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SA Ophthalmology-Neurology > Midterm #1 - Neurology Portion > Flashcards

Midterm #1 - Neurology Portion Flashcards

1
Q

This syndrome can progress to a cat mutilating its tail (pictured below)

A

Feline Hyperesthesia Syndrome

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2
Q

Which drug is one of the main forms of treatment for Feline Hyperesthesia Syndrome (example pictured below)?

A

Gabapentin

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3
Q

What is the mean age for Feline Hyperesthesia Syndrome?

A

1 year

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4
Q

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

A

Feline Idiopathic Epilepsy

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5
Q

What two drugs are used to treat Feline Idiopathic Epilepsy? Which of the two is better tolerated?

A

Phenobarbital and Levetiracetam (Keppra)

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6
Q

This type of seizure is defined as a seizure that is objectively and consistently precipitated by environmental or internal stimuli

A

Reflex seizure (audiogenic)

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7
Q

These type of seizures are caused by high pitched sounds and can be eliminated in 75% of cases by avoiding the noise

A

Audiogenic Reflex Seizures

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8
Q

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

A

Hippocampal Necrosis

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9
Q

How is hippocampal necrosis usually treated in cats?

A

Anti-epileptic therapy (Phenobarbital and Levetiracetam)

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10
Q

What are 6 common CNS infections in cats?

A

FIP, FeLV, FIV, Toxoplasmosis, Cryptococcus, and Panleukopenia

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11
Q

What is the most common cause of CNS disease in cats (both brain AND spinal cord)?

A

Feline Infectious Peritonitis

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12
Q

How is Feline Infectious Peritonitis diagnosed and treated?

A

Diagnosed by high CSF coronaviral titers; Treated by antiviral adenosine nucleoside analogue

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13
Q

When you have encephalitis and granulomas caused by toxoplasmosis, what feline neurological signs will you see?

A

Seizures, Vestibular signs, Cerebellar signs, and Obtunded

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14
Q

When you see segmental myelitis caused by toxoplasmosis, what feline neurological signs will you see?

A

Proprioceptive ataxia, weakness, and incontinence

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15
Q

What other kind of signs aside from neurological can manifest from toxoplasmosis infection?

A

Ocular signs

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16
Q

How do you diagnose Toxoplasmosis?

A

Serology +/- PCR

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17
Q

How do you treat Toxoplasmosis?

A

Clindamycin or Trimethoprim sulphonamide

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18
Q

How is Cryptococcus transmitted?

A

Via inhalation

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19
Q

What is the most common neurological sign seen in cats with Cryptococcus?

A

Gait Abnormalities

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20
Q

How do you diagnose Cryptococcus and which one is the gold standard?

A

Serology, CSF, Fungal culture; the gold standard is a fungal culture

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21
Q

How do you treat Cryptococcus?

A

Fluconazole, Prednisolone, Combination of Amphotericin B and Flucytosine

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22
Q

What viral infections predisposes cats to other CNS infections?

A

FeLV

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23
Q

If a cat infected with Feline Panleukopenia has Cerebellar hypoplasia, what is their prognosis?

A

Good, if all they have is cerebella signs

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24
Q

With Feline Ischemic Encephalopathy, what is the most common clinical sign that happens acutely?

A

Blindness

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25
Q

How do you treat Feline Ischemic Encephalopathy?

A

Ivermectin, Prednisolone once, and Pre-med with Diphenhydramine

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26
Q

What are the most common causes of cervical ventroflexion? (Pictured below)

A

Hypokalemia, Thiamine Deficiency, Myasthenia Gravis, Hyperthyroidism, Hepatic Encephalopathy

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27
Q

Deficiency of what vitamin causes vestibular signs, vision loss, mydriasis w/o pupil light reflexes, ataxia, and seizures in cats?

A

Thiamine

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28
Q

How do cats become deficient in thiamine?

A

Consumption of raw fish containing thiaminase, cooked food that the thiamine has been destroyed, meats preserved w/o sulfate

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29
Q

What type of tumor is most common in cats?

A

Meningioma

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30
Q

What is the first and second most common neoplasms affecting the spinal cord in cats?

A

Lymphosarcoma and Intracranial Tumors

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31
Q

This is defined as a sudden outburst, recurrence, or intensification of symptoms

OR

A fit, spasm, or seizure

A

Paroxysm

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32
Q

Paroxysmal or Episodic events are a transient abnormality in what factors?

A

Behavior, Movement, Sensation, Autonomic function, Consciousness

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33
Q

Read Chart

A
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34
Q

Name the stages of a seizure

A

Prodromal, Aura, Ictus, Post-ictal, Inter-ictal

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35
Q

What is the prodromal period of a seizure?

A

Abnormalities before the seizure

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36
Q

During what stage of a seizures will you see EEG abnormalities?

A

Aura

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37
Q

What features should you be looking for if you there episodic or paroxysms?

