Neuro Part 2 Flashcards
hypogastric n innervates _____ on _____ & _____ on ____
beta receptors
detrusor m
alpha receptors
internal urethral sphincter
pudendal n innervates ____ on _____
ACh receptors
external urethral sphincter
pelvic n innervates ____ on _____
ACh receptors
detrusor m
LMN bladder
flaccid bladder, hypotonic
UMN bladder
hypertonic, firm, hard to express
UMN dysfunction treatment
- alpha-anatagonists - Phenoxybenzamine or Prazosin
- striated m relaxants - Diazepam (valium)
LMN dysfunction treatment
- parasympathomimetics - Bethanechol
- PPA/estrogen
sequelae to bladder dysfunction
- UTI, cystitis
- urine scald
- bladder atony (prolonged distension > 24-48 hr)
- bladder rupture
- urine overflow
what does autonomic dysfunction of the bladder lead to
loss of nerve function but intact central integration = stranguria, dysuria, large residual volume
most common causes of multifocal CNS disease
infectious, inflam, neoplastic
meningoenceohalitis of unknown origin (MUO)
breed predispositon?
thought to be etiology?
treatment?
middle aged pugs, toys and terriers
immune mediated
prenisolone + anticonvulsants
younger dogs with severe neck pain acutely, no neurological deficits
steroid responsive meningitis arteritis (SRMA)
SRMA treatment
4-6 months slowly tapering steroids
most common differential for older dogs with multifocal CNS disease
neoplasia - lymphoma
FIP
etiology?
neuro signs seen with ____ form
most common cause of ____ in cats
age?
treatment?
feline coronavirus
dry form
hydrocephalus
> 2 yr
Remdesivir
what is the most likely infectious cause of multifocal CNS disease in the dog
Neospora meningoencephalomyelitis
Neospora meningoencephalomyelitis
diagnostic?
treatment?
MRI (cerebellum hyperintensity), CSF, Ab titers, CK/AST elevations
clindamycin/TMPS + pyrimethamine
rabies clinical signs
acute CN deficits
ascending LMN paresis
non-suppurate polioencephalomyeliti and craniospinal neuritis
canine distemper bimodal onset
dog < 1 yr =
dog > 1 yr =
< 1 yr = gray matter, forebrain signs
> 1 yr = white matter, brainstem, cerebellum and spinal cord
canine distemper
diagnostic?
treatment?
titers - IgM, IgG
CSF IgG distinguishes recent vx from true infection
steroids
diffuse and bilateral symmetrical is indicative of what?
intoxication
primary brain injury occurs _____ and causes _____
time of incident
direct mechanical injury
secondary brain injury occurs ____ and causes ____
minutes-days after
biochemical changes
cerebral swelling can continue to worsen for up to ____ hours post trauma then will stabilize and begin to resolve overtime
72 hours
what is the Cushing’s reflex/response
bradycardia < 60bpm in the face of hypertension >250mmHg due to increased ICP
how can you stabilize a patient/provide supportive care with head trauma
elevate head/neck/shoulders 30-45 degrees
avoid jugular compression
how would you treat a head trauma patient with hypovolemic shock
fluid resuscitation
O2 therapy to conscious patient? unconscious patient?
nasal cannula or O2 catheter
intubation + ventilation
contraindications of mannitol
hypovolemia
electrolyte abnormalities
don’t use if not hemodynamically stable
what drugs can you give for head trauma and increased ICP
mannitol or hypertonic saline
furosemide
analgesia
NEVER STEROIDS
best indicator for prognosis of head trauma patient
MGCS – trend in the first 48 hours is more valuable than an isolated neurologic evaluation
>8 associated with 50% survival
peripheral vestibular system
CN VIII
central vestibular system
vestibular nuclei
spinal cord
extraocular nuclei
cerebellum
most common causes of peripheral vestibular disease
- otitis media/interna
- old dog/geriatric/idiopathic vestibular disease
what is paradoxical vestibular disease
vestibular disease + cerebellar involvement
what is the one sign that can differentiate central vestibular disease from paradoxical vestibular disease
postural reaction deficits will always be on the same side of lesion
feline cerebellar hypoplasia
onset?
