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vet med 4 > Neuro > Flashcards

Neuro Flashcards

1
Q

Which 2 clinical signs can be expected with neuromuscular disease?

A

Weakness
Exercise intolerance

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2
Q

What are the systems that can cause weakness?

A
  • Cardiovascular and respiratory (ie. arrhythmia, hypotension, hypoxemia…)
  • Systemic/ Metabolic (i.e sepsis, electrolyte imbalance such as hypocalcemia, hypoglycemia..)
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3
Q

Weakness can be 2 things

A

1) focal
2) generalised (may involve CNs leading to signs such as dyphagia, dysphonia, regurgitation..)

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4
Q

What clinical signs may be seen with weakness?

A
  • difficulty getting up
  • short strides
  • stiff gait
  • plantigrade stance
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5
Q

On Physical exam, what signs may you see that makes you think of signs of weakness?

A
  • muscle hypertrophy
  • muscle atrophy
  • myalgia (muscle pain)
  • ventroflexion in cats
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6
Q

What do postural reaction tests assess?

A

Proprioception

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7
Q

If a patient has a spinal cord injury, would the postural reactions be affected?

A

If the lesion is cranial to the limb segment- then yes.

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8
Q

If a patient has neuromuscular weakness, what would the postural reactions be like?

A

Intact, can be reduced. The animal is weak but knows where its limbs are (it is only the motor unit that is affected)

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9
Q

In neuromuscular disease, are the spinal reflexes increased or decreased?

A

Typically decreased (especially if neuropathy)

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10
Q

If all spinal reflexes are reduced and reduced tone in all limbs- what is the most likely explanation and the least likely?

A
  • Most likely: generalised myopathy, neuropathy or junctionopathy
  • Least likely: Spinal cord lesion in C6-T2 and L4-S3
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11
Q

What happens to muscles in a neuromuscular disorder? (LMN loss)

A

Atrophy

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12
Q

Common cause of ventroflexion in the cat

A

hypokalaemia

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13
Q

Common cause of eclampsia in the bitch?

A

hypocalcemia

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14
Q

What is ‘reflex fatigue’?

A

If you repeat reflex again and again it will eventually stop occurring i.e. Palpebral reflex. This mimics exercise tolerance (i.e Myasthenia Gravis)

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15
Q

Ventroflexion in a cat- is it a neuropathy? a junctionopathy? or a myopathy?

A

Myopathy

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16
Q

You have a patient with really flaccid limbs, decreased spinal reflexes and a plantigrade stance- Is it more likely to be a neuropathy, junctionopathy or myopathy?

A

neuropathy

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17
Q

You have patient with weakness, myalgia, exercise intolerance and normal spinal reflexes- neuropathy? a junctionopathy? or a myopathy?

A

myopathy

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18
Q

80% of dogs with acquired Myasthenia Gravis will have…

A

Megaesophagus

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19
Q

Megaesophagus predisposes to …?

A

aspiration pneumonia

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20
Q

What diagnostic tests can we do to test for myopathy?

A

Look at muscles enzymes: CK, AST, ALT enzymes.
Urinalysis: myoglobinuria

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21
Q

What test can be used to differentiate between muscle disuse due to orthopedic problems Vs myopathy/neuropathy?

A

electromyogram

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22
Q

What test helps us differentiate between neuropathy, junctionopathy or a myopathy

A

nerve conduction test

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23
Q

Acute Canine Polyradiculoneuritis is cause by?

A

Immune mediated inflammatory disease affecting the ventral nerve root

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24
Q

If a dog has miosis, ptosis and facial paralysis - is it peripheral or central vestibular disease?

A

peripheral

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25
Q

If a cat seems obtunded and has a horizontal strabismus that can change direction- is it peripheral or central vestibular disease?

A

central

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26
Q

Central vestibular disease includes what structures?

A

the vestibular nuclei
the cerebellum
the cerebral cortex

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27
Q

Peripheral vestibular disease includes which structures?

