Neuro 1 & flow charts Flashcards
tell me about the spinal cord onion
in other words, what is affected when different parts of the spinal cord is injured?
from outside to inside: proprioception, proprioception/motor, motor (paralysis), urinary continence, deep pain
how much the spinal cord is squished determines C/S
if the animal isn’t paralyzed, don’t do a deep pain test
- animal has to be paralyzed in order for there to be no deep pain
what history questions are important to ask during a neuro exam?
- signalment (species, age, sex, breed, coat color)
- onset and timeline of complaint (acute, chronic, progressive, non-progressive)
- owner description (not interpretation) –> videos are wonderful
- behaviour changes noted by O
what aspects of the distant exam are important during a neuro exam?
- level of consciousness (normal, disoriented, depressed, stuporous, comatose)
- posture and body position at rest (head tilt, head turn, ventroflexion of neck, spinal curve, decerebrate/decerebellate rigidity, Schiff-Sherrington posture, wide base stance)
- gait evaluation (normal, ataxia, paresis or plegia, circling, lameness)
- abnormal involuntary movement (epileptic seizures, myoclonus, tremors, myotonia, myokymia, cataplexy)
what are the 3 types of ataxia?
sensory: weakness with swing and scuff (proprioception is off)
cerebellar: jerky and exaggerated
vestibular: drift, fall, roll
what is the difference between a response and a reflex?
response: involves the cerebral cortex. animal is aware that they are doing this
reflex: not conscious, doesn’t involve cerebrum
anesthetized animals have reflexes, not responses
what are the cranial nerves? like what are the numbers and are they somatic, motor, or both?
Oh, Oh, Oh, To Touch And Feel Velvety Girls’ Vaginas, Ah Heaven
Some Say Marry Money But My Brother Says Big Brains Matter Most
what are the cranial nerve tests?
how does upper motor neuron vs lower motor neuron injury affect the following;
- posture
- gait
- motor function
- segmental reflexes
- resting muscle tone
- passive limb flexion and extension
- muscle atrophy
how does an injury in the brain affect the following signs: (think of the worst case scenario, like say absent or present)
- withdrawal reflex thoracic
- withdrawal reflex pelvic
- extensor carpi radialis reflex
- patellar reflex
- perineal reflex
- consicous proprioception of forelimbs
- conscious proprioception of hindlimbs
- any pathognomonic signs?
- present
- present
- present
- present
- tight wink
- absent or present depending on where the injury is
- same as 6
- N/A
how does an injury in C1-C5 affect the following signs: (think of the worst case scenario, like say absent or present)
- withdrawal reflex thoracic
- withdrawal reflex pelvic
- extensor carpi radialis reflex
- patellar reflex
- perineal reflex
- consicous proprioception of forelimbs
- conscious proprioception of hindlimbs
- any pathognomonic signs?
- present
- present
- present
- present
- tight wink
- absent
- absent
- N/A
how does an injury in C6-T2 affect the following signs: (think of the worst case scenario, like say absent or present)
- withdrawal reflex thoracic
- withdrawal reflex pelvic
- extensor carpi radialis reflex
- patellar reflex
- perineal reflex
- consicous proprioception of forelimbs
- conscious proprioception of hindlimbs
- any pathognomonic signs?
- absent
- present
- absent
- present
- tight wink
- absent
- absent
- two engine gait
how does an injury in T3-L3 affect the following signs: (think of the worst case scenario, like say absent or present)
- withdrawal reflex thoracic
- withdrawal reflex pelvic
- extensor carpi radialis reflex
- patellar reflex
- perineal reflex
- consicous proprioception of forelimbs
- conscious proprioception of hindlimbs
- any pathognomonic signs?
- present
- present
- present
- present
- tight wink
- present
- absent
- Shiff-Sherrington Posture
how does an injury in L4-S3 affect the following signs: (think of the worst case scenario, like say absent or present)
- withdrawal reflex thoracic
- withdrawal reflex pelvic
- extensor carpi radialis reflex
- patellar reflex
- perineal reflex
- consicous proprioception of forelimbs
- conscious proprioception of hindlimbs
- any pathognomonic signs?
- present
- absent
- present
- absent
- sad wink –> tail pull injuries
- present
- absent
- N/A
how does polyneuropathy injury affect the following signs: (think of the worst case scenario, like say absent or present)
- withdrawal reflex thoracic
- withdrawal reflex pelvic
- extensor carpi radialis reflex
- patellar reflex
- perineal reflex
- consicous proprioception of forelimbs
- conscious proprioception of hindlimbs
- any pathognomonic signs?
weakness everywhere (lmao that’s all the powerpoint says)
how do we divide the segments of the spine in neuro cases?
