neurology Flashcards
layers of spinal cord
proprioception-> proprioception/motor-> motor->urinary incontinence-> pain
important history
signalment, onset of complaint, description, behaviour changes
distant neuro exam
level of consciousness, posture/position, gait, involuntary movement
levels of concisousness
normal, disoriented (abnormal response), depressed (reduced response), stuporous (pain), comatose
postures/body position
head tilt- vestibular
head turn- forebrain
decerebrate rigidity-> neck and limbs extended (rostral brainstem-> will be stuporous or comatose)
decerebellate-> HL limb flexed, not usually comatose
schiff-sherrington posture-> rigid neck and FL, flaccid HL
gait
ataxia: sensory- weakness, scuffing
cerebellar- jerky
vestibular- drift, fall, roll
paresis/plegia, circling, lameness
involuntary movements
epileptic seizures
focal-> standing still, biting, twitching (depends on area of brain)
generalized-> fall, not rousable, limbs paddling etc have post ictal phase-> ADR
myoclonus-> repeated muscle twitches
tremors-> irregular twitching, more diffuse, shivering
myotonia-> muscle becomes stuck contracted
myokymia-> skin muscles twitching, looks like worms under the skin (ew)
cataplexy-> flaccid suddenly
response vs reflex
response- goes to brain, aware
reflex- not conscious, stays in spinal cord
cranial nerves
UMN vs LMN signs
FCE
fibrocartilaginous embolism
acute, non painful
negative CP on one side
loss of reflex and withdrawal-> localized to a plexus
dx- survey rads will be normal, could refer for MRI.
tx- supportive care (going outside), physio
recover in 2wks, to months
degenerative myelopathy
older lg dogs (GSD)
paraparesis, ataxia, spinal disease w T3L3 localization
symmetrical, non painful, muscle atrophy
dx of exclusion, refer for advanced imaging, genetic testing
tx- supportive, mobility support (weight management), physio to maintain muscle
discospondylitis
abscess of disc space
spinal pain above heart/kidney
caused by systemic illness/infection (UTI, bite wound, oral disease, pyoderma, endocarditis
dx- blood and urine culture, adv imaging, culture disc space
tx- 8wks abx (1wk IV if neuro)
pain relief cage rest
spinal fracture dx, tx
dx- rads are not that sensitive, CT
tx- euth, pain management, stabilize CV and spine
referral-> post op exercise restriction, pain management, physio
neoplasia
asymmetrical signs
dx- advanced imaging, grading and staging
tx- chemo, radiation, supportive care, exercise restriction, pain control, physio, euthanasia, palliative care
narrowed spaces, bone lysis, cortical destruction-> neoplasia
IVDD
pain, ataxia, loss of CP, potential loss of motor/pain
dx- localized to T3-L3, MRI, CT
tx- medical if ambulatory->
activity restriction 4-6wks-> pain control (NSAIDs, gabapentin, opioids)
rehab
weight managementv
vestibular disease
ataxia, head tilt, no CN deficits, no CP deficit
localization: central (head tilt same side, nystagmus away (FF), fall to same side, CN/CP deficits on same side.
paradoxical: head tilt away, nystagmus towards, fall away, no CN deficit, CP deficit towards
peripheral: head tilt towards, FF nystagmus away, fall towards, CN deficit, NO CP DEFICITS
central vestibular ddx
storage disease (young animals)
hydrocephalus (young), hypothyroid (older), thiamine deficiency, meningoencephalitis (F sm breed)
cerebrovascular disease- older
mteronidazole tox- hx
infectious (test CSF, cats most common)
trauma
peripheral vestibular
otitis media (horners)
idiopathic (old dogs)
hypothyroid (older)
ototoxicity (after ear meds)
trauma
neoplasia (older
congenital (young, rare)
seizure causes
hypoglycemic-> insulin OD, xylitol toxicity, insulinoma, liver failure, sepsis
high bile acids-> hepatic encephalopathy
high BUN-> uremic encephalopathy
hypothyroidism
hyponatremia
hypernatremia
common seizure inducing toxins
lead, organophosphate, bromethalin, pyrethrin, strychnine, ethylene glycol, rodenticide, permethrin
idiopathic epilepsy management
tx if 2+ seizures/month, longer than 5min, clusters (2+ in 24h)
check levels 2-4wks, 3m, 6m
infectious seizure causes
cats most common
erlichiosis, RMSF
parasitic, toxoplasma
bacteria
cryptococcus
distemper, FIP, panleuk, FIV< rabies
hepatic encephalopathy
dx- liver function (bile acids), imaging for shunt
tx- lactulose, abx, dietary changes (low protein)
refer for sx
non infectious inflammatory neuro
eosinophilic meningoencephalitis- young
encephalitis- pug, maltese, yorkie
GME- old dog
dx- genetic testing, CSF, advanced imaging
tx- anticonvulsants, steroids, chemo, euth
brain neoplasia
euthanasia
palliative- antiepileptic, steroids
referral-> imaging, staging, sx, chemo, radiation
horners syndrome
drooping of eyelid, constricted pupil, sunken eye, 3rd eyelid raised
horners causes
idiopathic- middle aged- older goldens, cocker, resolves
AA subluxation
young toy breed, congenital or trauma
neck pain, ataxia, weakness, paralysis
dx- flexed neck rads
tx- rest, neck brace, pain control, sx
trigeminal neuritis
older goldens
non supprative neuritis (demyelination)-> inability to close mouth
ddx: rabies, encephalitis, trauma, neoplasia
dx- high protein, cells in CSF
tx- supportive care, feeding
recover in 1-9wks
