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Medicine > Neuro > Flashcards

Neuro Flashcards

1
Q

CNS

A

brain

spinal cord

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2
Q

peripheral nervous system (PNS)

A

cranial nerves

spinal nerves

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3
Q

upper motor neuron (UMN)

A 
never leaves the CNS 
innervates lower motor neuron (LMN) 
descending control of reflex arc 
paresis/paralysis
hyperreflexia/hypertonus 
rigid limbs + extension
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4
Q

clonus

A

tremors

indicates chronic lesion

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5
Q

LMN

A

beings in CNS and exits through spinal nerves
form peripheral/cranial nerves
ventral horn- motor/efferent
flaccid, hyporeflexia, areflexia, no motor
sensory intact
hypotonus

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6
Q

sensory nerve

A

local reflex arc
proprioception/pain/reflexes
normal strength and motor
don’t know where feet are

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7
Q

dysmetria

A

abnormally metered gait

always cerebellar disorder- controls metering of gait

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8
Q

hypermetric

A

large exaggerated gait

what usually see

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9
Q

hypometric

A

short gait

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10
Q

spasticity

A

increase in tone

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11
Q

smooth muscle

A

hypertrophies when denervated

more responsive to stimuli

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12
Q

skeletal muscle

A

atrophy when denervated

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13
Q

C6-T2

A

LMN to forelimbs come out

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14
Q

triceps reflex

A

radial nerve

C7-T1 evaluated

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15
Q

quadriceps (patellar) reflex

A

most reliable reflex to interrupt
L4-L6 spinal cord segment
femoral nerve

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16
Q

extensor carpus radialis reflex

A

radial nerve
C7-T1 spinal cord segment
most reliable reflex in thoracic limbs

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17
Q

biceps reflex

A

musculocutaneous nerve

C6-C8

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18
Q

cranial tibial reflex

A

peroneal branch of sciatic nerve
L6-L7
flexion of hock

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19
Q

end of spinal cord

A

L5/L6

caudate equine continues past this

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20
Q

gastrocnemius reflex

A

tibial branch of sciatic nerve
L7-S1
extension of hock

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21
Q

flexor responses

A

sensory component, reflex arc, motor component
lost w/ LMN
present w/ UMN

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22
Q

crossed extensor reflex

A

typically absent- normal young animals
UMN lesions
one limb withdrawn, other extends

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23
Q

babinski reflex

A

normal:absent or slight flexion of foot
abnormal: extension foot/splaying toes
UMN lesion
sweep hemostat from distal to proximal foot

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24
Q

cranial nerve I

A

olfactory

sensory

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25
Q

CN II

A

optic

sensory

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26
Q

CN III

A

oculomotor

motor

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27
Q

CN IV

A

trochlear

motor

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28
Q

CN V

A

trigeminal

motor/sensory

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29
Q

CN VI

A

aducent

motor

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30
Q

CN VII

A

facial

motor/sensory

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31
Q

CN VIII

A

vestibulocochlear

sensory

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32
Q

CN IX

A

glossopharyngeal

motor/sensory

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33
Q

CN X

A

vagus

motor/sensory

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34
Q

CN XI

A

accessory

motor

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35
Q

CN XII

A

hypoglossal

motor

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36
Q

miotic pupil

A

horner’s syndrome

sympathetic denervation

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37
Q

mydriatic pupil

A

parasympathetic denervation

dysautonomia

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38
Q

ptosis

A

droopy upper eyelid

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39
Q

enophthalmos

A

sunken globe

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40
Q

pre-ganglionic Horner’s syndrome

A

spinal cord to cranial cervical ganglion
no dilation w/ dilute phenylephrine (direct acting)
dilation w/ hydroxyamphetamine (indirect acting)

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41
Q

post-ganglionic Horner’s syndrome

A

cranial cervical ganglion to pupil
denervation hypersensitivity of pupil
no response to hydroxyamphetamine
dilation w/ dilute phenylephrine