C1-C5
C6-T2
T3-L3
L4-S3
You have a patient presenting for ataxia. What sorts of questions do you have to ask to narrow down your differentials?
AKA, tell me about the ataxia flow chart
Is there head involvement?
- if yes, is it a head tilt or head tremors?
- if no, it’s proprioceptive ataxia
Head tilt = vestibular ataxia
- mental status normal or abnormal?
- proprioceptive deficits present?
head tremors = cerebellar ataxia
Proprioceptive ataxia - which limbs are involved?
- 1 leg
- only hindlimbs
- fore and himdlimbs
proprioceptive ataxia - is there pain?
proprioceptive ataxia - onset?
You have a patient with ataxia, specifically with a head tremor. What do you expect to see with that? what are your differentials?
cerebellar ataxia
dysmetria (esp hypermetria), head and body tremors, wide pelvic limb stance and gait
ddx: non-infectious meningoencephalitis, infectious meningoencephalitis, cerebellar hypoplasia
You have a patient with ataxia, specifically with a head tilt. What do you expect to see? What is important to look at next to determine next steps?
vestibular ataxia: leaning, falling, rolling, circling, strabismus, nystagmus
look at posture and mental status, and also nystagmus
You have a patient with ataxia, but with no head involvement? What do you expect to see? What is important to determine next?
Proprioceptive ataxia: truncal sway, abnormal limb stance, circumduction, abduction, and/or limb crossing, proprioceptive positioning deficits (knuckling)
determine limb involvement (1 leg, hindlimbs only, fore and hindlimbs)
You have a patient with ataxia, with no head involvement. There is only 1 leg involved. What is the -pathy involved?
You ask about the onset of the signs. What are your ddx for 1) acute and 2) progressive?
peripheral neuropathy
1) trauma, fibrocartilaginous embolism
2) neoplasia, ascending rabies
You have a patient with ataxia, with no head involvement. Only the hindlimbs are involved. You find out that there is pain involved. What are your differentials?
IVDD, discospondylitis, trauma, neoplasia
You have a patient with ataxia, with no head involvement. Only the hindlimbs are involved, and there is no pain. The signs have an acute onset. What are your differentials?
fibrocartilaginous embolism
You have a patient with ataxia, with no head involvement. Only the hindlimbs are involved, and there is no pain. The signs have an progressive onset. What are your differentials?
degenerative myelopathy, arachnoid cysts (puppy), neoplasia
You have a patient with ataxia, with no head involvement. Both the forelimbs and hindlimbs are involved. There is no pain. what are your differentials?
arachnoid cysts (puppy), neoplasia
You have a patient with ataxia, with no head involvement. Both the forelimbs and hindlimbs are involved. There is pain. There is a site of infection. What are your differentials?
discospondylitis
You have a patient with ataxia, with no head involvement. Both the forelimbs and hindlimbs are involved. There is pain. There is no site of infection. The onset is acute. What are your differentials?
IVDD, atlantoaxial subluxation, trauma
You have a patient with ataxia, with no head involvement. Both the forelimbs and hindlimbs are involved. There is pain. There is no site of infection. The onset is progressive. What are your differentials?
cervical spondylomyelopathy, neoplasia
You have an animal with ataxia, with a head tilt. Not counting vestibular disease, what 2 things could be going on?
asymmetrical focal cervical spinal lesion
otitis externa or aural irritation
tell me about the vestibular disease flow chart
honestly it’s so fucking complicated, I have no idea how to make flashcards out of this shit
You have a dog with signs of vestibular disease (head tilt, loss of balance, abnormal nystagmus, leaning, circling, falling, rolling). Tell me what you’d answer for each of these questions if the dog has central vs peripheral vestibular disease:
- vertical nystagmus?
- obtunded, stuporous, comatose?
- reduced/absent conscious proprioception?
- yes only to central, no to both central and peripheral (central can have it but also may not have it)
- yes only to central, no to both central and peripheral
- yes to central, no to peripheral
You have a dog that you’ve diagnosed with peripheral vestibular disease? what are your next steps?
otoscopic exam, ask about history of ototoxic drugs, ask about history of trauma, look at breed disposition for congenital vestibular disease
You have a dog that you’ve diagnosed with peripheral vestibular disease. You do an otoscopic examination and it’s normal. The dog has not had any recent trauma or ototoxic drugs, and is not a breed with predisposed congenital vestibular disease. what are your next steps?
thyroid profile
- look for hypothyroidism
rads/CT/MRI to evaluate middle/inner ear
- normal = idiopathic/geriatric vestibular syndrome (dx of exclusion!)
