Neurology (1-10) Flashcards
name the 4 things to observe in the hands off neurological examination
- mentation/sensorium
- posture
- gait
- asymmetry
name the 4 parts of the hands on neurological exam
- proprioception
- spinal reflexes
- cranial nerves
- (nociception)
name 3 tools needed for a neurological exam
- artery forceps
- reflex hammer (pleximeter)
- pen torch
name 5 possible mentations - levels of consciousness
- normal
- dull/depressed
- obtundation
- stuporous
- comatose
name the term
heard turn + body turn
pleurothotonus
name the term
hunched spine;
rounded back
kyphosis
name the term
dip of the back;
characterized by the arching of the spine, the raising of the head
lordosis
name the special posture
stuporous or comatose;
extension of all limbs;
extension of head and neck (opisthotonus);
acute rostral brainstem injury
decerebrate rigidity
name the special posture
mentation normal;
extension of head and neck (opisthotonus);
thoracic limbs extended;
hips flexed;
acute rostral cerebellar injury
decerebellate rigidity
name the special posture
extension of thoracic limbs;
normal mentation;
reduced to normal tone in pelvic limbs;
normal postural responses in thoracic limbs;
acute thoracolumbar injury
Shiff-Sherrington
name 3 causes of ataxia (uncoordinated gait)
- cerebellar
- vestibular
- general proprioceptive/spinal
name the term
inability to generate movement;
(weakness)
paresis
based on the prefix, which limb(s) are affected?
mono-
one limb only
based on the prefix, which limb(s) are affected?
para-
pelvic limbs only
based on the prefix, which limb(s) are affected?
hemi-
one thoracic and one pelvc (same side)
based on the prefix, which limb(s) are affected?
tetra-
all four limbs
what is it called to test hopping proprioception on thoracic limbs only
wheelbarrow
what is it called to test hopping proprioception on pelvic limbs only
external postural thrust
do withdrawal reflexes travel to the brain?
no
(spinal reflex)
do patellar reflexes travel to the brain?
no
(spinal reflex)
what nerve does the patellar reflex test?
femoral nerve
what is the appropriate withdrawal reflex?
flexion of all flexors
what is the appropriate patellar reflex?
kicking out of limb
what is the appropriate cutaneous trunci reflex?
bilateral contraction of cutaneous trunci
does the cutaneous trunci reflex travel to the brain?
no
(spinal reflex)
what spinal cord segments are involved in the withdrawal reflexes
(afferent nerve)
C6-T2 or L4-S1
what spinal cord segments are involved in the patellar reflex?
(femoral nerve)
L4-L6
what spinal cord segments are involved in the cutaneous trunci reflex?
(afferent nerve, brachial plexus, lateral thoracic nerves, cutaneous trunci mm.)
C8-L4/5
what spinal cord segments are involved in the perineal reflex?
S1-S3
what two neuro responses should you test for the head
(hands on)
- menace response
- nasal septal mucosal response
name 5 neuro reflexes you should test for the head
(hands on)
- pupillary light reflex
- palpebral reflex
- corneal reflex
- vestibulo-ocular reflex
- gag reflex
what nerves are involved in the palpebral reflex?
CN V & VII
(trigeminal & facial)
what nerves are involved in the corneal reflex?
CN V, VI, & VII
(trigeminal, abducens, facial)
what nerves are involved in the gag reflex
CN IX & X
(glossopharyngeal & vagus)
what nerves are involved in the vestibulo-ocular reflex?
CN III, IV, VI, & VIII
(oculomotor, trigeminal, abducens, vestibulocochlear)
name the 5 spinal cord segments
- C1-C5
- C6-T2
- T3-L3
- L4-S1
- S2-S3
what part of the brain is the prosencephalon?
forebrain
what part of the brain is the telencephalon?
cerebral hemispheres
what part of the brain is the diencephalon?
thalamic region
name the part of the brain
more functional subdivision of the brain, including cerebrum and diencephalon (thalamus)
forebrain
disease of what part of the brain would show these clinical signs?
