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Small Animal Optho/Neuro > Neurological Emergencies > Flashcards

Neurological Emergencies Flashcards

1
Q

What are some neurologic emergencies?

A

Mentation changes, seizures, traumatic brain injury, tetanus and Botulism and Toxins

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2
Q

What are the types of mentation changes and what part of the brain do they effect?

A

Obtunded (Decreased response to stimuli and consciousness) - forebrain or brainstem
Stuporous (Dulled) - Brainstem
Comatose (prolonged loss consciousness) - Brainstem

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3
Q

What is the ARAS (Ascending Reticular Activating System) Responsible for?

A

Wake and dreaming states (effects consciousness)

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4
Q

What are some causes of mentation cahnge?

A

Toxins, Metabolic, Cardiovascular, neurologic, hydrocephalus, inflammation (abscess, MUE, neoplasia, Trauma, Vascular

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5
Q

What is your clinical approach to mentation change?

A

Hx: rule out trauma, toxin or metabolic, signalment (hypoglycemia puppy), previous diagnosis
Ex: systemic hypothermia, pulse, pale, neuro
Min Database: CBC, Biochem (hypernatremia)

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6
Q

How do you confirm diagnosis of a stroke?

A

MRI or CT, CSF analysis

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7
Q

What are the 2 types of stroke?

A

Ischaemic or Haemorrhagic

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8
Q

What are some underlying causes of stroke?

A

Cushings (too much cortisol), Hypothyroidism, Hyperthyroidism, PLN, Liver Disease, Idiopathic, Hypertension, Neoplasia, Heart Disease

Toxin, vWD, Haemophilia, Neoplasia, Thrombocytopenia, Liver Disease, HYpertension

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9
Q

What is your triage treatment for Mentation Change?

A

Correct patient temp, correct metabolic derangements, treat toxin if indicated, Hypo/hypertension treatment, look for signs increased intracranial pressure
Hypothermic warm up

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10
Q

What do you do if you think the animal has gotten into a toxin that is causeing the neurological signs?

A

Decontaminate, treat if possible (call pet poison helpline), treat symptoms (muscle relaxer, anti-seizure), non-specific - IV fluids, Intravenous lipids, Ion trapping, Hemodialysis

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11
Q

What is the equation for Cerebral Perfusion Pressure?

A

CPP = MAP-ICP
(Want around 50mmHG)

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12
Q

What is normal ICP? Why so low?

A

ICP is normally 0-15mmHg
Low because there is not a lot of room between the skull and thehinflammation

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13
Q

What are some things that increase intercranial pressure?

A

Edema, Inflammation, CSF, Tumor and trauma

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14
Q

How can you decrease CPP?

A

Increase MAP or decrease CPP needed to perfuse brain

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15
Q

If ICP 200-300mmHg what occurs?

A

Reflex bradycardia

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16
Q

What is the Cushing’s Reflex?

A

When you have decreased cerebral blood flow (b/c increased ICP), raised Co2, meduallary vasomotor center, symatheric stimulation, increase MAP that increase CPP and ICP and Carotid baroreceptor that increased vagal stimulation and leads to reflex bradycardia

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17
Q

What are some signs of increased ICP?

A

Pupil Changes (myotic or mydriatic non-responsive) , Tetraparesis, ataxia, proprioception defects, cranial nerve defects, decerebrate posture

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18
Q

How do we decrease ICP?

A

Decrease edema (manitol, hypertonic saline, steroids, diuretics), Craniectomy, remove space occupying lesion (tumor, granuloma, depressed skull fracture)

18
Q

How does the brain try to decrease ICP?

A

Push out skull

19
Q

What are some primary neurologic diseases?

A

Encephalitis, Brain tumor, vascular accident, head trauma

19
Q

If it is primary neurologic what do you do?

A

Stabilize or decrease ICP to buy time and send to neurologist

20
Q

When is surgery the only option?

A

BP over 300

21
Q

What is status epilepticus?

A

Failure of seizures to terminate, meaning last longer than 5 min, or more than 2 without return to normal conciousness
TRUE EMERGENCY

22
Q

What the cascade that leads to brain damage?

A

Glutamate release, NMDA receptor - calcium influx, 2nd messencer, ca release and mitocondrial damage or Cosium influx, cytotoxic edema, cell death

23
Q

What are the systemic effects of brain damage?

A

Hypertension, tachycardia, arrhythmia, hyperglycemia, respiratory compromise (inadequate ventilation, noncardiogennic edema, aspiration pneumonia, hyperthermia, acidosis, myoglobinuria

24
Q

What leads to death with Status Epilepticus?

A

Brain herniation, ventricular arrhythmia, respiratory compromise, renal failure

25
Q

What is Emergency triage for status epilepticus?

A

Check temp (active cooling), Oxygen supplementation, Anti-seizure therapy

26
Q

What are some antiseizure therapies that can be used?

A

Diazepam (rectal or IV)
Midazolam (Nose or IV)
3 failed benzo go to Propofol (intubate)
Phemobarbitol and levetiracetam needed long term

27
Q

What are the 2 types of seizures?

A

Epilepsy and Reactive

28
Q

Reactive seizures are caused by what?

A

Metabolic and toxins (treatable)

29
Q

What are some differntials for structural epilepsy?

A

Cognitive dysfunction, hydrocephalus, prencephaly, neuronal ceroid lipofuscinosis, brain tumor, meningioencphalitis, traumatic brain injury, cerebral vascular accident

30
Q

What is traumatic brain injury?

A

Increased intracranial pressure that damages the cells
-Space occupying lesion
-Ischemia (K, Ca, EAA, Free Radical, mitochonria failure) - cytotoxic edema, necrosis and increase ICP)
-Injury - damage parenchyma and vasculature - contusion - increase tissue osmolar loat ICP

31
Q

When a traumatic brain injury occurs what are you look for? How do you triage it?

A

Seizures? (benzo/ASD)
-No seizures then evaluate ABS and then neuro eval (Airway (oxygen), Breathing (ventilation) and Cardio (perfusion)
TPR and metabolic evaluaiton
-Check spine, thorax, abdomen
-May need fluids and oxygen
-No imporvement then manitol and elevate head
-No improvement - surgical decompensation, hypersalivation and hypothermia

32
Q

What does the glagow comma scale tell you?

A

severity of coma (Normal is high 15-18)
-Use to monitor trends (evaluate every 4-24 hours

33
Q

What is the causative agent of tetanus?

A

Clostridium tetani (ubiquitous)

34
Q

How long does it take to see signs of Tetanus and what are they?

A

5-10 days post infection, generalized more common in dogs, stiffness, rigid, sardastic grim

35
Q

How do you treat tetanus?

A

Antimicrobials (metronidazole) and antitoxin

36
Q

What are the signs of botulism?

A

Flaccid paralysis (LMN)
within 12 hours of exposure
Diaphragm resistant to toxin

37
Q

What’s the treatment for botulism?

A

supportive care

38
Q

Where is the causative agent of botulism?

A

Clostridium botulinum

39
Q

What is the pathophysiology of these clostridiums?

A

Botulism - bind at neuromuscular junction - peripheral nerves affected

Tetanus - bind at brain stem (Renshaw cells)

40
Q

What are some clinical signs of a metabolic encephalopathies?

A

Seizure, behavioral change, aggression, anxiety, dementia, mania, mentation change, cortical blindness

41
Q

What are some etiologies of metabolic encephalopathies?

A

Hypoglycemia, hyponatremia, hypocalcemia, hepatic encephalopathy, thiamine deficiency

Small Animal Optho/Neuro (13 decks)

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