Neuro Treatment Flashcards
Steroid responsive meningitis arteritis (companion animal)
- Immunosuppression - corticosteroids (dexamethasone, prednisolone); mycophenolate, leflunomide
- Monitor haematology + biochem monthly
Meningoencephalomyelitis unknown origin (MUO) (companion animal)
- Immunosuppression - corticosteroids (dexamethasone, prednisolone); mycophenolate, leflunomide, cytosine arabinoside
- Monitor haematology + biochem monthly
- Life-long therapy - low dose
Feline infectious peritonitis (FIP) (cat)
- Steroids
- Interferon
- Nucleoside analogues e.g. GS-5734 (remdesivir) (legal), incorporated into viral RNA, prevent replication of virus, antivirals
- GS-441524 - tablet, convert to oral after 2w
- 12w Tx, approx £8,000
Neuronal ceroid-lipofuscinoses (NCL)
- Fatal
- Seizure management
- Minocycline - reduces neuro-inflam
- Can try L-carnitine (for metabolic brain disease), non-specific for mitochondrial disease
Listeria meningoencephalitis (ruminants)
- High dose procaine penicillin for at least 10d
- TLC - food + water
- Loss of saliva - dehydration, metabolic acidosis
- Transfaunication - promote rumen func recovery
- Corticosteroids (dexamethasone, cannot use in pregnant animals, risk of abortion) - cross BBB, prevent oedema + inflam
- NSAIDs
Lead intoxication (ruminants)
- Oral magnesium sulfate to precipitate lead in GIT
- IV EDTA to bind to lead (when disease progressed)
Urea intoxication (ruminants)
- Relieve bloat + give oral fluids w/ 6% vinegar
Sulfur intoxication (ruminants)
- Thiamine/vitamin B1
Polioencephalomalacia/cerebrocortical necrosis (CCN)
- Thiamine/vitamin B1 (high dose)
Streptococcal meningitis (pig)
- Systemic AB - penicillin
- NSAIDs/steroids
- Rehydration
Brain abscess (production animal)
- Systemic AB
- NSAIDs
- Euthanasia
Middle ear disease (calf)
- Systemic AB against mycoplasma bovis -> macrolides
- NSAIDs
Coenurosis / Gid (sheep)
- Sx removal if cyst v close to brain’s surface
Coliform meningitis / septicaemia (ruminant neonate)
- Systemic AB
- IVFT
- NSAIDs once urine output restored
- Supportive therapy + nursing
- IV glucose
- Heat lamp
Hypoglycaemia (lamb)
- IV/IP (intraperitoneal) glucose
- Active warming
- Oral milk for lambs
- Address risk factors
Swayback (lamb)
- Euthanasia
- Prevention by appropriate + careful copper supplements
Hypoglycaemia (piglet)
- Feed hourly
- Give IP 15 mL 5% glucose, q4 - 6h + stomach tube
Bacterial meningitis (poultry)
- Potentiated sulphonamide or Amoxycillin
Avian encephalomyelitis (epidemic tremor)
- Cull
- Supportive (Vacc parents)
Spinal osteomyelitis (poultry)
- Potentiated sulphonamide or Amoxycillin
Scoliosis (poultry)
- No Tx
- Review breeding
- Check nutrition
Discospondylitis (companion animal)
- AB based on culture: 1st choice = cephalosporin (cephalexin) if negative culture/until results available (enrofloxacin, 2nd), continue for at least 2 m (some cases 12 m)
- Disseminated fungal disease (aspergillus) - urine microscopy + mycological culture
- Analgesia - NSAIDs (gabapentin, paracetamol, complementary acupuncture therapy)
Mitochondrial myopathy (companion animal)
- Nutritional modification
- Cofactor Tx (shunt energy down NMDA Ca2+ pathway) - riboflavin, L-carnitine, thiamine, taurine
Myasthenia gravis (fulminant/acute + severe onset) (companion animal)
- Deal w/ aspiration pneumonia (due to megaoesophagus) - broad spectrum AB (IV cephalosporin) + metronidazole
- Anticholinesterases - pyridostigmine bromide CRI, titrated slowly to effect or neostigmine SQ once (shorter-acting)
