar hypoplasia, what is their prognosis?
Good, if all they have is cerebella signs
With Feline Ischemic Encephalopathy, what is the most common clinical sign that happens acutely?
Blindness
How do you treat Feline Ischemic Encephalopathy?
Ivermectin, Prednisolone once, and Pre-med with Diphenhydramine
What are the most common causes of cervical ventroflexion? (Pictured below)
Hypokalemia, Thiamine Deficiency, Myasthenia Gravis, Hyperthyroidism, Hepatic Encephalopathy
Deficiency of what vitamin causes vestibular signs, vision loss, mydriasis w/o pupil light reflexes, ataxia, and seizures in cats?
Thiamine
How do cats become deficient in thiamine?
Consumption of raw fish containing thiaminase, cooked food that the thiamine has been destroyed, meats preserved w/o sulfate
What type of tumor is most common in cats?
Meningioma
What is the first and second most common neoplasms affecting the spinal cord in cats?
Lymphosarcoma and Intracranial Tumors
This is defined as a sudden outburst, recurrence, or intensification of symptoms
OR
A fit, spasm, or seizure
Paroxysm
Paroxysmal or Episodic events are a transient abnormality in what factors?
Behavior, Movement, Sensation, Autonomic function, Consciousness
Read Chart
Name the stages of a seizure
Prodromal, Aura, Ictus, Post-ictal, Inter-ictal
What is the prodromal period of a seizure?
Abnormalities before the seizure
During what stage of a seizures will you see EEG abnormalities?
Aura
What features should you be looking for if you there episodic or paroxysms?
Age of onset, interepisodic examination, premonitory signs/triggers, event phenotype, consciousness, autonomic signs, muscle tone, episode frequency/duration, recovery rate
Define narcolepsy and cataplexy.
Narcolepsy - difficult staying awake
Cataplexy - sudden loss of muscle tone
What neurotransmitter is involved in sleep? (Think narcolepsy-cataplexy chart)
Orexin
What is type of paroxysmal disorder is this based off the characteristics and description below?
13 y/o, MN, Dachshund
- Upon discharge from dental, started passing out every time he tried to eat
Narcolepsy-Cataplexy
What is type of paroxysmal disorder is this based off the characteristics and description below?
4 y/o, FS, Yorkie
- presented for 6 month history of episodes of lip smacking and repeated swallowing that are now occurring multiple times a day
Upper GI disease and Fly biting
What is type of paroxysmal disorder is this based off the characteristics and description below?
3 y/o, FS, Border Collie
EEG revealed focal seizures
What is type of paroxysmal disorder is this based off the characteristics and description below?
6 y/o, MN, Mixed breed
- 10 month history of intermittent episodes of confusion, “staring off into space”
Transient Vestibular Attacks
What is type of paroxysmal disorder is this based off the characteristics and description below?
1 y/o, FS, Scottish terrier
- presented for 5 episodes of intermittent stiffness and difficulty walking over past two weeks
- acts painful and hunched over
Cramp or Hypertonicity in Scottish terries
What is type of paroxysmal disorder is this based off the characteristics and description below?
2 y/o, MN, Bulldog
- presented for 2nd opinion for refractory epilepsy
- focal facial seizures since 6 months of age
Idiopathic Head Tremors
What is type of paroxysmal disorder is this based off the characteristics and description below?
8 y/o, MN, Lab
- episodics postural repetitive myoclonus of the head
Myoclonic Epilepsies
This is a brief involuntary contraction of a muscle or muscle group followed by relaxation
Myoclonus
This is the phenotype of what kind of seizure?
- Sudden twitching, jerking movements of head +/- generalized muscle fasciculations, may be exacerbated by external stimuli
Myoclonic seizures
What is type of paroxysmal disorder is this based off the characteristics and description below?
6 y/o, MN, Mixed breed
- progressive generalized seizures for 9 months
- Falls over, legs stiffen then relax, urinates, appears unconscious
- Episodes last < 30 seconds
Syncope
Electrophysiology is important for paroxysms with impairment of what?
Consciousness
What is type of paroxysmal disorder is this based off the characteristics and description below?