A

Age of onset, interepisodic examination, premonitory signs/triggers, event phenotype, consciousness, autonomic signs, muscle tone, episode frequency/duration, recovery rate

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38
Q

Define narcolepsy and cataplexy.

A

Narcolepsy - difficult staying awake
Cataplexy - sudden loss of muscle tone

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39
Q

What neurotransmitter is involved in sleep? (Think narcolepsy-cataplexy chart)

A

Orexin

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40
Q

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

A

Narcolepsy-Cataplexy

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41
Q

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

A

Upper GI disease and Fly biting

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42
Q

What is type of paroxysmal disorder is this based off the characteristics and description below?

3 y/o, FS, Border Collie

A

EEG revealed focal seizures

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43
Q

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”

A

Transient Vestibular Attacks

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44
Q

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

A

Cramp or Hypertonicity in Scottish terries

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45
Q

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

A

Idiopathic Head Tremors

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46
Q

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

A

Myoclonic Epilepsies

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47
Q

This is a brief involuntary contraction of a muscle or muscle group followed by relaxation

A

Myoclonus

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48
Q

This is the phenotype of what kind of seizure?

  • Sudden twitching, jerking movements of head +/- generalized muscle fasciculations, may be exacerbated by external stimuli
A

Myoclonic seizures

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49
Q

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

A

Syncope

50
Q

Electrophysiology is important for paroxysms with impairment of what?

A

Consciousness

51
Q

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

A

????

52
Q

When is electrophysiology indicated?

A
  • High temporal density of episodes
  • Episodes witnessed by a veterinarian or accompanied by supporting clinical exam evidence
53
Q

When is an MRI indicated for paroxysmal disorders?

A

When there is an abnormal interictal examination consistent with neurological disease

54
Q

Name the primary and secondary injuries to the spinal cord

A
  • Primary: compression, contusion/concussion, laceration, traction
  • Secondary: Ischemia, Neuroinflammation, excitotoxicity, edema
55
Q

What are the normal forces that act on the axial skeleton?

A

Bending, Torsional, Shear, Axial Forces

56
Q

What part of the spine is resistant to all forces?

A

Articular facets

57
Q

What part of the spine is the most important stabilizer against lateral bending and torsion?

A

Intervertebral discs

58
Q

What part of the spine resists bending and axial loading?

A

Vertebral body

59
Q

Name the 4 stress riser regions

A

Craniocervical junction, cervical thoracic junction, T-L junction, L-S junction

60
Q

What are the goals of examination when there is trauma to the spinal cord? (3)

A
  • Do NOT make things worse
  • Establish the severity of neurological injury
  • Determinate what other injuries are present or need further investigation
61
Q

Recite the grades of the Modified Frankel Score (0-6)

A
62
Q

What two special neurological exam findings can throw off your localization?

A

Schiff-Sherrington phenomena and spinal shock

63
Q

Read Chart

A
64
Q

What analgesic do you NOT give to patients with traumatic spinal cord injuries? Which ones do you give instead?

A

Dexamethasone SP is a NO NO; Parenteral narcotic analgesics (morphine, Oxymorphone, hydromorphone, methadone, fentanyl)

65
Q

What type of imaging is indicated in ALL cases of traumatic SCI? All view should be obtained in what position?

A

Radiographs; All views should be obtained in lateral recumbency

66
Q

To determine if a traumatic SCI is unstable, how many compartments must be disrupted?

A

Disruption of 2/3 compartments = instability

67
Q

What are the indications for advanced imaging (CT and MRI)?

A
  • 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
68
Q

If a injury is stable what is the general treatment plan versus an unstable injury?

A
  • Stable injury = cage rest and analgesics
  • Unstable injury = surgical or conservative treatment
69
Q

What are some indications for conservative management? What is also required with conservation management?

A
  • 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

70
Q

For external coaptation, what sections must be immbolized?

A

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

71
Q

What should you NOT attempt before or after putting on a brace with traumatic SCI?

A

Reducing the fracture or luxation

72
Q

Read assessment of conservative therapy

A
73
Q

What are the two indications of surgical treatment of SCI?

A

If the injury is unstable and moderate-severe neurological signs (grade 3+)

74
Q

What are the goals of surgery with SCI?

A
  • Reduction of malalignment
  • Achievement of rigid fixation
  • +/- decompression of spinal cord
75
Q

When is additional decompression necessary in traumatic SCI?

A

When imaging confirms cord decompression
- Displaced fracture fragment
- Disc rupture
- Compressive hematoma
- Penetrating missile

76
Q

With cervical vertebral trauma, would you consider conservative or surgical treatment?

A

Conservative Treatment

77
Q

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

A

Sacrocaudal Luxation (Tail pull)

78
Q

Describe surgical and conservative treatment of sacrocaudal luxations

A
  • Conservative: cage rest, analgesia, and bladder management
  • Surgical treatment: tail amputation and variety of internal fixation methods
79
Q

What is the most important indicator in sacrocaudal luxations?