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42
Q

vestibular disease

A

brain stem

central or peripheral

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43
Q

central

A 
vestibular nucleus w/in brain stem
nystagmus any direction
changing nystagmus 
CP deficits 
any cranial nerve deficits (PM)
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44
Q

peripheral

A

outside brain stem- vestibular apparatus and CN VIII
never vertical nystagmus
CN VII deficits
constant nystagmus

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45
Q

pathological nystagmus

A

slow phase towards lesion

fast phase away from lesion

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46
Q

menace response

A

CN II afferent limb response
CN VII efferent limb response
central connections in brain stem and cerebrum

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47
Q

cerebellar disease

A

PLR intact but no menace response

absence of menace response w/ normal vision

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48
Q

pupillary light reflex

A 
CN II- sensory 
CN III- motor 
constriction of pupil
direct and consensual responses to localize lesion
can have PLR normal and be blind
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49
Q

pupil symmetry

A

CN3 parasympathetic motor
sympathetic innervation
anisocoria

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50
Q

anisocoria

A

different size pupils

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51
Q

physiologic nystagmus

A

turning head in either direction
CN 8
CN 3, 4, 6
fast phase in direction of movement

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52
Q

palpebral reflex

A

CN5 sensory
CN7 motor
brain stem connections
tap medial and lateral canthus- should blink

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53
Q

corneal reflex

A

moistened q-tip and touch cornea- should blink
CN 5 (opthalmic branch)
CN 7
brain stem connections

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54
Q

retractor bulbi reflex

A 
same time as corneal reflex
globe should retract when dog blinks 
CN5
CN6
brain stem connections
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55
Q

facial sensory response

A

rub finger along mandible or touch whiskers
blink or curl up face
pinch cheek skin along mandible- retract lip
CN5
CN7

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56
Q

gag reflex

A

touch either side of pharynx (lateral side)
dog should gag
CN9
CN10
nucleus ambiguus lesion cause damage to CN 9, 10, 12

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57
Q

cutaneous trunci (panniculus reflex)

A

ball point pen pushed into back
twitching of cutaneous trunci
entire sensory pathway- feeds up to C8-T1

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58
Q

myopathy

A

disease of muscle

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59
Q

most common myopathy of dogs

A

masticatory myositis
large breed dogs
immune mediated
azathioprine

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60
Q

max safe rate of K supplementation

A

0.5 mEq/kg/hr

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61
Q

C1-C5

A

cervical
exit point for CN XI
UMN signs to thoracic and pelvic limbs

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62
Q

C6-T2

A

cervico-thoracic segment
thoracic limbs- LMN exit for thoracic limbs
LMN signs to thoracic limbs
UMN signs to pelvic limbs

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63
Q

T3-L3

A

thoracolumbar

UMN signs to rear limbs when damaged

64
Q

L4-S2

A

lumbar sacral
pelvic limbs- LMN exit for thoracic limbs
LMN signs to rear limbs

65
Q

Cd

A

caudal

66
Q

LMN bladder

A

easy to express

67
Q

UMN bladder

A

typical to express

harder to express

68
Q

diskospondylitis

A

infection of intervertebral disk

space sometimes

68
Q

Type 1 IVDD

A 
Most common 
Degeneration/rupture of dorsal annulus
Extrusion nucleus pulposus
Chondrodystrophic breeds
Most common type large breeds
69
Q

Hyperesthesia

A

Increased sensitivity
Esp to pain
Like hyperalgesia

70
Q

Myelomalacia

A

Morbid softening of the spinal cord

72
Q

Type II IVDD

A

Progressive thickening of annulus fibrosus
Older large breeds
Slow onset
Damage from compression only