- head pressing
- staring at walls
- getting stuck in corners
- circling
- continuous pacing
- compulsive behaviour
- normal gait
forebrain disease
what is the most frequent clinical sign of forebrain disease?
generalised tonic clonic seizures
name the 11 categories of differential diagnoses
- Vascular
- Infectious/Inflammatory
- Traumatic
- Toxic
- Anomaly
- Metabolic
- Idiopathic
- Iatrogenic
- Neoplastic
- Nutritional
- Degenerative
(VITAMIN D) (VITTAMIINN D)
name 3 vascular diseases of the forebrain
- diffuse cerebral ischemia
- focal cerebral ischemia
- diffuse or focal hemorrhages
name the vascular disease of the forebrain
cardiopulmonary arrest;
anaesthetic complication;
severe cerebral oedema following a toxic or traumatic event
diffuse cerebral ischemia
name the vascular disease of the forebrain
causes:
chronic kidney disease, hyperadrenocorticism, idiopathic hypertension, septic or neoplastic emboli;
hypercoagulable state;
migrating parasites
focal cerebral ischemia
name 3 infectious diseases of the forebrain
- Rabies disease (Lyssavirus)
- canine distemper virus (CDV)
- Feline Infectious Peritonitis (FIP)
name the infectious disease of the forebrain
not endemic in the UK;
paralytic and furious manifestations
rabies
name the infectious disease of the forebrain
neurological abnormalities 1-3 weeks after systemic disease;
hyperesthesia, vestibular signs, ataxia, cerebellar signs, tetraparesis and myoclonus
canine distemper virus (CDV)
name the infectious disease of the forebrain
three presentations:
1. multifocal CNS disease
2. T3-L3 myelopathy
3. central vestibular syndrome
feline infectious peritonitis (FIP)
name the inflammatory disease of the forebrain
most common inflammatory disease in dogs;
unknown origin but autoimmune pathology;
2 forms:
1. necrotising
2. granulomatous
meningoencephalitis of unkown origin
this is the pressure exerted by tissues and fluids within the cranial vault
intracranial pressure (ICP)
name 4 causes of increased intracranial pressure (ICP) in head trauma
- intracranial hemorrhage
- cerebral oedema
- systemic hypotension
- hypoxaemia
name the 4 goals of head trauma management
- maintain ventilation
- avoid hypertension
- prevent/treat cerebral oedema
- treat increased ICP
name 1 anomalous disease of the forebrain
- hydrocephalus (congenital or acquired)
name the anomalous disease of the forebrain
increased CSF volume in dilated ventricular cavities
hydrocephalus
what are the 2 treatment options for congenital hydrocephalus?
- corticosteroids (medical)
- ventriculoperitoneal shunt (surgical)
name the metabolic disease of the forebrain
acquired or congenital portosystemic shunt;
“toxic” substances (ammonia) from intestinal degradation are not metabolised by liver or bypass it, reaching the brain
hepatic encephalopathy (HE)
name 3 ways to diagnose hepatic encephalopathy (HE)
- bile acid stimlation test
- abdominal ultrasound
- abdominal CT scan with angiogram
name 3 ways to medically treat hepatic encephalopathy (HE)
- low protein diet
- antibiotics
- lactulose
name the part of the brain
coordinates all the motor activities: voluntary movements, postural movements, reflex movements ;
assists in maintenance of the equilibrium;
controls RATE, RANGE, and FORCE of movement
cerebellum
name the term
swaying of the body (truncal ataxia) from side to side, forward and backward, and occasionally dorsoventrally
titubation
name the cerebellum disease
young dogs (<5y), small breeds;
mild non-suppurative encephalitis;
suspected autoimmune-mediated eitiology;
originally mistaken for seizures;
Tx with immunosuppressive doses of corticosteroids tapered over 3-6 months
idiopathic tremor syndrome
(‘white shakers’)
name the part of the brain
responsible for maintaing balance regulating the position of the eyes, trunk and limbs in relation to changes in position of the head
vestibular system
name 3 things that maintaining balance depends on
- vestibular receptors
- vision
- proprioceptive receptors in joints and tendons
name the 2 parts of the peripheral vestibular system
- vestibular receptors (in utricle and saccule and semicircular canals)
- vestibular nerve (CN VIII)
name the 2 parts of the central vestibular system
- vestibular nuclei (in brainstem)
- cerebellum
name the clinical sign of vestibular disease
involuntary rhythmic oscillation of the eyes (jerk eye movement with slow and fast phase) ;
physiological or pathological
nystagmus
The fast phase of nystagmus is (on the same side OR contralateral) to the lesion?
