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ECVIM Certifier > Neuro > Flashcards

Neuro Flashcards

1
Q

What defect do cats with complex partial seizures have?

A

ABs against voltage gated potassium channels (alter excitability neural membrane) - NG hippocampal necrosis

Dogs juvenile epilepsy mutation of voltage gated K channel

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2
Q

Threshold for voltage gated sodium channels?

A
  • 55

Membrane usually - 70

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3
Q

Mechanism of phenobarbital and diazepam?

A

GABA receptor agonist - increase time chloride channel open when GABA binds, make cell more neg

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4
Q

Glutamate - what is it and what does it do?

A

Major excitatory neurotransmitter.

AMPA and NMDA receptors.

AMPA depolarises membrane, release Mg ion, block NMDA. Bind NMDA allow sodium conduction and increase excitatory effect. NMDA channel also allow calcium in - more prolonged synaptic effects.

Can cause cell death from too much calcium if too much NMDA agonism.

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5
Q

Coton de Tulear motor learning/cerebellar dysfunction?

A

mGluR1 mutation (GRM1) - which is conc on purkinje cells cerebellum

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6
Q

Segments for patellar reflex?

A

L4 - L7

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7
Q

How to manage different kinds of brain oedema?

A

Cytotoxic/interstitial - underlying cause

Vasogenic - steroid/osmotics

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8
Q

What lactate most likely to produce encephalopathy?

A

D-lactate, not usually measured - bacteria in GI tract?

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9
Q

L-2-hydroxyglutaric aciduria?

A

Staffie and Yorkie, around 4y, grey matter hyperintensity

Measure in urine.

L2HGDH mutation.

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10
Q

First signs of lysosomal storage disease?

A

Cerebellar

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11
Q

Brain tumour characteristics that predict seizures?

A

Frontal lobe, contract enhancement, subfalcine/subtentorial herniation.

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12
Q

When should brain neoplasia be considered as a differential for seizures?

A

> 4y

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13
Q

Prognostic indicators for brain tumours?

A

Pos - meningioma, esp cat, supratentorial, surgery + RT

Neg - glioma, metastatic infratentorial

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14
Q

Idiopathic epilepsy dogs/cats?

A

Cats only 22 % idiopathic vs majority dogs

Dog male > female

Idiopathic epilepsy in cats later onset cf familial

Idiopathic more likely dog if > 4w between first and second seizure

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15
Q

Genetic evidence IE?

A

Pure breed

Offspring (more chance and earlier age)

Genetic up to 33 % incidence

Lagoto Romagnolo - LGI2

Belgian shephard - ADAM23

Both voltage gated potassium channel

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16
Q

Tier dx idiopathic epilepsy?

A

I 2 + seizure > 24h apart 6m-6y no exam abnormalities no min bloods abnormalities

II plus BAST MRI and CSF

III EEG

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17
Q

When is MRI/CSF recommended?

A 
After exclusion reactive seeizures
Age < 6m > 6y
Intracranial neuro abnormaltiies
Status/cluster
Drug resistance single AED highest dose
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18
Q

MRI changes idiopathic epilepsy?

A

Might have vasogenic/cytotoxic oedema with recent seizure, resolve 10 - 16w

Piriform, temporal, hippocampus, cerebral cortex

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19
Q

When to give AED?

A 
Structural
sTATUS
2 + IN 6m
Bad interictal
Increasing frequency or severity over 4 seizures (three interictal periods)
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20
Q

What AED to use first?

A

Phenobarbital > bromide

Phenobarbital similar efficacy imepitoin (latter less SEs)

30 % IE need > 1
50 % need SEs to be seizure free

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21
Q

Goal of tx IE?

A

Seizure freedom = extend inter seizure interval to 3 x pretx after min 3m tx.

Partial = prevent status/cluster, decrease frequency/severity

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22
Q

Negative px control IE?

A

Male, entire, young, cluster, border collie, GSD, Staffie

Euthanasia - young, high initial frequency, poor control, status

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23
Q

Criteria for CVA?

A

> 24h clin signs (otherwise is transient ischaemic attack)
Ischaemic (non-hemorrhagic > haemorrhagic ischaemic) more common than haemorrhagic

Territorial infarct = large vessel - cerebellum/cerebrum

Places - cerebellum, cerebrum, thalamus/midbrain, often ischaemic stroke does middle cerebral artery in dogs

24
Q

Ischaemic stroke?

A

No cause found 50 %

Greyhounds more than all other breeds combined - hypertension? - non haemorrhagic ischaemic

Territorial cerebellar CKCS, rostral cerebellar artery

Lacunar thalamic/midbrain large breed

Hyperlip and mini schnauz?

Haemorrhagic ischamic - venous thrombosis/vascular damage with leakage during repercussion - eg HSA

Cats - feline ischaemic encephalopathy middle cerebral artery.

25
Q

Global ischaemia?

A

Peracute neuro dysfunction after GA/CPR
Mouth gag cat - maxillary arteries - cerebral ischaemia vision hearing
Ketamine, brachycephalic

26
Q

Prognosis with CVA?

A

Good if survive > 30 d.
Ischaemic stroke cause = neg
Intracranial haemorrhage (non traumatic) - 60 % good/excellent, cerebellum neg , hypertension neg
A vasorum good outcome

27
Q

GME tx?

A

Procarbazine, cytarabine (both cross BBB)
Ciclosporin - might cross in GME? Trapped endothelial cells?

Female predip

28
Q

NME/NLE?

A

NME cerebrum with meningeal, loss demarcation white/grey matter - pug/maltese - lymph
NLE cerebrum and brainstem with less meninges/cerebral cortex - yorkie - lymph/mono

Procarbazine not as effective

29
Q

What AB cross BBB?