73
Q

cervical IVDD type I

A

C2-C3 most common

74
Q

cervical IVDD type II

A

pelvic limb signs precede thoracic limb signs

75
Q

thoracolumbar IVDD type I

A

T1-T11 lesions are rare

neurological deficits with pain are common

76
Q

group 1 IVDD

A

pain w/out deficits

majority conservative management

77
Q

group 2 IVDD

A

ambulatory paraparesis

majority conservative management

78
Q

group 3 IVDD

A

nonambulatory paraparesis, normal superficial pain

still conservative management but surgery may be more needed

79
Q

group 4 IVDD

A

paraplegia urinary and fecal incontinence, deep pain intact
conservative management or surgery
progressive myelomalacia possible

80
Q

group 5 IVDD

A

paraplegia w/ no deep pain

surgery w/in 24 hours or no recovery

81
Q

myelopathy

A

spinal cord pathology

82
Q

cervical spondylomyelopathy

A 
wobbler's syndrome 
vertebral malformation 
C5-6 and C6-7 disc spaces 
gradually progressing signs 
myelography for diagnosis
83
Q

stenosis

A

abnormal narrowing

84
Q

cauda equina syndrome

A 
lumbosacral vertebral canal stenosis 
subluxation/instability 
GSD
extension of limbs, tail elevation/paresis
incontinence (LMN bladder) 
possible 3+ patellars- pseudoreflex 
depressed flexion response
LMN disease 
MRI diagnosis 
strict rest + corticosteroids or decompressive laminectomy
85
Q

pontomedullary syndrome

A

CN deficits 5-12 (minus 11)

UMN to all limbs

86
Q

cerebellar syndrome

A

dysmetria in all limbs - cerebellum meters gait
intention tremors
ataxia w/ preserved strength

87
Q

strabismus

A

eyes do not line up in same direction

“cross eyed”

88
Q

vestibular syndrome

A

head tilt, falling, rolling
walking tight circles
nystagmus + V-L strabismus
peripheral vs. central

89
Q

central

A

horizontal, rotary, vertical, positional nystagmus

possible CN 5, 6, 7 deficits

90
Q

peripheral

A

horizontal, rotary nystagmus

possible CN 7 deficits

91
Q

midbrain

A

vision, hearing, motor control
sleep/wake, alertness
temperature regulation

92
Q

midbrain syndrome

A 
depression, coma
rigid extension of all limbs- decerebrate rigidity 
contralateral limb deficits 
UMN to limbs 
hyperventilation
CN 3 deficits
93
Q

hypothalamic syndrome

A 
behavior changes
CN II deficits
abnormal temp regulation
abnormal appetite 
central diabetes insipidus 
normal gait
94
Q

cerebral syndrome

A 
big wide circles
seizures 
contralateral limb and vision deficits 
circling, pacing, head pressing, head turn, body turn
behavior changes
95
Q

canine distemper encephalitis

A

cerebellar, optic tract, spinal cord, cerebrum
hyperkeratosis of foot pads
DX: PCR or CSF mononuclear pleocytosis

96
Q

bacterial meningitis/encephalitis

A 
middle aged to older
gradual onset
lethargy, reluctance to walk, anorexia
neck pain, hyperthermia, bradycardia (cushing's reflex) 
depression, seizures 
meningitis- more fever and pain
DX: CSF tap- neutrophilic pleocytosis
97
Q

fungal meningoencephalitis

A 
Cryptocccus neoformans 
dog/cat
c/s like bacterial meningitis 
granulamatous fungal plaques on fundic exam
Dx: CSF, serology
TX: fluconazole
98
Q

aseptic meningitis

A

2 inflammatory CNS dz (#1 distemper)

young (8-18m) large breeds
neck pain, fever, stiffness, ataxia-b/c neck pain
dx: leukocytosis w/ left shift, CSF neutrophilic pleocytosis, + response to steroids
tx: immunosuppressive prednisone

99
Q

beagle pain syndrome

A

necrotizing polyarteritis

frequently recurrent

100
Q

idiopathic vestibular disease

A

old dogs
acute to peracute onset
rapid recovery- marked improvement 24-48 hours
supportive care

101
Q

granulomatous meningoencephalitis (GME)

