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CVNT 2 > neurology > Flashcards

neurology Flashcards

1
Q

seizure definition

A

a hypersynchronous activation of a group of neurons within the brain

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2
Q

isolated seizure definition

A

seizure lasting less than 5 mins

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3
Q

cluster seizure definition

A

2 or more seizures within 24hrs, with complete recovery in-between

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4
Q

status epilepticus definition

A
  • seizures lasting longer than 5 mins
    or
  • 2 seizures without complete recovery in-between
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5
Q

partial/focal seizure definition

A

asymmetric, one part of brain affected

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6
Q

partial/focal seizure clinical signs

A
  • facial twitching
  • hypersalivation
  • behavioural changes
  • consciousness maintained
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7
Q

simple-partial/focal seizure definition

A

no change in mentation

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8
Q

complex-partial/focal seizure definition

A

change in mentation

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9
Q

generalised (tonic/clonic) seizure definition

A

bilateral cerebral hemisphere involvement

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10
Q

generalised (tonic/clonic) seizure definition

A

bilateral cerebral hemisphere involvement

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11
Q

generalised (tonic/clonic) seizure clinical signs

A
  • autonomic signs (urination/defecation)
  • loss of consciousness
  • pre-ictal, ictal and post ictal phases
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12
Q

pre-ictal phase of seizure (minutes)

A
  • stage before seizure
  • behaviour changes, altered mentation, attention seeking behaviour
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13
Q

ictal phase of seizure (<5 mins)

A
  • loss of consciousness
  • muscle contraction
  • urination/defecation
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14
Q

post-ictal phase of seizure (mins-days)

A
  • abnormal neurological signs
  • wobbly, quiet, varies
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15
Q

extracranial causes of seizures

A

toxins
- slug bait, antifreeze, permethrin (cats), pesticides, ivermectin (collies), human drugs
metabolic
- portosystemic shunts, hypoglycaemia, hypercalcaemia

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16
Q

intracranial causes of seizures

A

structural
- brain tumour, inflammation, hydrocephalus
functional
- idiopathic epilepsy

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17
Q

idiopathic epilepsy

A
  • most common causes of seizures
  • animals diagnosed >6 months-6 years
  • recurrent seizures
  • normal inter-ictal neuro exam
  • normal MRI, metabolic, CSF exam
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18
Q

diagnostics for seizures

A
  • history
  • bloods
  • MRI with contrast
  • CSF analysis
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19
Q

seizure mimic disorders

A
  • narcolepsy/cataplexy
  • fly-catching
  • movement disorder
  • syncope
  • 3rd degree AV block
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20
Q

narcolepsy/cataplexy

A
  • sleep-wake disorder
  • inherited
  • loss of muscle tone
  • no autonomic signs
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21
Q

fly catching

A
  • unknown cause
  • minutes to hours
  • normal mentation
  • no autonomic signs
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22
Q

movement disorder

A
  • episodic
  • patient remains conscious
  • spontaneous, involuntary movements
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23
Q

syncope

A
  • fainting
  • temp loss of consciousness
  • due to reduced oxygen to brain
  • cardiac/neuro/hypoglycaemia related
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24
Q

3rd degree AV block

A
  • prolonged hypoxic event
  • partial seizure like episodes
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25
Q

canine epileptoid cramping syndrome

A
  • movement disorder common in border terriers
  • conscious and responsive
  • no autonomic signs
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26
Q

emergency management of seizures

A
  • provide oxygen therapy
  • place IV catheter
  • diazepam 0.5-1mg/kg IV bolus, 2mg/kg rectally, 0.5mg/kg intranasally
  • assess circulation and temp
  • give mannitol IV if seizure lasts >15mins or cerebral oedema
  • collect bloods
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27
Q

phone triage questions for seizures

A
  • history of seizures
  • exposed to any toxins
  • head trauma?
  • how long is the patient seizing for?
  • how many seizures?
  • is patient conscious and responsive
  • autonomic signs? (urine, defecation)
  • only transport patient when stable
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28
Q

nursing of seizure patients

A
  • quiet ward
  • lights dimmed
  • bottom kennel (easy access when seizing)
  • seizure plan on kennel with doses calculated
  • seizure pack with medication drawn up
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29
Q

if patient seizures…

A
  • note time
  • call vet
  • remove any dangers
  • dim lights, reduce noise
  • limit handling (just make them safe)
  • monitor vitals
  • don’t put hands in mouth
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30
Q

phenobarbital as medical management of seizures

A
  • (epiphen)
  • first line treatment, acts on GABA receptors in brain
  • increases synaptic inhibition
  • 2 weeks to become stable
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31
Q