4 y/o, FS, Lab Mix
*Did not get to this in lecture so guess
????
When is electrophysiology indicated?
- High temporal density of episodes
- Episodes witnessed by a veterinarian or accompanied by supporting clinical exam evidence
When is an MRI indicated for paroxysmal disorders?
When there is an abnormal interictal examination consistent with neurological disease
Name the primary and secondary injuries to the spinal cord
- Primary: compression, contusion/concussion, laceration, traction
- Secondary: Ischemia, Neuroinflammation, excitotoxicity, edema
What are the normal forces that act on the axial skeleton?
Bending, Torsional, Shear, Axial Forces
What part of the spine is resistant to all forces?
Articular facets
What part of the spine is the most important stabilizer against lateral bending and torsion?
Intervertebral discs
What part of the spine resists bending and axial loading?
Vertebral body
Name the 4 stress riser regions
Craniocervical junction, cervical thoracic junction, T-L junction, L-S junction
What are the goals of examination when there is trauma to the spinal cord? (3)
- Do NOT make things worse
- Establish the severity of neurological injury
- Determinate what other injuries are present or need further investigation
Recite the grades of the Modified Frankel Score (0-6)
What two special neurological exam findings can throw off your localization?
Schiff-Sherrington phenomena and spinal shock
Read Chart
What analgesic do you NOT give to patients with traumatic spinal cord injuries? Which ones do you give instead?
Dexamethasone SP is a NO NO; Parenteral narcotic analgesics (morphine, Oxymorphone, hydromorphone, methadone, fentanyl)
What type of imaging is indicated in ALL cases of traumatic SCI? All view should be obtained in what position?
Radiographs; All views should be obtained in lateral recumbency
To determine if a traumatic SCI is unstable, how many compartments must be disrupted?
Disruption of 2/3 compartments = instability
What are the indications for advanced imaging (CT and MRI)?
- No obvious radiographic lesion
- Radiographic lesion discordant with clinical localization
- Surgical therapy is indicated based on clinical and/or radiographic signs
- Evaluate integrity of spinal cord
If a injury is stable what is the general treatment plan versus an unstable injury?
- Stable injury = cage rest and analgesics
- Unstable injury = surgical or conservative treatment
What are some indications for conservative management? What is also required with conservation management?
- Cervical fractures
- Caudal lumbar or lumbosacral fractures with minimal neurologic deficits (grade 1-2)
- No significant concurrent injuries
- Intact pain perception
- If dictated by client constraints
External Coaptation is required
For external coaptation, what sections must be immbolized?
High motion segments above and below the level of the lesion
- Cervical injury: extends from behind the eyes to behind scapula
- T-L and Lumbar injuries: extends from cranial to scapula to tail
What should you NOT attempt before or after putting on a brace with traumatic SCI?
Reducing the fracture or luxation
Read assessment of conservative therapy
What are the two indications of surgical treatment of SCI?
If the injury is unstable and moderate-severe neurological signs (grade 3+)
What are the goals of surgery with SCI?
- Reduction of malalignment
- Achievement of rigid fixation
- +/- decompression of spinal cord
When is additional decompression necessary in traumatic SCI?
When imaging confirms cord decompression
- Displaced fracture fragment
- Disc rupture
- Compressive hematoma
- Penetrating missile
With cervical vertebral trauma, would you consider conservative or surgical treatment?
Conservative Treatment
Name the condition described below:
- Common in cats
- Plantigrade stance with paraparesis
- Weak/paralyzed, flaccid tail
- Diminished/absent perineal reflex, anal tone, tail pain perception
- Urinary/fecal incontinence
Sacrocaudal Luxation (Tail pull)
Describe surgical and conservative treatment of sacrocaudal luxations
- Conservative: cage rest, analgesia, and bladder management
- Surgical treatment: tail amputation and variety of internal fixation methods
What is the most important indicator in sacrocaudal luxations?
Presence of tail and perineal sensation
Read traumatic SCI treatment complications
If a patient’s mentation is obtunded, where can you localize the lesion?
Forebrain
If you have a patient that is stuporous and comatose, where can you localize the lesion?