A 
nunsuppurative inflammatory dz 
unknown etiology - immune mediated?
cerebrum, cerebellum, pontomedullary
diffuse/coalescing lesions
toy breeds 1-8 yo, females 
3 major forms
102
Q

GME 3 forms

A

ocular
focal form
disseminated form

103
Q

ocular form

A

rarely by itself
acute visual loss- blind
slowly progressive form

104
Q

focal form

A

mass lesion
signs related to site of compression
dead w/in 6 months

105
Q

disseminated form

A

most common
meningitis w/ neck pain, fever
brainstem, cerebral, cerebellar
rapidly progressive

106
Q

GME dx

A

c/s signs, signalment
MRI
CSF: mononuclear pleocytosis, elevated protein

107
Q

therapy

A

prednisone- cornerstone
azathioprine- not best choice
cyclosporine- good choice
cytosine arabinoside - like cyclosproine and good choice

108
Q

necrotizing meningoencephalitis

A

pug dog encephalitis (earlier age onset)
Yorkshire terrier necrotizing encephalitis (middle aged)
nonsuppurative- extensive cerebral necrosis
latent canine herpesvirus?
9mo-7y w/ variable onset

109
Q

pug dog encephalitis

A

acute: sudden onset seizures w/ abnormal behavior between; rapid progression to death
chronic: seizures w/ normal behavior between; gradually progresses to full disease
dx: signalment/history, CSF, necropsy
tx: antiepileptics (TOC), immunosuppressives

110
Q

Yorkie encephalitis

A 
variable CN deficits
variable long tract signs -UMN 
fewer seizures 
immunosuppressives TOC 
eventually fatal- stabilize disease is goal
111
Q

caudal occipital malformation

A

cavalier king charles spaniels
syringohydromyelia
c/s: spinal pain, paresis, ataxia, facial scratching/rubbing, resentment touching/grooming, LMN signs to thoracic limb
chiari- like malformation

112
Q

syringohydromyelia

A

abnormal spinal cord fluid accumulation

complex pathogenesis

113
Q

COMS MRI findings

A 
small foramen magnum
small caudal fossa volume
cerebellar herniation
hydrocephalus
syringohydromyelia
114
Q

COMS tx

A

medical: corticosteroids, carbonic anhydrase inhibitors (decrease CSF formation)
surgical: enlargement of FM, caudal fossa

115
Q

metabolic encephalopathies

A

uremic encephalopathy
hepatic
hypothyroidism

116
Q

uremic encephalopathy

A

long standing chronic renal failure

hypertension, hyperparathyroidism, acidemia

117
Q

hepatic encephalopathy

A

congenital (PSS) and acquired liver disease
acute or chronic liver disease
neurodepressive
ammonia, benzodiazepine like substance, GABA

118
Q

hypothyroidism

A

myxedema stupor or coma

119
Q

lysosomal storage disease

A

hereditary disease: accumulation of intermediate metabolite from lysosomal pathway defect- cell death
clinical syndromes: central/peripheral NS disease, hepatomegaly, skeletal abnormalities, young onset
Dx: clinical (presumptive), MRI, urine metabolite screen (limited), histopath (definitive)
therapy: none
acetyl-l- carnitine- slows progression maybe

120
Q

CNS neoplasia

A 
Meningioma 
astrocytoma 
oligodendroglioma 
choroid plexus tumor
ependymal tumors 
gangliocytomas 
medullolastomas
121
Q

meningioma

A

most common in dogs and cats
multiplies in cats
dural tails present

122
Q

astrocytoma

A

equal occurence in dogs
variable malignancy
increased risk in brachycephalics

123
Q

oligodendroglioma

A

more in males, brachycephalics

more often in frontal lobes

124
Q

choroid plexus tumor

A

arise in 4th ventricle

can occur in lateral and 3rd ventricles

125
Q

syncope

A

sudden loss of consciousness
deprivation of oxygen/glucose
complete recovery in seconds to minutes

126
Q

seizure

A

any involuntary activity that is brief and episodic
distruption in normal electrical activity
alteration in behavior, consciousness, motor activity, sensation, autonomic function
seizure focus

