Neurological disorders Flashcards
What is meningitis?
Dangerous infection causing inflammation to the spinal cord and brain
-Debilitating and potentially life threatening
Identify some clinical signs of meningitis
- Pyrexia
- Muscle spasms
- Depression
- Confusion
- Drooling
- Bulging eyes
- Neck extension
- Shivering
- Pruritis
- Weakness
- Stiff legs
- Drowsiness
- Drooping ears
- Adnormal chewing
- Sensitive to touch
- Nystagmus
- Ataxic
- Circling
- Collapse
- Unresponsive
- Paddling
- Seizures
- Coma
- Death
What are some possible causes of meningitis?
- Bacteria
- Chemicals
- Fungi
- Immune-related
- Injury to head or spine
- Parasites
- Protozoa
- Rickettsia
- Virus
What diagnostics can be used for meningitis?
- Full clinical history
- Vaccination status
- Physical examination
- Neurological examination
- Cerebrospinal fluid collection (Lumbosacral space)
- Blood tests
- Diagnostic imaging (MRI/CT)
What treatment and nursing care can be done for meningitis?
- Medication under VS direction
- Antibacterials
- Antivirals
- Antiprotozoals
- Steroids
- Pain relief
- IVFT
- Nutritional therapy
What are some clinical signs of traumatic brain injury?
- Depression
- Nystagmus
- Abnormal mentation
- Epistaxis
- Blindness
- Altered gait
- Abnormal pupil size
- Head tilt
- Dysphagia
- Seizures
- Ataxia
- Abnormally pupillary light reflex
- Lateral recumbency
- Facial-nerve paralysis
- Unconsciousness
What treatment and nursing care can be done for traumatic brain injury?
- Supportive care
- Raised food and water
- IVFT
- Sternal recumbancy
- Management of secondary complications (urinary scalds and pressure sores)
- Medication under VS direction (anti-inflammatories, anticonvulsants, antibiotics)
- Injury management
- Padded accommodation
What are some possible causes for seizures and epilepsy?
Within the brain: -Idiopathic epilepsy (unknown cause) -Brain tumours -Head trauma -Infection -Congenital abnormalities Outside the brain: -Metabolic (hypoglycaemia/hypocalcaemia) -Toxins
What is idiopathic epilepsy?
- Diagnosed only when there is no demonstrable pathologic cause
- Common in dogs
- First seizure usually between 6 months to 5 years
- Takes form of generalised tonic-clonic seizures (still twitching/loose consciousness)
- Common in beagles, GSDs, boxers, collies, poodles
What are secondary epilepsy causes?
Neoplastic causes:
- Primary or metastatic
- Abnormality in neurons adjacent to the tumour that are compressed or distorted or have inadequate blood supply
- Common in cats and dogs >5years
Developmental causes:
- Hydrocephalus (too much fluid due to over-production or issue with drainage)
- Enlargement of cerebral ventricular system secondary to increased cerebral synovial fluid
- Usually congenital
- More common in toy breeds
- Present at 2-3 months with behavioural issues
- Motor function ranges from almost normal to tetraplegic
- Can occur in adults secondary to other diseases (eg. neoplasia)
Inflammatory and infective causes:
-Any inflammatory or infectious disease has potential to cause seizures if it affects forebrain
Traumatic causes:
- Seizures may be seen immediately following head trauma
- Post-traumatic seizures may be seen many weeks to several years later
What are the most common metabolic causes of seizures?
- Hepatic encephalopathy
- Hypoglycaemia
What clinical signs may be seen before a seizure?
- Pre-ictal/phase one
- Unsettled movements (pacing, jaw clenching, abnormal licking/chewing, hiding/seeking owner)
- Excessive bodily functions (salivating, urinating, sweating)
- Heightened anxiety levels (vocalisation, glazed eyes)
What clinical signs may be seen during a seizure?
- Ictal/phase two
- Muscle stiffening (fall on one side, head back)
- Leg movements (stretched out with rigid/jerking/paddling movement)
- Breathing faster and heavier
- Vocalisation
- Eyes rolled back
- Excessive bodily functions (passing urine/faeces)
What clinical signs may be seen after a seizure?
- Post-ictal/phase three
- May lie motionless before attempting to get up (immediately after)
- Over next few minutes/days may be disorientated (care with aggression), staggered walking/ataxia, temporary loss of sight, excessive thirst/hunger, uncontrolled bladder/bowel activity
What diagnostics can be done for epilepsy and seizures?
