neurology

Question 1

layers of spinal cord

Answer 1

proprioception-> proprioception/motor-> motor->urinary incontinence-> pain

Question 2

important history

Answer 2

signalment, onset of complaint, description, behaviour changes

Question 3

distant neuro exam

Answer 3

level of consciousness, posture/position, gait, involuntary movement

Question 4

levels of concisousness

Answer 4

normal, disoriented (abnormal response), depressed (reduced response), stuporous (pain), comatose

Question 5

postures/body position

Answer 5

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

Question 6

gait

Answer 6

ataxia: sensory- weakness, scuffing
cerebellar- jerky
vestibular- drift, fall, roll

paresis/plegia, circling, lameness

Question 7

involuntary movements

Answer 7

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

Question 8

response vs reflex

Answer 8

response- goes to brain, aware

reflex- not conscious, stays in spinal cord

Question 9

cranial nerves

Answer 9

Question 10

UMN vs LMN signs

Answer 10

Question 11

FCE

Answer 11

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

Question 12

degenerative myelopathy

Answer 12

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

Question 13

discospondylitis

Answer 13

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

Question 14

spinal fracture dx, tx

Answer 14

dx- rads are not that sensitive, CT
tx- euth, pain management, stabilize CV and spine
referral-> post op exercise restriction, pain management, physio

Question 15

neoplasia

Answer 15

asymmetrical signs
dx- advanced imaging, grading and staging

tx- chemo, radiation, supportive care, exercise restriction, pain control, physio, euthanasia, palliative care

Question 16

Answer 16

narrowed spaces, bone lysis, cortical destruction-> neoplasia

Question 17

IVDD

Answer 17

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

Question 18

vestibular disease

Answer 18

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

Question 19

central vestibular ddx

Answer 19

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

Question 20

peripheral vestibular

Answer 20

otitis media (horners)
idiopathic (old dogs)
hypothyroid (older)
ototoxicity (after ear meds)
trauma
neoplasia (older
congenital (young, rare)

Question 21

seizure causes

Answer 21

hypoglycemic-> insulin OD, xylitol toxicity, insulinoma, liver failure, sepsis
high bile acids-> hepatic encephalopathy
high BUN-> uremic encephalopathy
hypothyroidism
hyponatremia
hypernatremia

Question 22

common seizure inducing toxins

Answer 22

lead, organophosphate, bromethalin, pyrethrin, strychnine, ethylene glycol, rodenticide, permethrin

Question 23

idiopathic epilepsy management

Answer 23

tx if 2+ seizures/month, longer than 5min, clusters (2+ in 24h)
check levels 2-4wks, 3m, 6m

Question 24

infectious seizure causes

Answer 24

cats most common
erlichiosis, RMSF
parasitic, toxoplasma
bacteria
cryptococcus
distemper, FIP, panleuk, FIV< rabies

Question 25

hepatic encephalopathy

Answer 25

dx- liver function (bile acids), imaging for shunt
tx- lactulose, abx, dietary changes (low protein)
refer for sx

Question 26

non infectious inflammatory neuro

Answer 26

eosinophilic meningoencephalitis- young
encephalitis- pug, maltese, yorkie
GME- old dog
dx- genetic testing, CSF, advanced imaging
tx- anticonvulsants, steroids, chemo, euth

Question 27

brain neoplasia

Answer 27

euthanasia
palliative- antiepileptic, steroids

referral-> imaging, staging, sx, chemo, radiation

Question 28

horners syndrome

Answer 28

drooping of eyelid, constricted pupil, sunken eye, 3rd eyelid raised

Question 29

horners causes

Answer 29

idiopathic- middle aged- older goldens, cocker, resolves

Question 30

AA subluxation

Answer 30

young toy breed, congenital or trauma
neck pain, ataxia, weakness, paralysis
dx- flexed neck rads
tx- rest, neck brace, pain control, sx

Question 31

trigeminal neuritis

Answer 31

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