side effects of phenobarbital for seizures

A
  • hepatotoxicity (with high doses)
  • sedation
  • polydipsia/uria
  • polyphagia
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32
Q

potassium bromide as medical management of seizures

A
  • (libromide)
  • first line anti-epileptic or in conjunction
  • reduces neuronal excitability
  • 4 months to become stable
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33
Q

side effects of potassium bromide as medical management of seizures

A
  • gastric irritation
  • nausea
  • polydipsia/uria
  • sedation
  • pancreatitis
  • can cause serious lung issues in cats
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34
Q

levetiracetam as medical management of seizures

A
  • unknown method of action
  • used as adjunct to other anti-epileptic drugs
  • excreted unchanged in kidneys (fine with renal patients)
  • orally bioavailable
  • can cause ataxia, vomiting
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35
Q

imepitoin as medical management of seizures

A
  • (pexion)
  • only licensed for idiopathic epilepsy
  • acts on GABA receptors reducing electrical activity
  • can be used for noise phobias
  • do not use in dogs with impaired hepatic, renal or CVS function
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36
Q

advice for clients

A
  • nurse consult after initial diagnosis
  • follow up calls to check in
  • written communication
  • support groups
  • what does the owner need to know to care for pet at home
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37
Q

polyradiculoneuritis

A
  • immune mediated disease
  • affects myelin and/or axons (axonopathy)
  • most common peripheral neuropathy in dogs
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38
Q

presentation of polyradiculoneuritis

A
  • short-strided gate progressing to tetraparesis (weak limbs)
  • dysphonia (change in voice)
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39
Q

diagnosis of polyradiculoneuritis

A
  • accurate patient history
  • physical and neuro exam
  • EMG (electromyeligram)
  • NCV (nerve conduction velocity)
  • muscle and nerve biopsies
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40
Q

treatment of polyradiculoneuritis

A

intensive nursing care and physiotherapy

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41
Q

myasthenia gravis

A
  • disease of neuromuscular transmission affecting NMJ (junctionopathy)
  • congenital or required
  • autoantibodies act on Ach receptor and alter function
  • reduces number of functional receptors so muscles cant contract normally
  • 3 types of the disease
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42
Q

presentation of myasthenia gravis

A
  • muscle weakness and fatigue
  • more obvious when exercising
  • regurgitation due to oesophageal weakness
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43
Q

focal myasthenia gravis

A
  • targets one muscle group
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44
Q

generalised myasthenia gravis

A
  • targets all muscle groups
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45
Q

diagnosis of myasthenia gravis

A
  • presumptive based on history and presentation
  • thoracic radiographs- megaoesophagus
  • edrophonium/tensilon test- patient can walk normally after
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46
Q

treatment of myasthenia gravis

A
  • anticholinesterase therapy (bromides)
    side effects: GI signs, hypersalivation
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47
Q

polymyositis

A
  • immune mediated inflammatory myopathy
  • infiltration of inflammatory cells into skeletal muscle
  • idiopathic but can be associated with systemic disease
  • focal (one muscle) or diffuse
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48
Q

presentation of polymyositis

A
  • exercise intolerance and stiffened gate
  • muscle atrophy, dysphonia, regurgitation (effects oesophagus)
  • signs often wax and wane initially
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49
Q

diagnosis of polymyositis

A
  • diagnosis of exclusion
  • clinical history, biochemistry (increase in creatinine kinase), electrodiagnostic testing, muscle biopsy
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50
Q

treatment of polymyositis

A
  • corticosteroids at immunosuppressive doses
  • azothrioprine can be used along side steroids if patients cant handle their side effects
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51
Q

treatment of aspiration pneumonia

A
  • early admin of antibiotics
  • oxygen therapy, iv fluids
  • walking, turning patients
  • raised eating balls of food (wet food)
  • mechanical ventilation if necessary
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52
Q

aspiration pneumonia

A
  • inhalation of GI contents into lungs
  • pulmonary damage and inflammation
  • coughing, tachypnoea, crackles on auscultation
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53
Q

pressure sores

A
  • common complication for recumbent patients
  • increased pressure over bony prominences
  • leads to ischaemia and necrosis
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54
Q

prevention of pressure sores

A
  • thick padded bedding
  • turning every 2-4hrs
  • donut bandage
  • porous bedding
  • incontinence pads
  • non slippery floors
  • physiotherapy
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55
Q

treatment of pressure sores

A
  • bandages and commercial boots useful
  • debride if necessary
  • antibiotics if infected
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56
Q

muscle contracture

A

recumbancy and immobilisation leads to:
- adaptive shortening of muscles and soft tissues
- inelasticity of soft tissues

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57
Q

considerations for neurological diseases

A
  • temperament
  • client expectations, limits
  • disease process
  • other diseases
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58
Q

spinal cord definition

A

extracranial part of CNS

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59
Q

spinal column definition

A

encases and protects spinal cord and nerves

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60
Q

patient workup steps

A
  1. history
  2. physical exam
  3. neuro exam
  4. differential diagnosis
  5. diagnostic tests
  6. diagnosis/prognosis
  7. treatment
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61
Q

when is a neuro exam indicated?

