Neurology Flashcards
What is chiari-like malformation?
What is syringomyelia?
What are at least three common CS?
Malformation of the skull and cranial vertebrae –> overcrowding of brain, subsequent partial herniation –> compression of brain stem and cervical spinal cord, CSF obstruction, syringomyelia (fluid filled cavity within the spinal cord parenchyma)
CS:
**Note - can be painful WITHOUT syringomyelia
–Can be asymptomatic, or vague CS that overlap with other diseases
–Yelping
–Phantom scratching
–Neck pain (decr mobility, head shy, etc)
–Facial pruritus, rubbing
Less common:
–Seizures
–Air licking
–Vestibular, other CN deficits, proprioceptive deficits
–Pain while defecating
JVIM 2019 Rusbridge
True or False: CKCS with more brachycephalic conformation are at greater risk for chiari-like malformation.
True
JVIM 2020
Complications of ventriculoperitoneal shunts to treat hydrocephalus:
–At least 4 complications
–More likely in dogs or cats?
–Usually occur in what time frame post op?
–Proportion that are surgically fixable?
Shunt obst, disconnection, kink, excessive shunting, pain, infxn
Coiling of shunt into SQ tissues – most common complication in cats, no dogs
**Note – sz are NOT a complication of shunts!
Cats > dogs
Within 6mo
Half
JVIM 2019 Schmidt
JVIM 2019 Gradner
JVIM 2020 Farke
Vertebral malformations:
–What dog breed is most at risk?
–Are neuro deficits common or uncommon? What two imaging findings are CS associated with?
–Do symptomatic dogs respond best to med, sx, or either?
Pug > other brachycephalic breeds
Uncommon. Assoc with:
–More severe kyphosis
–FEWER hemivertibrae
Sx! One study found ALL med dogs had progression of signs
JVIM 2019 De Decker
JAVMA 2018 Wyatt
Lafora disease:
–What is it?
–Signalment?
–CS?
–Impact on lifespan?
Autosomal recessive neuro storage disease
Middle aged beagles
Starts with generalized sz, then decr vision/hearing/learned tricks, staring, photosensitivity
Can still reach normal lifespan
JVIM 2021 Flegel
Chihuahuas with persistent fontanelles:
More numerous/larger associated with what three other malformations?
Chiari
Syringomyelia
Ventriculomegaly
**Also, tended to be smaller dogs
JVIM 2021 Kiviranta
Two 6wk GSD puppies from the same litter with course, side to side tremors affecting their head and trunk. Tremors interfere with walking but go away at rest. They have been shaky since birth but the breeder thought they would grow out of it. The siblings and parents are normal.
–Top ddx?
–Mode of inheritance?
–Basic mechanism?
–Progression?
Hypomyelinating leukodystrophy (“shaking puppy syndrome”) in GSDs. Autosomal recessive. Abnormal CNS myelination.
Puppies are often euth’d. If not, tremors may improve until 6-7mo old. Adults will have severe PL ataxia.
JVIM 2021 Quitt
Two 3mo old Bouvier des Ardennes siblings (look like a big/tall Westie). Both have intention tremors and more recent onset generalized hypermetric ataxia. One puppy is considerably more affected than the other. The parents and other siblings are normal.
–Top ddx?
–Cause?
–One other breed that gets this?
–Prognosis?
Spinocerebellar ataxia
KCNJ10 homozygous mutant (autosomal recessive inheritance) –> cerebellar spongy degeneration, demyelinating myelopathy
Belgian malinois
Poor – likely to progress to nonambulatory status before 1yr old
JVIM 2023 Stee
What is caused by LAMA2 gene deletion?
Prognosis?
Congenital muscular dystrophy (progressive weakness and loss of muscle mass; can confirm with bx, genetic analysis)
Progressive disease w/ no specific tx. Poor px.
JVIM 2021 Shelton
What is caused by SCN9A variant?
Congenital insensitivity to pain
Autosomal recessive
JVIM 2023 Gutierrez-Quintana
True or False: Idiopathic epilepsy is the most common cause of seizures in cats <1yr old.
False – structural disease (FIP, congenital malformation, trauma)
JAVMA 2018 Qahwash
When is ammonia level NOT diagnostically helpful in a cat with seizures?
A) Preictal
B) Postictal
C) In between seizures
B - can have transient hyperammonemia WITHOUT liver dysfunction, goes back to normal within a couple hours
JFMS 2021 Nilsson
In cats, which are more commonly associated with recurrent seizures?
A) Younger
B) Older
C) Idiopathic epilepsy
D) Structural brain disease
B, D
JFMS 2019 Hazenfratz
JVIM 2020 O’Neill
What is high HMGB1 associated with?