contralateral
name 4 clinical signs of Horner syndrome
(vestibular disease)
- ptosis (drooping of the upper eyelid)
- enophthalmus (eyes sinking deeper in socket)
- miosis (constriction of the pupil)
- 3rd eyelid protrusion
peripheral or central vestibular disease?
- proprioceptive deficits
- vertical resting or positional nystagmus
- nystagmus changing direction with changes in head position
- cranial nerve deficits other than CN VII
- cerebellar signs
- decreases level of consciousness
- paradoxical vestibuar syndrome
central vestibular disease
name the central vestibular disease
contradictory vestibular signs;
caused by loss of cerebellar inhibition of the vestibular output;
ex: Left head tilt & Right postural reactions deficits
paradoxical vestibular syndrome
name the vestibular disease
- absent physiological and/or pathologic nystagmus
- absent head tilt
- side-to-side swaying of the head
- broad-base stance
- falling to either side
bilateral vestibular disease
what nutritional deficiency can lead to central vestibular disease?
thiamine deficiency
what is the most common viral cause of central vestibular infectious disease?
FIP
name the central vestibular inflammatory disease
subacute ot chronic sterile inflammation, supected immune-mediated disorder;
middle age small breed dogs;
disseminated, focal and ocular form;
prognosis guarded to poor;
definitive diagnosis by histopathology;
traditional Tx: immunosuppressive doses of corticosteroids
granulomatous meningoencephalomyelitis (GME)
name the toxic central vestibular disease
characterized by anorexia, vestibular ataxia and vertical nystagmus;
recovery may be enhanced by administration of diazepam at 0.4 mg/kg TID for 3 days (competitively displaces cause from GABA receptors)
metronidazole intoxication
name the cranial nerve diseased
loss of appetite, anosmia (difficult to assess);
nasal discharge, nasal obstruction;
DD: viral, bacterial or fungal rhinitis; nasal adenocarcinoma, meningioma, neuroblastoma
CN I (olfactory)
name the cranial nerve diseased
blindness & pupillary light reflex (PLR) deficit
CN II (optic)
what 3 nerves/pathways are involved in the menace response?
- CN II
- complete visual pathway to occipital cortex
- CN VII
what 2 cranial nerves are involved in the blinking reflex
- CN V
- CN VII
what cranial nerve is involved in an obstacle course/cotton ball test
CN II
(optic)
what 4 cranial nerves/pathways are involved in the PLR (direct and consensual)
- CN II
- complete PLR pathway
- CN III
- sympathetic innervation
list the 7 parts of the visual pathway to occipital cortex
(Menace Response pathway)
- neuroepithelial cells, bipolar and ganglion cells
- optic nerve
- optic chiasm
- optic tract
- lateral geniculate nucleus
- optic radiation
- occipital lobe
name the 12 parts of the complete PLR pathway
- neuroepithelial cells, bipolar and ganglion cells
- optic nerve
- optic chiasm
- optic tract
- lateral geniculate nucleus
- optic radiation
- occipital lobe - pretectal nuclei
- Edinger-Westphal nucleus
- CN III (oculomotor nerve)
- ciliary ganglion
- ciliary nerves
- sphincter pupillae muscle
name the 5 step evaluation of blindness and PLRs
- menace response
- palpebral (blinking reflex)
- obstacle course/cotton ball test
- PLR (direct and consensual)
- ophthalmoscopic exam
what is the most common differential diagnosis for blindness WITHOUT PLRs
SARD (sudden acquired retinal degeneration)
where is the oculomotor (CN III) nuclei located?
