Neurology Flashcards
Define Parapesis
partial loss of voluntary motor ability in 2 limbs - most commonly affecting the hindlimbs
define paraplegia
complete absence of any voluntary motor ability in 2 limbs - most commonly affecting the hindlimbs
List 7 common clinical conditions causing parapesis/ paraplegia in dogs/cats
IVDD
ischaemic myelopathy
FCE
spinal fracture
neoplasia
MUO
degenerative myelopathy
what is MUO
meningoencephalomyelitis of unknown origin
define tetraparesis
partial loss of voluntary motor ability - weakness in the ability to generate gait - in all 4 lilmbs
Define tetraplagia
complete absence of any voluntary motor ability in all 4 limbs
List 6 common clinical conditions causing tetraparesis/ tetraplegia/ cervical pain in dogs and cats
IVDD
MUO
SRMA
FIP
discospondylitis
atlantoaxial subluxation
what is SRMA
steroid responsive meningitis arteritis
List 3 common clinical conditions that cause generalised neuromusclular weakness in dogs/ cats
clostridial diseases
poly myositis
IPRN-idiopathic polyradiculoneuritis
what is IPRN
idiopathic polyradiculoneuritis
Describe the presentation of MUO
usually chronic, painful, progressive and multifocal
Describe how MUO occurs
autoimmune idiopathic inflammation of the meninges in the brain and spinal cord
Decsribe how to diagnose MUO
non definitive but:
MRI
bloods
CSF tap
Describe how to treat MUO
high immunosuppressive dose of steroids and/or immunosuppressive agents
variable prognosis
Describe the pathophysiology of FCE
is a focal embolus of fibrocartilage within the ascending artery of the spinal cord- can be bilateral or unilateral
Decsribe how to diagnose FCE
MRI
Describe how to treat FCE
conservative management - assess bladder and bowel function
they usually recover with time and physio
Describe the presentation of FCE
sudden onset non-painful paresis/paralysis, especially if unilateral - highly suspicious of FCE
Describe the 3 manifestations of IVDD
type 1 - nuclear extrusion (disc bursts an pushes out
type 2 - protrusion (disc shifts upwards)
disc cyst - small amount of nuclear material comes out of the spinal cord and is very hydroscopic which causes a build up of water around the disc
Describe how to diagnose IVDD
radiography or MRI
Describe the presentation typically seen with IVDD type 2
= protrusion
usually progressive in onset, clinical signs predominantly by compression
Describe the typical presentation of IVDD type 1
= extrusion
usually sudden onset pathology (but can get multiple episodes which can resolve spontaneously without intervention)
Describe how to treat IVDD
referral for surgical removal
conservative - rest and NSAIDs
Describe the pathophysiology of degenerative myelopathy
progressive degeneration of the spinal cord
Describe the presentation of degenerative myelopathy
chronic progressive hindlimb ataxia
non-painful condition
Describe how to diagnose Degenerative Myelopathy
is by exclusion (IVDD protrusion) there are no signs yet identified on MRI
which breed commonly gets Degenerative Myelopathy
GSDs
Describe how to treat Degenerative Myelopathy
no effective therapy
physio been shown to slow the rate of progression but not prevent
Describe the pathophysiology of spinal fracture
needs significant trauma unless there is a pathological fracture
Describe the presentation of spinal fractures
acute onset of clinical signs- can be exacerbated by movement of unstable structures
Describe how to diagnose a spinal fracture
conscious radiography
Describe how to treat a spinal fracture
conservative management if fracture is stable - rest and analgesia
euthanasia
refer for surgical stabilisation
what is the prognosis of a spinal fracture
determined by the degree of concussion, compression or laceration damaged sustained by the spinal cord
Describe ischaemic myelopathy
loss of blood supply to the spinal cord - caused by some form of blockage
Describe how neoplasia affecting CNS generally present
progressive with focal presentation
can be painful or non-painful
Describe how to treat neoplasia that affect the CNS
no effective chemo protocol
corticosteroids at anti-inflammatory doses
Surgical excision is unlikely to be curative due to the inability to remove a surgical margin
Describe the pathophysiology of discospondylitis
is infectious inflammation within the nucleus pulposus of the disc
Describe how discospondylitis presents
chronic progressive spinal pain without obvious neurological deficits that may be focal on palpation of difficult to localise.
Chronic pain but can occasionally progress to ataxia or some paresis
Describe how to diagnose discospondylitis
radiography- in chronic cases
CT/MRI
Describe how to treat discospondylitis
systemic antibiotics (for 6 weeks)
can perform surgey to lance the abscess
Describe the pathophysiology of polymyositis
autoimmune inflammation within the muscles leads to large amounts of pain
Describe how polymyositis presents
chronic lameness or lethargy secondary to generalised pain
Describe how to treat polymyositis
corticosteroids at an immunosuppressive dose
Describe how to diagnose polymyositis
definitive on muscle biopsy
why do toy breeds more commonly get atlantoaxial subluxations
they have laxity of the tendons holding C1 and C2
Decsribe how to diagnose an atlantoaxial subluxation
radiography - conscious or GA with careful dynamic views
CT/MRI
How does atlantoaxial subluxation present
Variable:
- cervical pain
- intermittent collapse
- tetraparesis
DEcsribe how to treat a atlantoaxial subluxation
immobilise the joint for 6 weeks and provide analgesia
neck brace and cage rest
some cases will need surgical stabilisation
what are atlantoaxial subluxations associated with
significant trauma incident (eg dogs running into patio doors with forced head ventroflexion)
OR
in young toy breed dogs where anatomical factors will predispose.