progression?
cause?
from birth
static
inutero infection with feline panleukopenia virus
common signs of cerebellar ataxia
truncal sway
wide base stance
dysmetria
intention tremor
cerebellar abiotrophy
breed predispositon?
onset?
progression?
kerry blue terrier, gordon setters, rough-coated collies, arabian horses
normal at birth, onset 2-36 months
progressive/gradual
infarction
onset?
progression?
causes?
peracute < 24hf
static/improved
kidney, CV dz, infection, coagulopathy
corticosteroid-responsive tremor syndrome (CRTS)
cause?
onset?
treatment?
“white shaker dog syndrome”
thought to be autoimmune, worsens with exercise, stress, excitement, disappears during sleep seen at rest
acute onset-intention tremor of head/limbs/body
prednisolone or diazepam
acute generalized ddx for neuromuscular diseases
polyradiculoneuritis
myasthenia gravis
botulism
tick paralysis
polymyositis immune mediated/infectious
chronic progressive ddx for neuromuscular diseases
myasthenia gravis
polymyositis inflam/infectious
localized neuromuscular diseases ddx
traumatic
facial paresis/paralysis
spinal n hypertrophic neuritis
brachial plexus
trigeminal n
gold standard diagnostic test for myasthenia gravis
AChR Ab test
flaccid paralysis ddx
acute polyradiculoneuritis
botulism
tick paralysis
west highland white terrier or jack russel with ascending flaccid tetraparesis and dysphonia but retains tail wag
acute polyradiculoneuritis
acute polyradiculoneuritis 4 causes
- idiopathic, post vx or contact with racoon
- immune-mediated
- campylobacter and raw feed
- bengal cats
acute polyradiculoneuritis diagnostic
F waves or CSF analysis (albuminocytological dissociation)
Botulism
cause?
clinical signs
contaminated feed with C. botulinum
junctionopathy, dysautonomia and concurrent GI signs
Neospora caninum clinical signs and treatment
radiculoneuritis and myositis
- arthrogryposis
clindamycin / TMPS + Pyrimethamine and physical therapy
masticatory muscle myositis
cause?
clinical signs?
treatment?
auto-Ab to 2M myosin isoform
bilateral masticatory muscle atrophy, trismus
prednisolone, PT
immune-mediated polymyositis
cause?
breeds?
treatment?
immune-mediated
large breeds
prednisolone + analgesia
tetanus
pathogenesis/MOA
clinical signs
contaminated wound, tetanospasmin, binds irreversibly preventing GABA and glycine, and causes prolonged contraction
sawhorse stance, hypersensitivity, risus sardonicus, trismus/lockjaw
idiopathic facial n paralysis
unilateral or bilateral?
ddx?
treatment?
prognosis?
unilateral
hypothyroidism, otitis media/interna, trauma, neoplasia, polyneuropathy
artificial tears
should resolve 6-8 weeks
idiopathic trigeminal neuropathy
unilateral or bilateral?
clinical signs?
treatment?
prognosis?
bilateral inflammation
dropped jaw
PT or tape muzzle
resolves ~3wks
what is the most common cause of inability to close the mouth
idiopathic trigeminal neuropathy
DDX for unilateral trigeminal lesions?
trigeminal nerve sheath tumor
neuromyopathy ddx
ischemic neuropathy
hypokalemic neuropathy
chronic neuropathy ddx
diabetes
hypothyroidism
common causes of ischemic neuropathy in the cat? dog?
feline aortic thromboembolism due to cardiomyopathy
dogs - renal disease
hypokalemic neuropathy 3 causes
reduced intake
renal failure, hyperthyroid
burmese cat
if a cat has cervical ventroflexion and muscle weakness, what would you consider on the ddx
hypokalemic neuropathy
