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Phase 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

What antibiotics penetrate the BBB?

A

3rd gen cephalosporins
Fluoroquinolones
Metronidazole
Chloramphenicol
Trimethoprim
Sulfonamides

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2
Q

What is the max amount of CSF you can take and what are normal cell and proteins amounts?

A

1 ml/5 kg
Cell counts <5 cell/uL
Protein <25 mg/dL (cisterna, <45 mg/dL (lumbar)

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3
Q

What structures show normal contrast enhancement on MRI?

A

Meninges, choroid plexus, pituitary glands, pharyngeal mm. Should not normally cross the BBB.

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4
Q

What electrodiagnostic study can help diagnosis myasthenia gravis and botulism, and what are the findings?

A

Repetitive nerve stimulation
MG= >10% decremental response
Bot= facilitation (increased amplitude and AUC with higher stimulation rates)

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5
Q

What do the M wave, F wave, and H reflex assess?

A

M= distal motor nerve conduction velocity
F= proximal motor nerve, ventral nerve root and ventral grey horn
H= sensory and motor, sensory fibers proximal to the electrode, alpha motor neuron, polyneuropathies, spinal cord

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6
Q

What are the surgical options for dorsal stabilization of AA luxation?

A
  1. AA wiring
  2. Nuchal ligament technique
  3. Dorsal cross-pinning + PMMA
  4. Kishigami AA tension band
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7
Q

What are the surgical options for ventral stabilization of AA lunation?

A
  1. Transarticular screws/pins
  2. Pins + PMMA
  3. Screws + PMMA
  4. Ventral plating
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8
Q

What are the angle for screw/pin placement for AA lux?

A

Transarticular pins are at 40 deg mediolateral and 20 deg ventrodorsal, aim for alar notch. Pins in caudal axis are 30deg mediolateral

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9
Q

What are the grades of nerve injury?

A

Grade 1: neurapraxia= interruption in function but normal structure, reversible
Grade 2: axonotmesis= axon disrupted, wallerian degeneration distally, recover after weeks
Grade 3: neurotmesis= axon/ endometrium disrupted
Grade 4: neurotmesis= axon/endoneurium/perineurium disrupted
Grade 5: neurotmesis= entire nerve severed

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10
Q

Treatment options for Cervical IVDD

A

Conservative (40% recurrence)
Ventral Slot/Slanted ventral slot (90-100% recover; 70% for large dog with IVDP)
Dorsal Laminectomy (100%)
Hemilaminectomy (80%)
Fenestration (33%)

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11
Q

Treatment options for Wobblers

A

Static: Decompression
Ventral Slot (Inverted Cone)
Dorsal Lam (continuous)
Dorsal Hemilam
Dynamic: Distraction-Stabilization.
Pins + PMMA
Screw-bar + PMMA
Locking plate
Discectomy + PMMA plug or cortical graft
Cervical disc arthroplasty

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12
Q

Treatment options for LS/CES

A

Dorsal laminectomy +/- partial discectomy, +/- foraminotomy
Distraction and Stabilization +/- graft or cage/Interbody device
Pins/screws + PMMA
Dorsal crosspinning/lag screws across zyga joints
SOP
Pedicle screw-rod fixation

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13
Q

Treatment options for vertebral fractures

A

Pins/screws + PMMA (C, TL, LS)
Screw Bar + PMMA (C)
ESF (TL)
Pedicle screw/rod (LS)
Locking plates (C, TL, LS)
Spinous process stabilization (Thoracic)
Auburn spinal plate
Lumbar plate
Spinal stapling/segmental fixation

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14
Q

What are the angles for pin placement in the cervical vertebrae?

A

Ventral stabilization. Enter at midline of caudoventral body. 35 degrees dorsolateral (45 for C7).

If C2: spinous process –> dorsal techniques, if body –> ventral.
Body: cranial and caudal body, 40 deg lateral, can cross AA joint to increase stability (like AA lux).

Always ventral stabilization before dorsal decompression

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15
Q

What are the angles for pin placement for LS stabilization?

A

Transarticular for CES: 30-45 deg, base of L7 spine –> zyga joints –> ilial wing

For fracture:
L7 pedicles: enter caudal to base of cranial articular process –> ventral and slightly craniomedial
Sacrum: enter caudal to cranial articular surface of sacrum –> ventral or engage ilium (aim for tuber sacrale)

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16
Q

What are the angles for pin placement for TL fractures?

A

Thoracic: enter at accessory process/tubercle of rib
Lumbar: enter at base of transverse and accessory
Both: 30-60 deg lateral to medial
30 if exiting midbody
60 if exiting lateral body
24 for T5-9 (Schmitt study)
Want them to diverge dorsally.