A
  • seizures
  • behavioural changes
  • gait abnormalities
  • change in posture, positioning
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62
Q

why is a neuro exam performed?

A
  • identify if nervous system involvement
  • identify specific location
  • aid diagnosis and prognosis
  • continuous assessment of conditions
63
Q

upper motor neurons

A
  • located between cerebral cortex and spinal cord
  • send signals to lower motor neurons
64
Q

lower motor neurons

A
  • connect the CNS to effector muscle
  • send signal to make muscle contract
65
Q

ataxia definition

A

uncoordinated gait

66
Q

paresis/paretic definition

A

weakness, decreased voluntary movement

67
Q

paralysis/plegic definition

A

no voluntary movement

68
Q

hemi- definition

A

both limbs on one side affected

69
Q

para- definition

A

both pelvic limbs affected

70
Q

quadra-/tetra- definition

A

all 4 limbs affected

71
Q

head tilt definition

A

one ear is below the other

72
Q

head turn definition

A

nose turned towards body

73
Q

ventroflexion of neck

A

low head carriage

74
Q

scoliosis definition

A

spine bends laterally

75
Q

lordosis definition

A

spine deviates ventrally

76
Q

kyphotic definition

A

spine arched dorsally

77
Q

decerebrate rigidity definition

A

extension of all limbs, head and neck

78
Q

decerebellate rigidity definition

A

extension of thoracic limbs, head and neck

79
Q

proprioceptive positioning test

A

if you put the top of a patients paw on the ground, they should move it back to its natural position

80
Q

hopping test

A

pick one leg off ground and make patient move from side to side

81
Q

visual placing test

A

hold patient towards a table and place their paw on it
- patients should reach out for the table before their paw touches it

82
Q

tactile placing test

A

cover patients eyes, gently brush their feet towards edge of table
- they should replace paw in natural position

83
Q

hemi-walking test

A

front and back limbs on one side are lifted and supported whilst patient hemi walks to the side

84
Q

spinal reflexes of thoracic limb

A
  • withdrawal
  • extensor carpi radialis reflex
  • biceps brachii and triceps reflex
85
Q

spinal reflexes of pelvic limb

A
  • patella reflex
  • cranial tibial and gastrocnemius
86
Q

perineal reflex

A

perineum is pinched causing constricture

87
Q

panniculus reflex

A

pinching either side of the spinal column (on skin) causing a twitch down the spine

88
Q

deep pain

A

when patient doesn’t feel noxious stimuli due to damage or compression of spinal cord

89
Q

deep pain evaluation

A
  • pinch digit or nail bed on each limb
  • looking for patient to react
  • if no reaction (not including withdrawal reflex) they are deep pain negative
90
Q

acute causes of spinal injury

A
  • intervertebral disc disease (IVDD)
  • trauma (fracture, luxation)
  • infarction (fibrocartilaginous embolism)
91
Q

chronic causes of spinal injury

A
  • degenerative disk disease
  • degenerative myelopathy
  • cervical stenotic myelopathy (wobblers)
92
Q

diagnostics for spinal patients

A

imaging
- radiographs (not ideal to move patients to put plate under)
- CT (3D, can’t see spinal cord damage)
- MRI (gold standard)
CSF tap (possibly)

93
Q

conservative treatment of spinal patients

A
  • 6 weeks strict rest
  • physio
  • anti-inflamms
  • analgesia
94
Q

surgical treatment of spinal patients

A
  • hemilaminectomy
  • ventral slot
  • dorsal laminectomy
  • spinal stabilisation
95
Q

upper motor neuron bladder

A
  • increased urethral resistance
  • detrusor and urethral sphincter can contract at same time
  • can cause urinary retention
  • difficult to manually express
96
Q

lower motor neuron bladder

A
  • flaccid bladder
  • doesn’t contract spontaneously
  • bladder continues to fill causing leaking of urine
  • bladder muscle is overstretched
  • easy to manually express
97
Q

nursing considerations of spinal patients

A
  • long term patients
  • enrichment
  • nutrition
  • temp control
  • padded bedded, turning
  • excretion management
  • grooming
98
Q

what does the skull vault contain?