midbrain
what nucleus is the parasympathetic component of CN III
Edinger-Westphal nucleus
name 3 functions of CN III (oculomotor nerve)
- innervation of dorsal, medial & ventral recti and ventral oblique extraocular muscles
- levator palpebral muscle of upper eyelid
- sphincter pupillae muscle for contricition of pupil
what extraocular muscle is innervated by CN IV (trochlear nerve)
dorsal oblique
what clinical ocular sign is seen with a CN IV deficit
lateral rotation of the eye
what 2 ocular muscles are innervated by CN VI (abducent nerve)
- lateral rectus extraocular muscle
- retractor bulbi muscle
what 2 clinical ocular signs will be seen with a CN VI (trochlear nerve) deficit?
- medial strabismus
- inability to retract the globe
name the 3 branches of CN V (trigeminal)
- mandibular branch
- ophthalmic branch
- maxillary branch
name the trigeminal nerve (CN V) branch
Motor - muscles of mastication;
sensory - lower jaw
mandibular branch
name the trigeminal nerve (CN V) branch
sensory - dorsal eyelid and cornea
ophthalmic branch
name the trigeminal nerve (CN V) branch
sensory - ventral eyelid and nasal area
maxillary branch
name the cranial nerve
Function:
motor - muscles of facial expresion
sensory - inner surface pinna
taste sensation rostral two-thirds tongue
CN VII (facial nerve)
what test can be performed to asses CN VIII (vestibulocochlear nerve)
BAER test
(brainstem auditory evoked response test)
name the cranial nerve
motor - muscles of pharynx
sensory - pharyngeal mucosa and caudal third of tongue
parasympathetic function - zygomatic and parotid salivary glands ;
gag and swallow reflex
CN IX (glossopharyngeal nerve)
name the cranial nerve
motor - muscles of pharynx, larynx (recurrent laryngeal nerve) and palate (deficit leads to dysphagia);
motor parasympathetic - viscera in chest and cranial abdomen (deficit leads to inspiratory dyspnea due to laryngeal paralysis);
sensory - pharynx, larynx and viscera (deficit leads to megaoesophagus)
CN X (vagus nerve)
name the cranial nerve
motor - neck muscles (trapezius, sternocephalicus and brachiocephalicus)
CN XI (accessory nerve)
name the cranial nerve
motor - intrinsic and extrinsic muscles of the tongue ;
deficits in tongue movements, atrophy, and deviation of the tongue
CN XII (hypoglossal nerve)
name the term
“a non-specific, proxysmal event of the body that represents an abnormality of forebrain neurotransmission”
originated by an imbalance of excitatory and inhibitory influences on the cerebral neurons
seizure
name the epileptic seizure phase
behavioural changes or autonomic signs that may precede an observable seizure
pre-ictal phenomenon
name the epileptic seizure phase
a sudden paroxysmal neurologic occurrence
ictus
name the epileptic seizure phase
a transient clinical abnormality of teh CNS function that appears or becomes more evident when the clinical signs of the seizure have ended;
disorientation, ataxia, central blindness, behavioural changes
post-ictal phenomenon
name the type of seizure
involvment of both the cerebral hemispheres;
tonic-clonic, tonic, atonic, absence seizures
generalized seizures
name the type of seizure
activation of only a part of a cerebral hemisphere;
simple or complex
focal seizures
name the type of focal seizure
consciousness is not impaired
simple focal seizure
name the type of focal seizure
with impairment of consciousness
complex focal seizure
name the term
two or more seizures in a 24-hour period or one seizure per day
cluster of seizures
name the term
a seizure that shows no clinical signs of arresting after 5 minutes of activity, or recurrent seizures with no recovery between them
status epilepticus
name 7 differential diagnoses for a seizure
- syncope
- narcolepsy/cataplexy
- neuromuscular
- paroxysmal diskinesia
- vestibular episode
- idiopathic head tremor
- pain
name the term
signs occur suddenly against a background of normality
paroxysmal