- Immunosuppression (if pneumonia under control) - IV mycophenolate, dexamethasone
Myasthenia gravis (maintenance) (companion animal)
- Immunosuppression - prednisolone - avoid or low as possible (1mg/kg/day PO), PUPD inc aspiration pneumonia; mycophenolate 10mg/kg BID, Leflunomide 2-4mg/kg PO SD; azathioprine if mycophenolate / leflunomide not tolerated 1-2mg/kg q24-48h
- Anticholinesterases - pyridostigmine bromide (Mestinon) 1-3 mg/kg PO BD/TD
Polymyositis / Myasthenia gravis feeding (companion animal)
- Small meals often (4 – 6 meals daily) - walnut sized balls; easy to prehend; high protein - high fat; anti-gulp bow
- From height - raised/stairs /bailey chair
- Coupage
- Prokinetics - erythromycin (1–3 mg/kg BID); viagra?
Neuroprotection - dietary manipulation (companion animal)
- Antioxidant supplementation (protects against age-related neuronal impairments) - Vit E, C, carotenoids, flavonoids, selenium, L-carnitine, lipoic acid (not cats), essential fatty acids
- Medium-chain triglycerides (MCTs) - metabolised to ketone bodies = alternative source of energy for neurones
Cognitive decline (companion animal)
- Altering neurotransmission - L-deprenyl (selegiline) -> inc noradrenalin + dopamine, neuro protective, improves memory + longevity, useful for anxiety/social withdraw, 4 w to see effects
- Neuroprotection - propentofylline -> inc molecular signal adenosine, improves cerebral blood flow, glial cell modulator: stimulates astrocytes (protect nerve cells from inflam mediators, free radicals + glutamate), depresses microglial cells (inflam cells), not licensed in cats
Sundown syndrome/sleep disorder (companion animal)
- Melatonin
- Alprazolam
- Predictable routine
- Daytime activity/interaction
- Pheromone therapy
Stupor/coma (unconsciousness) initial management (companion animal)
- Raise head
- Keep normal temperature
- Maintain blood pressure
- Maintain ventilation
- Minimum data base - blood gas / electrolytes
Hepatic encephalopathy (companion animal)
- Mannitol
– Vasogenic cerebral oedema
– 0.25g/kg 15 - 20% solution over 30 - 60 mins
– May be repeated 1-2 x after 4 - 8 hours if hydrated / electrolytes monitored / corrected - Lactulose (3.1 - 3.7 g/5ml)
– Non-absorbable disaccharide
– 3 parts lactulose 7 parts warm water retention enema
– 18- 20ml/kg
– Alters bacterial flora
– Decreases bowel transit time
– Decreases bowel pH - Antibiotics
– Metronidazole 10mg/kg BID
– Amoxicillin 10m/kg BID/TID
Cerebral oedema (companion animal) / brain tumour
- Hypertonic saline (7.5% - 3 - 5 mL/kg), wait 30 min, repeat boluses after checking acid.base electrolyte status (+ correction), +/- colloids, increases CO, dec intracranial pressure, but doesn’t restore cerebral blood flow
- Mannitol (but repeated admin can result in hyperosmolar state + -> acute renal failure)
- Corticosteroids - methylprednisolone, dexamethasone
Stupor/coma (unconsciousness) management / cerebral oedema (companion animal)
- Rehydrate (esp if using diuretics) - don’t over-hydrate -> inc cerebral oedema
- Seizure control - diazepam, levetiracetam, phenobarbital, propofol infusion
- Sedatives (reduce muscle spasm + brain metabolic requirements) - dexdomitor
- Occipital craniectomy
Neurogenic bladder management (companion animal)
- Empty bladder: manually or indwelling catheter
- Monitor UTI
Pharmacological aids:
- To relax urinary sphincter + express bladder 20 - 30 min after admin (UMN relaxation): prazosin, phenoxybenzamine (expensive); diazepam (caution in cats)