- Monitoring/filming
- History and neurological exam
- Blood tests (haematology and biochemistry)
- Cerebral spinal fluid (CSF) tap
- MRI
- CT
- EEG
How can seizures be classified?
-According to the area of the brain
Focal (partial) seizures:
- Start in and affect just a part of the brain
- May be large part of one hemisphere or small area in one lobe
- Characteristics depend on which part of the brain
- Clinical signs = focal facial twitching, salivation, excessive rubbing of face
Generalised seizures:
- Affect both sides of brain
- Most common is tonic-clonic (tonic = loose consciousness, muscles go rigid, 10-30 seconds, clonic = rhythmical movements, running/paddling, chewing)
- Autonomic activity may start in either tonic or clonic phase
What treatment and nursing care can be done for a seizuring patient?
- Monitor vitals and number of seizures
- Keep diary of progress
- Regular check ups
- Keep in position where cannot hurt themselves & make owner aware
- Remove sensory stimuli where possible (light/sound)
- Stay calm
- Medication under direction of VS
- IVFT
- O2
- Lubricate eyes
- Nutrition
What is intervertebral disc disease?
- Discs gradually degenerate with age (gradual degeneration is not associated with pain/weakness)
- Rupture will cause compression or concussion
- Damage extent is distinguished by the type of force, degree of force applied to the spinal cord and the length of time that the force was applied
What breeds may be more at risk to invertebral disc disease and why?
- Small breeds such as Dachshund, beagle, bassets and cocker spaniels
- Termed as chonderodystrophoid (genetic form of dwarfism)
- Average onset of clinical signs 3-6 years of age
- Defect in development of cartilage throughout the skeleton
What types of disc diseases are there?
Type I:
-Nucleus pulposus (inner of disc) becomes calcified and extrudes out of the annulus fibrosus (outer of disc)
Type II:
- Annulus fibrosus (outer of disc) collapses and protrudes (bulges) upwards
- Slower degenerative process
What clinical signs may be seen with disc disease?
- Pain
- Reluctance to move neck to eat/drink
- Ataxia
- Plegia (dragging limbs)
- Incontinence
- Proprioception issues
What diagnostics can be done for spinal disc disease?
- Bloods
- X-rays
- Myelogram
- CT
- MRI
- Spinal tap
What aftercare may be needed for a patient after spinal/disc surgery?
- Bladder expressions 3-4 times daily (if necessary)
- Physical rehabilitation for muscle strength and flexibility
- Cage rest for at least 4 weeks
What complications may be seen after spinal/disc surgery?
- Urinary scalds
- Seizures
- May not fully recover
- Bladder infections
- Ulcers
What is granulomatous meingoencephalomyelitis (GME)?
- Inflammatory disease of brain, spinal cord and meninges of unknown cause
- Mainly occurs in dogs
- Clinical signs could vary and may indicate focal or multifocal dysfunction
- Diagnosis to rule out other disease
- Treatment = corticosteroids but poor prognosis
What is syringomyelia?
- Fluid filled sacs develop in the spinal cord close to the brain
- Common in Cavaliers (skull too small)
- Due to obstruction in CSF flow
What clinical signs and diagnosis are there for Syringomyelia?
Clinical signs:
- Pain (common in neck)
- Scoliosis
- Neurlological defects
Diagnosis:
-Imaging
What treatment can be done for Syringlomyelia?
- Analgesics and corticosteroids
- Drugs to reduce CSF production (omeprazole)
- Physical therapy (massage and hydrotherapy)
- Cage rest
- Surgery in some cases
What is myasthenia gravis?
- Neuromuscular disease
- Presents as muscle weakness
- Caused by interference with nerve-muscle communication
- Could effect few specific muscles or whole body
- Receptors not functioning properly so normal muscle contraction does not occur
What clinical signs may be seen with myasthenia gravis?
- Megaoesophagus = regurgitation, coughing, aspriation pneumonia
- Weakness more pronounced after exercise
- Fatigued palpebral reflex
- Immobility
What diagnostics can be done for myasthenia gravis?
- Specific lab tests (anti cholinesterase receptor antibody levels)
- Anti cholinesterase medication (mestinon syrup) or neostigmine (prostigmine)
- Corticosteroids