A

the hair cells
the vestibulocochlear nerve
the ampulae cristalis
the maculae

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28
Q

Could a peripheral lesion causing vestibular disease also lead to facial paralysis?

A

Yes

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29
Q

Could a peripheral lesion causing vestibular disease also lead to Horner’s syndrome?

A

Yes

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30
Q

What is this and how do you treat it?

A

SCCED or ‘indulent ulcer’ or ‘boxer ulcer’

Ulcerative disease

treatment: only ulcer that can be debrided (cotton bud, diamond burr or keratectomy)

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31
Q

What is this? What is the risk?

A

A foreign body.

Ulcerative disease

It can migrate and damage the lens.

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32
Q

What is this? How do you treat it?

A

This is a melting ulcer caused my Pseudomonas.

Ulcerative disease

Fluroquinolones required. This is an emergency do not wait!

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33
Q

What is this? How do you treat it?

A

This is a perforation filled with a fibrin plug.

Ulcerative disease

Do not remove the fibrin plug. Requires surgical treatment.

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34
Q

What does this represent?

A

a desmetocoele.
Ulcerative disease.
Pattern caused by uneven fluorescein staining

35
Q

What is this?

A

Corneal oedema due to endothelial disease.

36
Q

What is this? What are the causes? Treatment?

A

Mineral deposits in the cornea

Non ulcerative

Can be there for lots of different reasons :
- Old age
- Chronic irritation
- Hereditary
Can also occur with some systemic disease i.e. hypothyroidism, diabetes, lipid deposits- you need to treat the systemic underlying cause

37
Q

What is this? Treatment?

A

Pigmentary keratitis is found in almost in every brachycephalic pug. It can progress to the degree where it becomes blinding. So important to monitor the progression

38
Q

What is this?

A

Acute Bullous Keratopathy.

Non ulcerative

Very rare

Patients present suddenly with extreme corneal oedema

39
Q

What causes this?

A

Feline Herpes

Non ulcerative

40
Q

What is this?

A

Chronic superficial keratitis (Pannus)

Caused by UV damage

Treatment is cyclosporin and corticosteroids

41
Q

What is this?

A

Eosinophilic keratitis

Full of eosinophils

Non ulcerative disease

Treat with cyclosporin and corticosteroids

42
Q

What is this?

A

Keratoconjunctivitis Sicca (Dry eye)

Ulcerative disease

43
Q

What is this?

A

Deep ulcer

Ulcerative disease

When the ulcer becomes deeper than 50 % then we need to provide some mechanical support to prevent it from this also from rupturing.

44
Q

What is this?

A

Corneal sequestrum

Non ulcerative disease

necrotic part of the cornea

Would need to be removed

45
Q

Causes of corneal edema

A

endothelial degeneration
uveitis
lens luxation
glaucoma

46
Q

What are the 4 medical management treatments for corneal opacity

A
  • anti-collagenase
  • antibiotics
  • mydriatic cyclopegics
  • anti-inflammatories/ immunosupressives
47
Q

How long does it take for the epithelium

A

1 - 2 hours

48
Q

If deeper layers of the epithelium are lost how long may it take to repair?

A

a week if the limbus stem cells are still intact.

49
Q

How long do vessels take to grow per day in the process of corneal healing?

A

0.5mm per day

50
Q

How long does it take for the stroma to heal?

A

weeks to months

51
Q

How long does it take for the endothelium to grow?

A

Unfortunately the endothelium is only one cell thick and is non-regenerative.

52
Q

What features can be seen with progressive retinal atrophy (PRA) when examining the fundus?

A
  • hyperreflective tapetum
  • vascular attenuation
  • end stage: catarracts
53
Q

What can cause retinal toxicity in cats?

A

enrofloxacin

54
Q

What causes symblepharon in cats?

A

FHV1

55
Q

What is this?

A

pigmentary keratopathy

56
Q

What is this? What does it need to be differentiated from?

A

synechia

Needs to be differentiated from persistent pupillary membranes (PPM)

57
Q

What is this?