- To promote detrusor activity (only works if there is already some detrusor activity present): bethanechol, cholinergic agent, if urinary sphincter closed then will be painful
Sx:
- Sacral ventral root (motor) stimulation, placement of silicon-insulated platinum electrodes around both S2 nerve roots (open up spinal segments = laminectomy), attached subcutaneous receiver coil, activated transcutaneously -> urination on demand (can be painful)
Sphincter mechanism incompetence
- Phenylpropanolamine = sympathomimetic
- If affected by lack of hormones - oestrogen/testosterone
Epilepsy
- Don’t delay Tx therapy - becomes more dangerous when inc seizures, will be become difficult to control epilepsy (inc freq)
- 1y anti-epileptic drugs (dog): imepitoin (pexion); phenobarbital (+ diazepam); potassium bromide, to dec excitation of nerves (paroxysmal discharge = electrical activity associated w/ seizure)
- Monitor: seizure dairy; serum conc for therapeutics; liver func; pancreas; haematology
- If not controlled: switched to anticonvulsant e.g. pexion to phenobarbital; novel antiepileptic drugs (levetiracetam, zonisamide, topiramate (cats)); propentofylline; diet therapy
Equine herpesvirus myeloencephalopathy (EHM)
Supportive care:
- Palatable feeds
- IVFT
- Nursing care
- NSAIDs to reduce fever and inflammation
- Heparin to prevent thrombus production
- Valacyclovir to reduce viraemia
- Biosecurity - isolation, prevent spread, limit horse to horse contact
Viral encephalitis (equine herpesvirus myeloencephalopathy/west nile encephalopathy)
Mild cases:
- Tight monitoring and supportive care
- NSAIDs, fluids, etc.
Neurologic cases:
- Referral for ICU care and monitoring - IVFT
- NSAIDs
- Neuro-protective antioxidants - vit E
- Supportive + nursing care
- Recumbent horse care
- Prevention - vaccination - esp. high-risk horses if travelling to endemic countries e.g. Italy, environmental control - mosquito control, monitor birds death + report to local authority
Toxicoinfectious disease (clostridial neurotoxins) - tetanus (equine)
- Vaccination (toxoid) - first vaccine at 6 mo of age, two vaccines 4 weeks apart, then booster q 2 years, pregnant mares: booster in the last trimester
- Tetanus antitoxin - provides protection during risk period (lasts 3-4 weeks) (unvaccinated horses with wound/surgery) - combination of toxoid and antitoxin often used for at-risk case, routine administration in a neonate foal
- AB: Penicillin or metronidazole
- Debride and clean the wound
- Sedatives & pain control: diazepam, butorphanol, etc.
- Muscle relaxer: methocarbamol
- Nursing care - keep the horse in a quite environment and minimise external stimuli, soft and palatable feeds, sling if recumbent
Toxicoinfectious disease (clostridial neurotoxins/clostridium botulinum) - botulism (equine)
- Hyperimmune plasma
- Botulinum antitoxin: need to know right strain in the area
- Supportive & nursing care: takes 7 – 10 days until new NMJ replaces toxin-bound tissues
- Soft and palatable feeds, sling if needed, ventilator in young foals (50% fatal, esp if recumbent)
Equine dysautonomia (equine grass sickness)
- Nursing care
- Supportive care
- Prognosis is poor to grave
Streptococcal suis meningitis (porcine)
- Penicillin
- Vacc sow + piglet
- All-in-all-out / reduce batch mixing
- Destock + disinfect (faeces + dust)
Salt poisoning / water deprivation (porcine)
- Nursing, spontaneous recovery
- Betamethasone