A

Presence of tail and perineal sensation

80
Q

Read traumatic SCI treatment complications

A
81
Q

If a patient’s mentation is obtunded, where can you localize the lesion?

A

Forebrain

82
Q

If you have a patient that is stuporous and comatose, where can you localize the lesion?

A

Brainstem

83
Q

This is an abnormal response to stimulus but still able to respond their environment somewhat

A

Obtunded

84
Q

If a patient has a mentation change, what should you try to rule out?

A

Trauma, toxins, or metabolic cause

85
Q

When doing an examination for mentation change, it should lead to localization of one of which 4 regions?

A

Forebrain, brainstem, multifocal, or systemic

86
Q

What is the equation for Cerebral perfusion pressure (CPP)?

A

CPP = MAP - ICP

87
Q

The CPP should stay within what range?

A

70-100 mmHg

88
Q

Remember the Cushing’s Reflex Chart

A
89
Q

What are some other signs of increased intracranial pressure?

A
  • Pupil changes
  • Tetraparesis and ataxia
  • Cranial nerve deficits
  • Decerebrate posture
90
Q

With neurological emergencies, what is the first thing you want to do if there is an increase CPP?

A

Decrease intracranial pressure

91
Q

What are 3 ways to decrease intracranial pressure?

A
  • Decrease edema
  • Craniectomy
  • Remove the space occupying lesion
92
Q

What methods of decreasing edema have a fast onset, short duration?

A

Mannitol and 7.2% hypertonic saline

93
Q

What method of decreasing edema is more for long term management?

A

Corticosteroids and Diuretics

94
Q

If the mentation change is primarily neurological, what are some potential differentials?

A

Encephalitis, brain tumor, vascular accident, and head trauma

95
Q

If the mentation change is primarily neurological, what should you consider doing first before referring?

A

Decrease ICP first

96
Q

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

A

Status Epilepticus

97
Q

Remember brain damage chart

A
98
Q

What type of systemic effects will you see with a neurological emergency?

A

Hypertension, Tachycardia, Arrhythmias, hyperglycemia, respiratory compromise, hyperthermia, acidosis, and myoglobinuria

99
Q

Death from a neurological emergency is not from the emergency itself but from what causes?

A

Ventricular arrhythmias, respiratory compromise, renal failure

100
Q

If a patient goes into status epilepticus, what should you do treat the emergency?

A

Check temperature (active cooling), O2 supplementation, anti-epileptic therapy

101
Q

What are the first two go to drugs with anti-epileptic therapy?

A

Diazepam (IV and rectally) and Midazolam (Intanasally - more effective than rectal diazepam)

102
Q

After 3 failed benzodiazepines, what drug is next to try in anti-epileptic therapy?

A

Propofol

103
Q

What are the two long term anti-epileptic drugs?

A

Phenobarbital and Levetiracetam

104
Q

Review treatment of status epilepticus

A
105
Q

A reactive seizure has two main categories of causes? (Think DAMNITV)

A

Toxin and metabolic causes

106
Q

What are the 3 types of epilepsy?

A
  • Idiopathic
  • Structural
  • Epilepsy of unknown cause
107
Q

What can increase intracranial pressure?

A

Edema, Inflammation, Tumor, and trauma

108
Q

Remember traumatic brain injury treatment chart

A
109
Q

Localized tetanus more common in _____; Generalized tetanus more common in ______

A

Cats; dogs

110
Q

How do you treat tetanus?

A

Antimicrobial therapy (Metronidazole) +/- anti-toxin

111
Q

This results in flaccid paralysis (LMN), autonomic signs (regurgitation or diarrhea), clinical signs within 12 hours of exposure, treatment is supportive care

A

Botulism

112
Q

Botulinum toxin binds to what two proteins?

A

Synaptobrevin and SNAP-25

113
Q

Tetanus binds to what type of cells (axons)?

A

Renshaw cells

114
Q

This type of encephalopathy causes the following signs:
- seizures
- behavior changes (aggression, anxiety, dementia, mania)
- cortical blindness

A

Metabolic encephalopathies

115
Q

In terms of membrane resting potential, what element does NOT play a role?

A

Calcium

116
Q

What are the physiological functions of the vestibular system?

A
  • Maintains posture and balance relative to the head, body, and limbs
  • Detects acceleration and deceleration
  • Coordinates eye movement
117
Q

The vestibulocochlear nerve (CN8) runs through structure?

A

Internal Acoustic Meatus

118
Q

What are the main parts of the vestibular apparatus?

A

Saccule, Utricle, and Semicircular canals

119
Q

This is the dilation at the base of each semicircular canal

A

Ampulla

120
Q

What structures of the vestibular system contains otoliths?

A

Utricles and Saccules

121
Q

When talking about central vestibular disease, where are we localizing to? (2)

A

Flocculonodular lobe or the medulla

122
Q

The vestibular function maintains _______ and ______ and excites what?

A

Support and balance; excites antigravity muscles

SA Ophthalmology-Neurology (2 decks)

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