A

TMPS

30
Q

Most common fungal meningoencephalitis?

A

Crypto (neoformans) both cats and dogs

Crypto more likely to be in CSF also

Antigens Crypto, coccidioides, blastomyces

NOT aspergillus/histoplasma

Culture hazardous to humans - blasto, coccidiosis, histo - these might be assoc with pulm lesions

31
Q

What antifungals cross BBB?

A

Fluconazole, flucytosine (NB drug resistance latter)

NOT itraconazole

32
Q

CSF FIP?

A

Neutrophilic then lymph/macro

33
Q

Metronidazole tox?

A

Maybe GABA - treat with diazepam

Vestibular dog forebrain cat

34
Q

SRMA CSF?

A

Increased IgA, B:T cell ratio (blood too), IL6 and IL 8

CD11a expression - neutrophils to subarachnoid space

MMP2

Serum and CSF IgA v sens less spec

35
Q

Clinical presentation SRMA?

A

Can have deficits if chronic, may be due to subarachnoid bleeding

Half of IMPA BMD/Boxer/Akita have concurrent meningitis

36
Q

SRMA remission?

A

80 %

IgA might still be increased

CRP predicts relapse

37
Q

Discospondylitis bacteria?

A

Staph, strep, e coli

Aspergillus in young GSD female

Young basset systemic TB

Brucella

38
Q

Discospondylitis sites?

A

L2-4 for migrating plant material (diaphragmatic crus insertion)

L7 - S1,. caudal cervical, mid-thoracic, thoracolumbar

May be assoc empyema

39
Q

Discospondylitis presentation?

A

Spinal pain

30 % fever/systemically unwell

Blood/urine culture pos 75 %

40
Q

Imaging discospondylitis?

A

XR may be N 1st 2-4w

XR - narrow disc space, irregular end plate, lysis/osseous proliferation

XR change lags behind clin imp

41
Q

Discospondylitis neg px?

A

Fungal, fracture/subluxation, endocarditis

42
Q

Hypothyroid neuropathy?

A

GAG/glycogen accum in Schwann cells causes dysfunction and demyelination.

Microtubule assembly and axonal transport req T4

NaKATPase dysfunction and impaired axonal transport

Mucinous deposits compress cranial nerves?

43
Q

Neuro in hypothyroidism?

A

Single/several limbs

Trigeminal, facial, vestibular, often unilateral often multiple

Axonal degeneration/demyelination

44
Q

Polyradiculoneuritis?

A

Racoon, vax, infection
Guilian Barre syndrome - shared antigen inciting stim with peripheral nerves

anti-GM2 ganglioside ABs

Ventral nerve roots inflamm

Ddx MG tick paral botulism

Steroids not helpful. IVIG might be

45
Q

Tick paralysis?

A

Dermacentor/Ixodes

Neurotoxin female ticks prevents ACh release

5-9d post tick attachment

Cats resistant

AUS - cats too, plus ANS/cardiac dysfunction, get worse after tick removal

46
Q

Botulism?

A

Neurotoxin type C (BoNTC), v rare cats

SNARE cleaved by toxin, no Ach release

Aminoglycoside and ampicillin potentiate NM blockade

47
Q

Myaesthenia gravis pathophys?

A

AutoAB cf nicotinic AChR, complement mediated destruction

48
Q

MG signalment?

A

<4 or >9

Akita, GSD, GRet

Abyssinian, Somali

49
Q

Clinical presentation?

A

Mesaoesophagus less common in cats

Cervical ventroflexion more common cats

Spinal reflexes usually there generalised diminished fulminant. fulminant not better with rest.

Fulminant - around 15 % dog and cat, u retention poss, assoc with thymoma

Focal - ocular, facial, oesophagus, pharyngeal, laryngeal

50
Q

Concurrent dz MG?

A

Thymoma, hT4, hAC, polymyositis, masticatory myositis

51
Q

AChR AB titre?

A

Species specific.

98 % generalised.

May be neg early, affected by steroids.

52
Q

Edrophonium test?

A

Inhibits anti cholinesterase

Isn’t perfectly specific and not all MG improve

Cholinergic crisis - weakness salivation tremors vomiting bradycardia bronchoconstriction resp distress

Atropine and intubation req

53
Q

MG tx?

A

Pyridostigmine/neostigmine

Bradycardia hyper salivation diarrhoea vomiting muscle cramping weakness

Mycophenolate, ciclosporin, azathioprine spare innate target adaptive immune - MMF no diff survival

Spontaneous remission 88 %

54
Q

Congenital MG?

A

JRT, springer, mini dachs - AChR deficiency
Other breeds probably the same, samoyed/smooth fox terrier
Auto recessive GDH JART SFT

6 - 9 W

Gammel Dansk Honsehund 4m and not responsive to anticholinesterase - presynaptic?

Need to quantify AChR in muscle bx

Spontaneous resolution mini dachs, GDH stable and mild

55
Q

Labrador EIC?

A

DNM1 auto rec

Enzymes maintain synaptic vesicle function in sustained neurotransmission

< 2y

Los patellar reflex

Pyruvate/lactate normal

56
Q

Feline panleukopenia?

A

FPV in last 3w gestation/1st 3w life, destruction germinal layer, cerebellar hypoplasia
Hydrancephaly
Vac mod live FPV in pregnancy

57
Q

FIP?

A

33 % neuro, most common in non-effusive, cerebellum/pons/medulla oblongata

Eyes 53 %

Seizures 1/3 = poor px

37 % normal MRI

RTPCR in CSF, serology unhelpful

ECVIM Certifier (11 decks)

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