A
  • 80% parenchymal tissue (brain)
  • 10% blood
  • 10% CSF
99
Q

intracranial pressure (ICP)

A

exerted between skull and intracranial tissues
- 5-10mmHg

100
Q

central perfusion pressure (CPP) equation

A

CPP= MAP-ICP

101
Q

cushings reflex

A
  • triggered by severe, acute increase in
    ICP
    signs:
  • rise in MAP and reflex bradycardia
  • life threatening sign
102
Q

causes of intracranial disease

A
  • trauma
  • inflammatory (menigoencephalitis)
  • infectious
  • neoplastic
  • toxins
  • seizures
  • anomalous (hydrocephalus)
103
Q

obtunded mentation

A

awake but less responsive, will sleep if left

104
Q

stuporous mentation

A

only responds to noxious/painful stimuli

105
Q

circling definition

A

tight circles, one way

106
Q

menace response

A
  • move hand towards patients face
  • they should blink and retract from the hand
107
Q

palpebral reflex

A
  • medial canthus, patient should blink
108
Q

cranial nerve reflex tests

A
  • menace response
  • palpebral
  • PLR- pupillary light reflex
  • gag reflex
  • oculocephalic reflex
109
Q

oculocephalic reflex

A
  • phsyiological nystagmus
  • patients eyes are covered and they are moved quickly, eyes should follow
  • absence of reflex indicates severe brainstem damage
110
Q

miosis/miotic pupil definition

A

constricted

111
Q

mydriasis/mydriatic pupil definition

A

dilated

112
Q

anisocoria pupil definition

A

asymmetric

113
Q

pupil clinical signs of deterioration

A
  • pupils go from miotic to mydriatic
  • mid-size fixed pupils unresponsive to light
114
Q

clinical signs of intracranial disease

A
  • altered mentation
  • loss of cranial reflexes
  • altered respirations
  • loss of consciousness
  • seizures
  • altered posture
115
Q

what 3 domains does glasgow coma score assess?

A
  • motor activity
  • brainstem reflexes
  • level of consciousness
    lower the score, more severe the deficits
116
Q

treatment of raised intracranial pressure

A
  • mannitol infusion
  • hypertonic saline infusion
117
Q

mannitol infusion as treatment of raised ICP

A
  • hyperosmolar
  • reduces cerebral oedema
  • increases CPP and cerebral blood flow
  • rapid onset
  • duration of action= 1.5-6hrs
  • boluses of 0.5-1.5g/kg
  • diuretic (isotonic fluids after to maintain vascular vol)
  • crystallises at room temp (warm)
118
Q

hypertonic saline therapy as treatment for raised ICP

A
  • similar osmolarity to mannitol
  • improves haemodynamic status
119
Q

nursing management of raised ICP patients

A
  • recumbancy considerations
  • elevate cranial part of body (not just head)
    • 30-40 degrees
  • no jugular sampling
  • ocular care (eye drops)
  • mouth checks of intubated patients (4-6hrs)
  • nutritional support (4-6hrs if conscious)
120
Q

hydrocephalus

A

excessive accumulation of CSF in ventricular system

121
Q

causes of hydrocephalus

A
  • obstruction to CSF outflow
  • decreased absorption of CSF
  • increased production of
    CSF
122
Q

clinical signs of hydrocephalus

A
  • enlarged, dome shaped skull
  • behavioural changes
  • slowness in learning
  • loss of coordination
  • visual deficits
  • seizures
  • depressed mentation
123
Q

management and treatment of hydrocephalus

A
  • medical= prednisolone, omepromazole
  • surgical= diverting CSF to another location (ventriculoperitoneal shunt)
124
Q

meningoencephalitis of unknown origin (MUO)

A

non infectious inflammatory disorder of CNS
- unable to tell which type in live patient

125
Q

3 types of meningoencephalitis of unknown origin

A
  • granulomatous ME (GME)
  • necrotising (NME)
  • necrotising leukoencephalitis (NLE)
126
Q

clinical signs of meningoencephalitis

A
  • more commonly small dogs, female, older than 6 months
  • seizures, tremors, blindness, altered balance, head tilt, typical neurological signs
127
Q

diagnosing meningoencephalitis

A
  • clinical exam
  • blood tests
  • MRI of brain
  • CSF analysis (inflammatory signs)
128
Q

management of meningoencephalitis

A

immunosuppressive drugs:
- steroids
- cyclosporine
- azathioprine
- cytarabine
antiepileptics (if necessary)
nursing care