- otitis media/interna, neoplasia, nasopharyngeal polyp, foreign body
You have a dog diagnosed with central vestibular disease. What should you consider for your workup?
enzyme levels, hx of trauma, hx of diet (all fish diet), hx of toxic exposure (metronidazole), thyroid profile, CSF analysis, MRI/CT/Rads
You have a dog diagnosed with central vestibular disease. You look at the enzyme levels and they’re wack (idk how, the flow chart doesn’t say lmao). What does the dog likely have?
storage disease
You have a dog diagnosed with central vestibular disease. You note from your history that the dog was hit by a car a week ago. what does the dog likely have?
traumatic brain injury
You have a dog diagnosed with central vestibular disease. You note from your history that the dog only eats fish. What does the dog likely have?
thiaminase deficiency
You have a dog diagnosed with central vestibular disease. You note from your history that the dog recently had Giardia and was treated with metronidazole. what does the dog likely have?
metronidazole toxicity
You have a dog diagnosed with central vestibular disease. You do a thyroid profile and note low T4. What does the dog have?
hypothyroidism
You have a dog diagnosed with central vestibular disease. You do a CSF analysis and note inflammatory changes. what does the dog likely have?
how does your answer change if the CSF analysis revealed infectious changes?
necrotising meningoencephalitis
need to do further ancillary testing to come to a conclusion (PCR, CSF serology, biopsy)
you have a dog diagnosed with central vestibular disease. You want to do imaging. What can imaging tell you?
if the dog has neoplasia, ischemic injury, or a congenital anomaly
What questions do you have to ask in order to determine if a pet has had a seizure?
- lost of impaired consciousness? (yes if seizure)
- animal at rest prior? (yes if seizure)
- animal’s behaviour abnormal before and after episode? (yes if seizure)
What are some causes of epilepsy?
- toxic (heavy metals, pesticides, ethylene glycol, methylxanthines, mycotoxins, drugs)
- metabolic (hepatic encephalopathy, hypoglycemia, Na imbalance, hyperlipoproteinemia, thiamine deficiency)
- idiopathic (genetic)
- infectious inflammation
- structural epilepsy
- degenerative epilepsy
- non-infectious inflammation
You have a 2 yo patient with confirmed seizures. They’ve been progressively getting worse over the past couple months. On your neuro exam, you don’t note any abnormalities. Your history is not suggestive of any trauma, toxic, or metabolic cause. What is the most likely diagnosis?
idiopathic epilepsy (genetic)
age of onset b/t 6mo and 6 yrs, no abnormal neuro exam, no hx of trauma, metabolic, toxic exposure, progressive
You have a patient with confirmed seizures. They’ve been progressively getting worse over the past couple months. On your neuro exam, you note some abnormalities. What is your next step?
blood work, MRI, and/or CSF analysis
if abnormal, explore PCR, serology, CSF culture/cytology
and take into account signalment
what are the components of Horner’s syndrome?
miosis, protruding 3rd eyelid, ptosis, enopthalmos
You have a cat with Horner’s syndrome. What are the next steps?
look at mental state (altered, not altered)
if non-altered mental state, perform a 1% phenylephrine test (looking for mydriasis within 20 mins)
You have a cat with Horner’s syndrome. you notice that the cat has an altered mental state. that is most likely going on?
brainstem lesion
You have a cat with Horner’s syndrome. you notice that the cat doesn’t have an altered mental state. you perform a 1% phenylephrine test and you see mydriasis within 20 mins. What is going on? what are your ddx?
post-ganglionic lesion (somewhere along the course up the vagosympathetic trunk)
otitis media/interna, iatrogenic (from TECA-BO), idiopathic, neoplasia
You have a cat with Horner’s syndrome. you notice that the cat doesn’t have an altered mental state. you perform a 1% phenylephrine test and there is no response. what do you look at next?
pelvic UMN signs and thoracic LMN signs = pre-ganglionic lesions (t1-t3 spinal segments)
thoracic and pelvic UMN signs = central/cervical spine
You have a cat with Horner’s syndrome. you notice that the cat doesn’t have an altered mental state. you perform a 1% phenylephrine test and there is no response. You see that the cat has pelvic UMN signs and thoracic LMN signs. what is going on and what are your ddx?
pre-ganglionic lesions (t1-t3)
tick paralysis, brachial plexus avulsion, iatrogenic (from sx, epidural, block), trauma to vagosympathetic trunk (hx of strangulation)
You have a cat with Horner’s syndrome. you notice that the cat doesn’t have an altered mental state. you perform a 1% phenylephrine test and there is no response. You see that the cat has thoracic and pelvic UMN signs. what is going on and what are your ddx?
central/cervical spine
neospora, fibrocartilaginous embolism, trauma to spinal cord