A) Idiopathic epilepsy
B) Immune mediated meningoencephalitis
C) Protozoal cause of meningoencephalitis
D) Intracranial neoplasia
E) Canine cognitive dysfunction
A
JVIM 2020 Koo
Are definable seizure triggers (stress, sleep deprivation, weather, hormones) more common for focal or generalized seizures?
Focal
JVIM 2019 Forsgard
Dogs with seizures triggered by eating:
–Possible overrepresented breed?
–More common with idiopathic epilepsy or structural brain disease?
–Effect of changing eating habits (food, bowls, meal size, etc)?
Lab
Idiopathic epilepsy
None – need antiseizure drugs
JVIM 2020 Brocal
Efficacy of the following novel treatments for refractory epilepsy (great, modest/equivocal, worsening)
Medium chain TG
Telmisartan
CBD
All modest/equivocal
JVIM 2020 Berk
JAVMA 2022 Hanael
JAVMA 2019 McGrath
Which antiepileptic drug should be avoided in cats and why?
Bromide –> asthma
JFMS 2018
Which two causes of seizure are less responsive to miazolam CRI?
A) Idiopathic epilepsy
B) Structural epilepsy
C) Reactive seizure
D) Status epilepticus
Which midaz bolus route works faster: intranasal or IV? Does either work better?
C, D
Intranasal works faster unless IVC is already in place. Comparable efficacy.
JVIM 2020 Bray
JVIM 2019 Charalambous
In dogs with status epilepticus who survive to discharge, what two factors are associated with recurrence of status epilepticus?
Prior drug resistant epilepsy
Predominance of a focal seizure phenotype
JVIM 2022 Fentem
Which is true about TDERM phenobarb in cats? Keppra?
A) No bioavailability
B) Variable bioavailability, dosing is trial/error with therapeutic drug monitoring
C) Consistent bioavailability but unable to reach therapeutic dose target
D) Consistent bioavailability and able to reach therapeutic dose target
Pheno - B) variable, trial/error guided by therapeutic drug monitoring
Keppra - D) consistently reaches target goal (from human lit – not established for cats)
JFMS 2019 Heller
JVIM 2019 Smith
How do concurrent phenobarb and/or zonisamide affect the pharmacokinetics of keppra?
A) No effect – stable pharmacokinetics
B) Zonisamide causes variable keppra pharmacokinetics, but pheno does not
C) Pheno causes variable keppra pharmacokinetics, but zonisamide does not
D) They both cause variable keppra pharmacokinetics
E) Unclear – highly variable pharmacokinetics even with keppra monotherapy
C – although pharmacokinetics are variable with keppra monotherapy, pheno makes it worse
JVIM 2018 Munana
Why does midaz have diminishing returns for cluster seizures?
When used with midaz, provides better control of clusters, status epilepticus:
Pheno IV
Keppra rectal
Internalizatoin of GABA-A receptors
Keppra - 94% response rate vs 48% pheno
JVIM 2019 Cagnotti
Which is associated with older cats, stable to improving neuro signs, lateralizing, nonpainful?
A) IVDD
B) Spinal empyema
C) Spinal LSA
D) Spinal MCT
E) Ischemic myelopathy
Which spinal segment does this most commonly affect?
E, C6-T2
JFMS 2020 Mella
12yr MN mixed breed dog with moderate ambulatory proprioceptive ataxia, tetraparesis, CP deficits x4. He has R sided Horner’s.
–Neurolocalization?
–Most likely cause?
C2-C5. Horner’s is unreliable to determine lateralization.
Noncompressive intraparencymal disease (probably FCE)
Summary: cervical myelopathy + Horners –> usually FCE
JVIM 2023 Murthy
Wobbler’s:
–What is the technical term for it?
–Age of onset and difference in etiology for large vs giant breed dogs?
Cervical spondylomyopathy: caused by any combination of vertebral canal stenosis, movement assoc compression, etc
Large breed: median 7yrs, due to intervertebral disc compression
Giant breed: median 2-3yrs (but can be puppies), articular process proliferation
JVIM 2019 Bonelli
Which on this list is the most sensitive test for discospondylitis in dogs with myelopathy?
A) Back pain
B) Fever
C) Neutrophilia
D) Hyperglobulinemia
E) CRP
E) CRP
JVIN 2020 Trub
Which is most common in cats with discospondylitis?
A) Back pain
B) Fever
C) Neuro deficits
D) Positive intradisc FNA culture
E) Positive blood culture
Treatment and prognosis?