Name a common spinal tumour seen in cats
lymphosarcoma
what neurological signs can metronidazole cause at high doses
vestibular signs
How does wet FIP present
oedema in tissues
Describe how dry FIP presents
rapidly progressive - causes granulomas in tissues (can occur in nervous system)
sudden hindlimb ataxia which can progress
Describe how to diagnose neurological FIP
bloods
MRI
Describe how to treat FIP
Supportive care: anti-inflammatories, appetite stimulants (mirtazapine), vitamin B12, s/c fluids at home, anti-oxidants
Remdesivir
Euthanasia?
Describe how to diagnose clostridial disease
CSF tap
MRI
bloods
Describe how botulism presents
sudden onset neuromuscular weakness affecting all limbs- flaccid paralysis
Describe how to treat botulism
remove the animal from the source of the toxin (generally dead animal) - should be recover after this
Describe how tetanus presents
varies from mild stiffness to severe spasm and inability to stand
Describe how to treat tetanus
clean wounds
supportive therapy
anti-toxin- not as important as in horses
Describe the pathophysiology of IPRN
inflammation of the nerve roots, travels from the back legs forwards - stops at cervical region of goes further and takes out the diaphragm
Describe how IPRN presents
progressive ascending lower motor neurone weakness, initally of the distal himdlimbs progressing to all limbs
Describe how to treat IPRN
usually left limiting
no specific treatment- conservative therapy with support and physio
Describe the pathophysiology of SRMA
is an autoimmune condition with inflammation targeted towards the arteries in the meninges.
Describe how SRMA presents
in young dogs around 12 months old
acute onset severe neck pain without evident neuro deficits
Describe how to diagnose SRMA
CSF tap - will see neutrophils
MRI- to rule out other differentials
Describe how to treat SRMA
extended course of corticosteroids at immunosuppressive doses - 6 weeks min
How does neospora present
generalised muscle issue not paralysis
hindlimb rigidity in young dog
muscle pain
describe central vestibular syndrome
lesions affecting nerve roots within the brain
describe peripheral vestibular syndrome
lesions affecting peripheral nerve roots
List 4 common clinical conditions causing central or peripheral vestibular syndrome in dogs or cats
idiopathic vestibular disease
otitis interna
MUO
neoplasia
List 3 common clinical conditions causing cranial nerve dysfunction in dogs and cats
trigeminal neuropathy
facial paralysis
trigeminal neoplasia
what is a notifiable disease causing neurological signs in dogs and cats
rabies
DEfine seizure
abnormal electrical activity within the brain causing episodes and neurological deficits and the disruption of the autonomic nervous system during episodes
List 4 common clinical presentations producing seizures in dogs and cats
idiopathic epilepsy
metabolic brain disease
structural brain disease
neurotoxicity
what are head tilts commonly associated with
vestibular disease
OR
ear infections
define nystagmus
involutary rapid eye movements
List the clinical signs of vestibular disease
head tilt
ataxia
wide-based stance
circling
leaning
falling
positional strabismus
will bilateral vestibular disease have a head tilt or nystagmus
no
List the clinical signs seen with central vestibular disease
possible paresis or proprioceptive deficits
consciousness may be depressed, stuporous or comatose
CN 5-7may be affected
horizontal, rotary or vertical nystagmus may be present
List the clinical signs seen with peripheral vestibular disease
alert
CN 7 affected
possible horner’s syndrome
horizontal or rotary nystagmus
Describe how to differentiate central from peripheral vestibular disease
both will have head tilt towards lesion, nystagmus, circling, nausea
central will have other neurological signs
Describe how to diagnose idiopathic vestibular syndrome
by exclusion
Describe how to treat idiopathic vestibular disease
conservative management- if nausea significant part of presentation can try anti-emetic
no specific treatment
Describe presentation of trigeminal neuropathy
sudden onset dropped jaw
can maually close jaw with no pain
Describe how to diagnose trigeminal neuropathy
by exclusion (TMJ problems and masticatory myositis)
Describe how to treat trigeminal neuropathy
conservative therapy (support eating and drinking)- return to function in 4-6 weeks
Describe how facial paralysis presents
facial asymmetry
absence of blink
lateral deviation of the nose
Describe presentation seen with trigeminal neoplasia
progressive head assymmetry secondary to atrophy of temporal and masseter muscle unilaterally
Describe how to diagnose trigeminal neoplasai
CT/MRI
Describe how to diagnose neospora
serology
Describe how to treat neospora
Clindamycin if caught early
PTS -
a case present with its first seizures with no known aetiology - what is the first diagnostic test?
biochem and haematology
a cat present with a right head tilt and nystagmus - where is the lesion ?
right vestibular lesion
what do seizures with altered mentation mean between them mean
forebrain lesion
what drugs are used to control seizures
benzodiazapeam and phenobarbitone
List the side effects of using phenobarbital to control seizures
risk of hepatic damage
sedative effect
PU/PD
how long does phenobarbital take to get to a therapeutic dose to control seizures
2 weeks
why would we use imepitoin instead of phenobarbital to control seizures
if worried about liver pathology
why don’t we do blood test with imepitonin
it has a big therapeutic range
what seizure case is phenobarbitone licensed in
progressive cases
frequent seizures
cluster seizure
when is imepiton licensed in small animal seizures
idiopathic epilepsy
why can we us Benzodiapazerm as an anticonvulsant in cats but not dogs
dogs develop a tolerance
what can we give if diazepam hasn’t stopped a seizures
phenobarbital
CRI propofol
what is the lesion is you have a vestibular disease plus any neurological deficits
central vestibular lesion
what are signs of bilateral vestibular disease
head swings side to side
shifting nystagmus
what cranial nerves effect swallowing
CN 9, 10, 12
dog present with dysphagia - how do you decide if it bilateral or unilateral
the tongue will hang out of one side if unliateral
is dysphagia is profoundly bilateral - where must the lesion be
brainstem- effecting multiple CN
