Neuro Emerg Flashcards
Which breeds almost never have FCE?
chondrodystrophic breeds
What is the typical clinical presentation of FCE?
- peracute onset (<6 hours)
- usually non-painful but hyperesthesia reported
- nonprogressive after 24 hours - unless other secondary injury e.g., myelomalacia
- often asymmetric myelopathy
What does FCE look like on MRI?
T2
* hyperintense focal, relatively sharply demarcated intramedullary lesion (grey matter)
T1
* iso- to hypointesne spinal cord grey meatter
MRI may be normal for first 24-48 hours after injury
What does ANNPE look like on MRI?
T2
* intramedullary hyperintesity overlying a IV disc with reduced volume and signal intesnsity of the nucleus pulposus
* narrowed disc space
* nucleus pulposus material in the epidural space dorsal to the affected disc
What are negative prognostic indicators for recovery from FCE?
- more severe MRI lesions
- LMN signs
- bilateral symmetrical deficity
- loss of nociception
How fast do dogs usually improve from FCE?
within 2 weeks
What are the meninges?
dura mater
arachnoid
pia mater
with idiopathic meningoencephalitis (e.g., MUO) where are lesions located?
concentric proliferation of inflammatory cells around blood vessels - predominantly in the white matter of the CNS
What is the most common CSF finding in dogs with MUO?
- mononuclear pleocytosis
- TP elevations
What is the gene mutation responsible for IVDD in chondrodystrophic dog breeds?
fibroblast growth factor 4 retrogene on chromosome 12
accelerates IVD degeneration
What is Hansen type I versus II IVDD?
Hansen type I: nucleus pulposus herniates through the annulus fibrosus - extrudes into the vertebral canal
Hansen type II: annulus protrudes due to shifting of nuclear material
What MRI changes has been associated with worse outcome and progressive myelomalacia?
- intramedullary T2 hyperintensity
- CSF T2 hypointensity and attenuation
What MRI sequence is primarily recommended for IVDD diagnosis?
T2 weighted sagittal and transverse
What is the main complication from contrast myelography?
seizures
When comparing medical with surgical management what is the outcome in TL-IVDD with ambulatory paraparesis?
medical: 80%
surgical 98.5%
When comparing medical with surgical management what is the outcome in TL-IVDD with nonambulatory paraparesis?
medical 81% - less complete
surgical 93%
When comparing medical with surgical management what is the outcome in TL-IVDD with paraplegia but deep pain responsive?
medical 60% - prolonged recovery and less complete
surgical 93%
When comparing medical with surgical management what is the outcome in TL-IVDD with paraplegia and deep pain negative?
medical 21%
surgical 61%
What is the minimum recommended duration of restricted activity for TL-IVDD?
at least 4 weeks
What is the recommendation on corticosteroids for medical management of TL-IVDD?
not recommended for routine use of medical management of the acute phase
chronic phase - some dogs may benefit
What is the recommendation on NSAIDs for the medical management of TL-IVDD?
recommend use for 5-7 days - if no contraindication present
What are recommendations for analgesia for medical management of TL-IVDD?
- NSAIDs, gabapentin, pregabalin as options
- consider muscle relaxants: diazepam or methocarbamol
- recommend hospitalization if pain severe enoug hto require opioids
What is the current recommendation on timing for surgery in TL-IVDD?
- no recommendation made
- but emphasize that surgery shouldn’t be declined due to prolonged sigs
What is Pregabalin’s MOA?
involves binding to the alpha-2-delta subunit of voltage-gated calcium channels (VGCCs) in the central nervous system
What indicates in a dog with TL-IVDD that it is able to urinate or not?
paraplegic - cannot urinate voluntarily
paraparetic (i.e., motor present) and pain perception - can urinate voluntariy