A

Hypopyon

58
Q

7 causes of cataracts

A
  • congenital
  • inherited
  • nutritional
  • traumatic
  • metabolic
  • PRA
  • senile
59
Q

What are the clinical signs of uveitis?

A
  • hypopyon
  • hyphaema
  • aqueous humour flare (tyndall effect)
60
Q

Uveitis is a local or systemic problem?

A

Both

local: a trauma, corneal ulcer
systemic: pyometra, urinary tract infection, hyphaema could be due to coagulopathies

61
Q

What is the pathophysiology of glaucoma?

A

Aqueous humous is produced by the ciliary body, flows through the pupil and should exits in the drainage angle. There is a problem of outflow leading to increased IOP and optic nerve damage.

62
Q

What are the signs of acute glaucoma?

A
  • corneal oedema
  • episcleral congestion
  • hyperemia
63
Q

What does this show?

A

Persistent pupillary membranes

These can extend from
either iris to iris, iris to
lens or iris to cornea.

64
Q

What is this?

A

iris atrophy

can occur with age.
The pupil margin
ragged; this can appear
as mydriasis if the pupil
margin is not examined
closely

65
Q

What does this represent?

A

an iris coloboma.

Developmental defect leaving a hole is this iris at 6 o clock

66
Q

What does this represent?

A

Iris melanoma- can be benign melanosis or
a neoplastic change for
example iris melanoma

67
Q

What is this?

A

a uveal cyst.

Spherical cysts formed
from the uveal
epithelium, these are
usually free floating in
the anterior chamber,
however can also burst
and leave pigment on
the corneal endothelium

68
Q

What is this?

A

anterior lens luxation. anterior displacement of the lens means the pupil cannot constrict and dilate as normal.

69
Q

What is SARDs?

A

Sudden acquired retinal degeneration syndrome.

Acute blindness - idiopathic

70
Q

What does the fundus of a SARDs dog look like?

A

Normal

71
Q

When doing an electroretinogram for a SARDs patient what may you expect?

A

a flat line

72
Q

What is this?

A

optic nerve neurits

This is an inflammation of
the optic nerve and
manifests as blindness or
if very early reduced
vision. The optic nerve
head is pink/
haemorrhagic, swollen
and there can be
peripapillary oedema/
retinal detachment.

73
Q

Cataracts can lead to glaucoma. How?

A

cataracts—> uveitis—> pre-iridal fibrovascular membranes (PIFM)—> synechia—> glaucoma

74
Q

uveitis can cause miosis or mydriasis?

A

Miosis

75
Q

Horner’s syndrome can be defined by what 4 characteristics?

A

Miosis,
enophthalmos, third
eyelid protrusion and
ptosis (drooping of the
upper eyelid)

76
Q

Glaucoma- miosis or mydriasis?

A

Mydriasis

77
Q

Dysautonomia- miosis or mydriasis?

A

mydriasis

Means dysregulation of the autonomic system.

78
Q

Fear- miosis or mydriasis?

A

Mydriasis-

When animals are very
stressed, they have a
heightened sympathetic
stimulation and thus
mydriasis that is usually
not very responsive to
bright light and therefore
a reduced or absent PLR

79
Q

In a chiasmal lesion would the pupils be constricted or dilated? PLR absent or present?

A

dilated-

Nothing works!

80
Q

In a re-chiasmal lesion (right) what would the PLR direct and indirect be in each eye?

A
81
Q

In an oculomotor nerve lesion (left) what would the PLR direct and indirect be in each eye?

A
82
Q

Parasympathetic nucleus of CN3 lesion (right)

A
83
Q

With SARDs what would the menace response and PLR be?

A

No menace response, absent or decreased PLR

84
Q

Enophthalmia define

A

retraction of the bulb within the orbital cavity known as
enophthalmia. Due to ocular pain, reduced amount of
retrobulbar fat, periocular/facial muscle atrophy (typical of
elderly cats, weight loss, long-term use of steroids)

vet med 4 (11 decks)

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