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surgery 3 > Neurology > Flashcards

Neurology Flashcards

1
Q

Which spinal lesions would you get normal to hyper-reflexive

A

C1-C5

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2
Q

What spinal lesions would give normal to hypo-reflexive?

A

C6-T2

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3
Q

Predisposition for cervical intervertebral disc disease

A

Large dogs associated with Hansen type II protrusions at disc
Doberman associated with cervical spondylomyelopathy

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4
Q

Signs of cervical intervertebral disc

A
  • radicular pain or nerve root signature often with impingement of C5 and C8
  • most common sign = cervical spinal pain, low head, neck carriage, neck guarding, stilted and cautious gait and spasms of muscle
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5
Q

Non surgical treatment for cervical intervertebral disc disease

A
  • conservative indicated with 1st episode of pain only or with milked paresis
  • strict cage confinement (4-6 weeks), corticosteroids and muscle relaxants
  • harness during limited walking exercises
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6
Q

Surgical treatment for intervertebral disc disease

A
  • persistent pain or moderate to severe neurological deficits
  • removal of the disc
  • ventral slot decompression - most commonly performed
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7
Q

Predisposition of thoracolumbar intervertebral disc disease

A

Chondrodystrophic breeds —> hansen type I in thoracolumbar region - progressively decreases from T12-T12 causally

Most common site for Hansen type I in large non-chondrodystrophic breeds - between L1 and L2

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8
Q

Signs of thoracolumbar intervertebral disc

A
  • percute (<1hr), acute (<24hr), gradual (>24hr)
  • persecute/acute disc extrusion = “spinal shock” or shiff-Sherrington posture
  • (vary) spinal hyperesthesiia/paraplegia with/without pain perception
  • dogs with back pain —> reluctant to walk - show kyphosis
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9
Q

Diagnosis of thoracolumbar IVDD

A

Signalmen’s, history, and neurological examination
CT, MRI, surgery

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10
Q

Differentials for thoracolumbar IVDD

A

Trauma, fibrocartilaginious emoblism, degenerative myelopathy, discospondilitis, neoplasia etc

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11
Q

Treatment for thoracolumbar IVDD

A

Non surgical - same as other IVDD
Surgical
- decompression alone is inadequate to restore spinal cord function when an extramural mass is greater than 4mm in diameter (so decompression and remove)
- decompressive procedures = dorsal laminectomy, hemilaminectomy and pediculectomy

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12
Q

Another name for degenerative lumbosacral stenosis

A

Cauda equina syndrome

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13
Q

Predisposition for cauda equina syndrome

A

Middle age dogs of medium - large breeds
GSD most commonly affected
7 yrs, 2x more likely in male than female
Working dogs that are heavily trained are prone

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14
Q

Cause of cauda equina syndrome

A

Degenerative lumbosacral stenosis (DLSS)

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15
Q

Pathogenesis of cauda equina

A

Soft tissue and bony changes, possibly in conjunction with abnormal motion of the lumbosacral joint, impinge on the nerve roots/vasculature of the cauda equina

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16
Q

Signs of cauda equina

A
  • lumbosacral (caudal) pain
  • maintain characteristic posture, keeping their lumbosacral joints flexed (increases the canal —> decreasing nerve root compression)
  • pelvic limb lameness, tail paresis or paralysis
  • urinary or faecal incontinence
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17
Q

Compression of sciatic nerve (L6-S2)

A

Abnormal proprioceptive positioning, muscle atrophy, parapetáis, reduced flexor reflex

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18
Q

Compression of pudenal nerve

A

Reduced/absent perineal reflex, poor anal and urethral sphincter tone and decreased/abnormal perineal skin sensation

19
Q

Compression of pelvic root

A

Atomic bladder that’s easily manually expressed

20
Q

Compression of caudal nerve (CD1-5)

A

Reduced tail tone, tail paresis/paralysis, decreased tail sensation/paraesthesia of the tail

21
Q

Diagnosis of cauda equina

A

Lordosis test = detects pain even in stoic dogs, not specific and doesn’t differentiate lumbosacral pain from hip pain

Extension/traction of tail and palpación of lumbosacral joint per rectum

Survey/stress radiography, myelography, epidurography, discography, CT, MRI

22
Q

Differentials for cauda equina

A

Neruologic diseases = degenerative myelopathy, IVDD, myopathies
Orthopaedics: CLR, DJR
Other disease: prostatic, primary disease of urogenitcal, primary dermatological disease