129
Q

prognosis of meningoencephalitis

A
  • variable
  • patients that show improvement within 3 months have good prognosis
  • focal lesions have better prognosis than multifocal lesions
130
Q

general considerations for nursing neurological patients

A
  • ambulatory vs non ambulatory
  • surgical vs non-surgical
  • continent vs incontinent
  • temperament
  • recumbancy
  • normal routine
131
Q

kennel set up for neuro patient

A
  • thick bedding (duvet, mattress)
  • incontinence sheets
  • use vet bed as top layer to wick away any urine
  • pad out sides of kennel with pillows for extra comfort (not for seizure, head trauma patients)
132
Q

ways to void a bladder

A
  • manual expression
  • intermittent catheterisation (twice a day, easier in males)
  • in-dwelling catheterisation
133
Q

risks of overflow incontinence

A
  • urine scalds due to leakage
  • risk of UTI’s
134
Q

bladder expressing

A
  • express every 6-8hrs
    • BID initially for indwelling catheter as can cause iatrogenic trauma
  • empty indwelling catheter bag 3-4 times daily
135
Q

decubital ulcer definition

A
  • open skin wound caused by continued pressure of skin on firm surface
  • will eventually cause tissue ischemia
  • occurs at bony prominences
136
Q

4 stages of decubital ulcer

A
  1. pigmented area
  2. small lesion
  3. deeper lesion towards muscle
  4. intrudes into muscle down to bone
137
Q

skin care and sore prevention

A
  • chlorexyderm (treats mild urine scalds)
  • talcum powder (soaks up moisture)
  • cavilon (no sting barrier cream)
  • POM-V flamazine (surface thickness sores, under direction of vet)
138
Q

exercise for neurology patients

A
  • important even if non-ambulatory (sniffing)
  • mobilises joints and muscles aiding recovery
  • use proper equipment (sling, rear harness, paw covers)
139
Q

wound management of spinal patients

A
  • cold therapy (15 mins 4X a day for 48-72hrs)
  • wrap in towel, not directly on skin
140
Q

faecal incontinence management

A
  • check skin daily for sores
  • nappies shouldn’t be left on for long periods of time to avoid continued contact of faeces and skin
141
Q

role of physiotherapy in neuro patients

A
  • promote recovery
  • prevent further complications
  • preserves neuromuscular function in chronic spinal cord damage
  • increases survival times for degenerative myelopathy
142
Q

benefits of physiotherapy

A
  • pain management
  • improve range of motion
  • reduce muscle contraction
  • stimulate nervous system
  • improves blood perfusion
  • encourages relearning of motor patterns
143
Q

considerations for physiotherapy

A
  • patient factors (size, temperament, degree of disability)
  • client factors (financial, household, expectations)
144
Q

types of physiotherapy

A
  • massage
  • passive range of motion
  • assisted exercises
  • active exercises
  • proprioceptive exercises (placing feet in correct position)
  • neuromuscular electrical stimulation
  • hot/cold therapy
  • hydrotherapy
145
Q

massage techniques/routine

A
  • effleurage= gentle contact with palm
  • petrissage= roll, squeeze, kneads skin and muscle
  • percussion= tapping of skin
  • vibration= limbs are gently shaken
146
Q

coupage definition

A
  • respiratory physiotherapy
  • important in recumbent, pulmonary disease patients
  • loosens secretions, clears airway
  • contraindicated with thoracic trauma, fractured ribs, no gag reflex
147
Q

passive range of motion (PROM) definition

A
  • flexes and extends joints natural range of motion
  • monitor for pain
  • 3-4 times a day for 10 mins
148
Q

assisted exercises

A
  • standing, walking, sit-stand, 3 legged standing, weight shifting
149
Q

proprioceptive exercises

A
  • standing, weaving
  • wobble board, uneven surface, over poles
150
Q

active exercises

A
  • improves strength, promote independence
  • lead exercise on steps, ramps
151
Q

E-stim

A
  • neuromuscular electrical nerve stimulation
  • stimulates muscle contraction
  • increases tissue perfusion
  • slows neurogenic muscle atrophy
152
Q

benefits of E-stim

A
  • increases muscle strength, range of motion
  • enhances function
  • reduces pain, oedema, muscle spasm
153
Q

how E-stim works

A
  • 1 electrode near motor point of muscle, 1 electrode along muscle body
  • check for muscle contraction
  • adjust pulse intensity
  • 10-20 mins a day

CVNT 2 (33 decks)

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