Brainstem
This is an abnormal response to stimulus but still able to respond their environment somewhat
Obtunded
If a patient has a mentation change, what should you try to rule out?
Trauma, toxins, or metabolic cause
When doing an examination for mentation change, it should lead to localization of one of which 4 regions?
Forebrain, brainstem, multifocal, or systemic
What is the equation for Cerebral perfusion pressure (CPP)?
CPP = MAP - ICP
The CPP should stay within what range?
70-100 mmHg
Remember the Cushing’s Reflex Chart
What are some other signs of increased intracranial pressure?
- Pupil changes
- Tetraparesis and ataxia
- Cranial nerve deficits
- Decerebrate posture
With neurological emergencies, what is the first thing you want to do if there is an increase CPP?
Decrease intracranial pressure
What are 3 ways to decrease intracranial pressure?
- Decrease edema
- Craniectomy
- Remove the space occupying lesion
What methods of decreasing edema have a fast onset, short duration?
Mannitol and 7.2% hypertonic saline
What method of decreasing edema is more for long term management?
Corticosteroids and Diuretics
If the mentation change is primarily neurological, what are some potential differentials?
Encephalitis, brain tumor, vascular accident, and head trauma
If the mentation change is primarily neurological, what should you consider doing first before referring?
Decrease ICP first
This is described as:
- failure of a seizure to terminate
- Any seizure lasting longer than 5 minutes
- >2 seizures without return to normal consciousness
- considered a TRUE emergency
Status Epilepticus
Remember brain damage chart
What type of systemic effects will you see with a neurological emergency?
Hypertension, Tachycardia, Arrhythmias, hyperglycemia, respiratory compromise, hyperthermia, acidosis, and myoglobinuria
Death from a neurological emergency is not from the emergency itself but from what causes?
Ventricular arrhythmias, respiratory compromise, renal failure
If a patient goes into status epilepticus, what should you do treat the emergency?
Check temperature (active cooling), O2 supplementation, anti-epileptic therapy
What are the first two go to drugs with anti-epileptic therapy?
Diazepam (IV and rectally) and Midazolam (Intanasally - more effective than rectal diazepam)
After 3 failed benzodiazepines, what drug is next to try in anti-epileptic therapy?
Propofol
What are the two long term anti-epileptic drugs?
Phenobarbital and Levetiracetam
Review treatment of status epilepticus
A reactive seizure has two main categories of causes? (Think DAMNITV)
Toxin and metabolic causes
What are the 3 types of epilepsy?
- Idiopathic
- Structural
- Epilepsy of unknown cause
What can increase intracranial pressure?
Edema, Inflammation, Tumor, and trauma
Remember traumatic brain injury treatment chart
Localized tetanus more common in _____; Generalized tetanus more common in ______
Cats; dogs
How do you treat tetanus?
Antimicrobial therapy (Metronidazole) +/- anti-toxin
This results in flaccid paralysis (LMN), autonomic signs (regurgitation or diarrhea), clinical signs within 12 hours of exposure, treatment is supportive care
Botulism
Botulinum toxin binds to what two proteins?
Synaptobrevin and SNAP-25
Tetanus binds to what type of cells (axons)?
Renshaw cells
This type of encephalopathy causes the following signs:
- seizures
- behavior changes (aggression, anxiety, dementia, mania)
- cortical blindness
Metabolic encephalopathies
In terms of membrane resting potential, what element does NOT play a role?
Calcium
What are the physiological functions of the vestibular system?
- Maintains posture and balance relative to the head, body, and limbs
- Detects acceleration and deceleration
- Coordinates eye movement
The vestibulocochlear nerve (CN8) runs through structure?
Internal Acoustic Meatus
What are the main parts of the vestibular apparatus?
Saccule, Utricle, and Semicircular canals
This is the dilation at the base of each semicircular canal
Ampulla
What structures of the vestibular system contains otoliths?
Utricles and Saccules
When talking about central vestibular disease, where are we localizing to? (2)
Flocculonodular lobe or the medulla
The vestibular function maintains _______ and ______ and excites what?
Support and balance; excites antigravity muscles