127
Q

pre-ictal period

A

period right before the seizure

128
Q

ictus

A

the seizure itself

usually relatively brief

129
Q

post-ictus

A

period of recovery after the seizure
variable duration
temporary blindness for up to 2-4 days

130
Q

interictal period

A

time between seizures

important to determine normalcy

131
Q

primary epileptic

A

no underlying cause

familial epilepsy

132
Q

secondary epileptic

A

identifiable structural cerebral lesion

hydrocephalus, neoplasia

133
Q

reactive epileptic

A

normal brain

metabolic cause

134
Q

dogs <1 year, > 7 years

A

secondary or reactive

135
Q

cats

A

secondary or reactive

136
Q

abnormal interictal period

A

secondary

137
Q

time between seizures

A

< 4 weeks- secondary or reactive

>4 weeks- primary

138
Q

asymmetric localizing signs interictal

A

secondary

139
Q

abnormalities CBC/chem

A

reactive

140
Q

primary/familial epilepsy

A

most common
beagles, GSD, poodles, labs
1-5y first seizure
large breeds hard control

141
Q

treatment- no

A

very infrequent seizures (2-3/year)
infrequent w/ not change (1/month or less)
repetitive seizures can lead to kindling and mirroring

142
Q

kindling

A

recruiting additional neurons outside seizure focus to make larger seizure focus

143
Q

mirroring

A

making seizure focus in opposite hemisphere in exact same spot

144
Q

treatment- yes

A 
frequent seizures (>1/month) 
decreasing interictal period
cluster seizures
145
Q

treatment options

A

phenobarbital
potassium bromide
zonisamide- first choice
felbamate, gapabentin (not effective as sole), levetiracetam, topirmate
carbamazepine, diazepam, primidone, phenytoin- don’t use these 4

146
Q

phenobarbital

A 
standard therapy 
sedation, polyphagia, PU/PD 
15 days to steady state 
idea therapeutic range 20-30 
trough levels not important 
long term monitoring- serum levels, hepatic enzymes, serum bile acids
147
Q

potassium bromide

A 
first line or add on 
non-hepatotoxic 
sedation, ataxia 
don't use in cats- pulmonary toxicity 
usually phenobarb works better 
28 day T1/2
148
Q

gabapentin

A

not effective by itself

Q8 hr dosing

149
Q

felbamate

A

nervousness at high doses
risk of hepatotoxicity
Q8-12h dosing
expensive but less so now- reasonable add on

150
Q

zonisamide

A

drowsiness, ataxia, GI upset (levels needed control seizures)
Q12h dosing
expensive - very

151
Q

levetiracetam

A 
favorite add on 
100% bioavailable
very safe in dogs 
Q8hr dosing- long release for BID use 
expensive (cheaper than others though)
152
Q

fish oil

A

high omega 3-FA decrease excitatory potential of cells

stabilize cell membrane increasing seizure threshold

153
Q

goals therapy

A

ideal: stop all seizures - almost never happens
realistic: increase time between seizures, decrease seizures in a cluster
realistic expectations for clients

154
Q

therapy fails

A 
check phenobarbital fails 
check thyroid/triglyceride levels 
add potassium bromide
add fish oil
eliminate other issues (allergies) 
evaluate KBr levels
newer anti-epileptic agents 
CT/MRI? castrate male dogs? antioxidant therapy?
155
Q

cluster seizures

A

multiples seizures in 24 hour period
per rectum diazepam or intranasal
may decrease # or severity

156
Q

status epilepticus

A

failure of normal termination
any seizure >5 minutes
>3 seizures w/out return to consciousness
more severe cluster
brain damage: hypoxia, hyperthermia, acidosis, loss of autoregulation
must terminate all seizure activity

157
Q

status epilepticus tx

A

diazepam first line
propofol CRI second line
isoflurane anesthesia- 3rd line
initiate phenobarb therapy at same time

Medicine (2 decks)

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