23
Q

Treatment for cauda equina

A

Conservative: rest, NSAIDs, weight loss
Surgery: decompression, distraction-fusion

24
Q

Spinal fracture or luxación

A

Spinal trauma common cause of spinal cord dysfunction in dogs and cats (trauma either exogenous or endogenous )

25
Q

Clinical assessment of spinal fracture or luxation

A
  • owner: place animal on rigid movable board (if not available, blanket, like a sling), and multiple people to move and to reduce additional injury
  • at hospital: suspected vertebral column injury, should be immobilised ASAP
  • need to see if has multiple organ trauma to determine whether life threatening or not
26
Q

Treatment for spinal fracture or luxation

A

Corticosteroids
- prior to/during radiographing evaluation - if not severely hypotensive should be given
- methyprednisolone sodium succinate - within 1hr of the trauma is beneficial

Non-surgical
- cage confinement (4-6 weeks), external support bandages/casts

Surgical
- indications: spinal instability and spinal cord compression

Post-operative
- fentanyl patch
- if recumbent, animal needs to be turned at least every 1-4 hr
- extra padding under dog with foam rubber/thick fleece or small soft-sided waterbeds
- measure the urine output, manually expression every 6 hours if not urinating on their own

27
Q

Head trauma management

A

Death usually results from progressive increases in intracranial pressure (ICP)

28
Q

Cause of head trauma management

A

Vehicle accidents
Gun sohots
Animal bites
Fall

29
Q

Primary brain injury

A
  • direct parenchymal damage: contusions, lacerations, diffuse axonal injury
  • direct vascular damage: intracranial haemorrhage, vasogenic oedema, decreased perfusion
  • refers to physical disruption of intracranial structures that occurs immediately at the time of the traumatic event
30
Q

Secondary brain injury

A

ATP depletion

31
Q

Degree of neurological dysfunction

A
  1. Pain only
  2. Ataxia, conscious proprioceptive deficits, paresis
  3. Paraplegia
  4. Paraplegia with urinary retention and overflow
  5. Paraplegia with urinary retention and overflow and loss of deep pain perception
32
Q

Intracranial pressure definition

A

ICP = pressure exerted by tissues and fluids within the cranial vault

33
Q

ICP normal pressure

A

5-12mmHg

34
Q

CPP and CBF

A

Cerebral perfusion pressure is a primary determinant of cerebral blood flow and hence brain oxygenation and nutritional support

35
Q

What are normal contents of cranial cavity?

A

Parenchyma, blood and CSF

36
Q

Pressure auto regulation

A

Between meal arterial BP (MABP) extremes of 50 and 150mmHg, ICR remains constant

If MABP rises, vasoconstriction occurs in brain, if falls, vasodilation

37
Q

Chemical auto regulation

A

Direct responsiveness of brain vasuclature to partial pressure of CO2 in arterial blood, elevated PaCO2 = vasodilation and vice versa

38
Q

Fluid therapy for brain injury

A

Aggressive fluid therapy to counteract hypotension but may aggravate brain oedema

Blood pressure must be restored to normal ASAP

Hetastarch, hypertonic saline, dextran-70, crystalloids

39
Q

Hetastarch

A
  • BEST choice for RESTORING normal BP in head trauma
  • 10-20mL/kg for shock
  • composed mainly of amylopectin
  • can be: rapid bolus in dogs
  • cats: 5mL/kg incrementes over 5-10 minutes to avoid vomiting and nausea
  • long duration
40
Q

Hypertonic saline

A
  • shock dose 4-5mL/kg given over 3-5 minutes
  • contributes to brain oedema because of Na
  • it may disrupt BBB
  • short duration can combine hypertonic with dextran 70/hetastarch may prolong
41
Q

Dextran-70

A

Composed of linear glucose reditúes
10-20mL/kg to effect for shock in dogs
Cats 5mL/kg a blouses over 5-10minutes, max 20mL/kg
Side effects: renal failure and coagulation disorders possible but v rare
Metabolism of dextran ay lead to increased blood glucose levels, séquela that should be aoivded in severe head trauma

42
Q

Crystalloids

A

90mL/kg/h (dogs)
60mL/kg/h (cats) for shock

43
Q

Specific medical therapy for head trauma victim

A

Mannitol (osmotic diuretic, reduces brain oedema and ICP in cases of severe brain injury)
Furosemide (loop diuretic)

surgery 3 (6 decks)

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