17
Q

What is the pin placement technique?

A
  1. Pilot holes through cis cortex
  2. Probe down to transcortex (ensure no breach, look at angle)
  3. Pilot hole through trans cortex
  4. Measure, blunt the pin and determine number of exposed threads needed
  5. Insert pin with low speed, high torque drill
18
Q

Name the ligaments of the dens, which is most important?

A

Apical (dens to basioccipital)
Transverse (holds dens ventral)
Alar ligaments*** x2 (dens to occipital bone )

19
Q

Treatment options for nerve injury

A

Neurotization (nerve transfer or rein nervation)
Reconstruction (end-to-end neurorrhaphy)
Preimplantation of rootlets –> cord

20
Q

Conservative treatment for IVDD

A

Rest and pain meds
Acupuncture (70% helpful)
Chemonucleolysis with chondrotinase ABC (90% improve, 80% excellent)

21
Q

Types Dorsal laminectomies

A

Funkquist A: removes spinous process, laminae, articular process, 50% of pedicle
Funkquist B: leaves the articular process and pedicles
Modified: remove laminae, spinous processes and caudal articular processes, undercut the pedicles
Dorsal lam + hemi –> 75% of spinal cord exposed

22
Q

Signs of IVDE on rads

A

Narrowing/wedging of the disc space *highest sensitivity
Increased articular process overlap
Mineralized material superimposed over the intervertebral foramen/vertebral canal
Reduced intervertebral foramen diameter

23
Q

Complications of myelography. How to decrease risk

A

Seizures
Myelopathy/Deterioration (30% dobies)
Apnea
Subarachnoid hemorrhage
Meningitis
Arrhythmias
Death

Max dose of 8 ml by LUMBAR. (Higher risk with big does and cisternal punctures

24
Q

Signs of IVDE on CT

A

Loss of epidural fat opacity surrounding the spinal cord
Visible spinal cord compression
* Compressive material is typically hyperattenuating (hemorrhage + mineral)
Mineral-dense material within the vertebral canal
Material within epidural space consistent with hemorrhage density

25
Q

CSF Biomarkers associated with failure to recover ambulation

A

Creatinine kinase
Myelin basic protein
Protein tau
Monocyte chemotactic protein-1

26
Q

Complications of fenestration

A

Diskospondylitis
Pneumothorax
Iatrogenic damage to spinal cord/Roots/nerves
Vertebral instability

27
Q

Types of spina bifida

A

Occulta = no clinically obvious malformation
Cystica = concurrent meningocele/meningomyelocele/myeloschisis
Aperta = open to environment

28
Q

What is the spinal cord termination for cats, large dogs, small dogs?

A

Large/giant breeds: L4
Dogs <15kg: L6
Cats/toy breeds: L7

29
Q

Abnormalities associated with LS disease

A

Hansen type II IVDD
Transitional vertebrae
Congenital osseous stenosis
Sacral osteochondrosis
Proliferation of the joint capsules/ligaments
Osteophytosis of the articular processes
Epidural fibrosis
Instability/malalignment of L7-S1 articulation

30
Q

Radiographic changes suggestive of LS disease

A

Sacral osteochondrosis (dorsal chip)
Transitional vertebrae
LS step formation
Disc vacuum phenomenon
Telescoping of the cranial laminae of the sacrum into the L7 foramen
(Collapse of the IVD space)
(Ventral spondylosis)
(End-plate sclerosis)

31
Q

CT/MRI changes suggestive of LS disease

A

CT:
Loss of epidural fat
Abnormal soft tissue density within the intervertebral foramina/vertebral canal
Bulging of the IVD
Displacement of the dural sac
Subluxation and osteophytosis of the ZA joint
MRI:
Loss of epidural fat,
IVDH
Foraminal stenosis due to ligamentous hypertrophy and soft tissue proliferation of the ZA joint
No correlation between severity of CS and degree of compression
Dynamic views

32
Q

What are the two models of instability for vertebral fractures?

A

3-compartment model for stability: >1 affected –>surgery
* Dorsal compartment – spinous processes, laminae, articular processes, pedicles, dorsal ligamentous complex
* Middle compartment – dorsal longitudinal ligament, dorsal portion of annulus, dorsal portion of vertebral body
* Ventral compartment – remainder of vertebral body, lateral and ventral annulus, nucleus pulposus, ventral longitudinal ligament
Simpler model: >1 affected –> surgery
* Intervertebral disc –> most important for rotational stability, also lateral bending
* Vertebral body
* Articular processes –> relatively less instability compared to other two

33
Q

Size and types of pins for vertebral stabilization

A

Positive profile, 25% of the vertebral body diameter

Phase 2 (4 decks)

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