A) Back pain (all cats in N = 17 study)
Fever and positive culture were uncommon
Tx: Clavamox or cephalosporine, median 3mo; plus NSAIDs +/- gaba
Px: Good for most (neuro function, pain control)
JFMS 2022 Gomes
Which diseases are associated with the following gene mutations?
COLQ
KCNJ10
LAMA2
MTRM13/SBF2
NDRG1
SCN9A
SOD1
COLQ
Congenital MG in golden retrievers; progressive muscle weakness (ME not a feature), most do horrible
KCNJ10
Spinocerebellar ataxia in Bouvier des Ardennes and Malinois
LAMA2
Congenital muscular dystrophy
MTRM13/SBF2
Demyelinating polyneuropathy in mini schnauzers, usually stable disease with good px
NDRG1
Alaskan Malamute polyneuropathy, can cause tongue atrophy
SCN9a
Congenital insensitivity to pain
SOD1
Degenerative myelopathy
**Note - most (all?) of these are autosomal recessive
Surgery is consistently helpful for:
A) Thoracic vertebral canal stenosis in cats
B) Thoracolumbar vertebral instability
C) Lumbosacral stenosis in dogs
B (pugs, articular process issue) and C
Hit and miss with A
JFMS 2020 Gillespie
JAVMA 2022 Tanoue
JSAP 2022 Aikawa
Define the following:
Schiff-Sherrington
Spinal shock
Central cord syndrome
Schiff-Sherrington: severe T2-L7 lesion with damage to the propriospinal tract –> unable to inhibit forelimb extensors. Normal gait, but extensor rigidity TLs when in lateral.
Spinal shock: T3-L3, severe injury –> interruption in descending motor tracts and local reflex changes –> can look like L4-S3 myelopathy (but not quite as flaccid), commonly have a reduced withdrawal
Central cord syndrome: gray matter spinal lesion, LMN signs TLs (floppy) and UMN signs PLs (incr tone); classically C6-T2 but one paper found more commonly C3-C5
JVIM 2022 McBride
JAVMA 2022 Ros
Constrictive myelopathy:
–Median age, breed?
–Does this tend to occur with or without other concurrent myelopathies?
–How common is fecal incontinence?
Middle aged pugs
Usually other concurrent myelopathies
Progressive disease – 80% become fecally incontinent
JVIM 2023 Wachowiak
Nontraumatic spinal cord hemorrhage:
–Top three causes? Px with these?
–Which is more important for px: etiology or severity of neuro signs?
Idiopathic»_space; Angiostrongylus vasorum > SRMA
Px was generally good to excellent. Etiology more important than severity of signs.
West
What percentage of dogs recover from IVDD with med vs sx:
–Spinal pain, ambulatory paraparesis
–Nonambulatory paraparesis
–Paraplegia, deep pain positive
–Paraplegia, deep pain neg
–Spinal pain, ambulatory paraparesis: 80%/99%
–Nonambulatory paraparesis: 81/93
–Paraplegia, deep pain positive: 60/93
–Paraplegia, deep pain neg: 21/61
**Note – less complete recovery with med vs sx mgmt
JVIM 2022 Olby
True or False: NSAIDs and pred are equally reasonable for acute and chronic IVDD.
False
Acute - use NSAIDs
Chronic - use pred
JVIM 2022 Olby
Four abx classes that can cross the BBB?
‘Amphenicols
TMS
Tetracyclines (somewhat)
Fluoroquinolones (somewhat)
1yr FS fawn colored pug. Routine wellness exam reveals multifocal spinal pain, reduced menace, and mild left sided paw placement deficits.
What ddx are you worried about? What are the CS of fulminant disease?
Early signs of necrotizing meningoencephalitis
Median onset of fulminant disease 1.5-2.5yrs old
CS = rapidly progressive sz, circling, visual deficits, behavior change
JVIM 2022 Windsor
What three factors are associated with post-MUO epilepsy? (1 signalment, 1 CS, 1 MRI)
How does this affect px?
Younger, with sz early in MUO, lesions in hippocampus
Shorter survival
JVIM 2020 Kaczmarska
High neutrophil:lymphocyte ratio can NOT differentiate MUO from which of the following?
A) Normal dogs
B) Idiopathic epilepsy
C) Intracranial neoplasia
D) Hydrocephalus
C) Intracranial neoplasia
So, high N:L –> ddx MUO or cancer
JVIM 2022 Park
What proportion of MUO dogs overall have seizures? Those with BBB dysfunction?
20%
70%
JVIM 2022 Hanael
CSF collection:
Which should be sampled for diagnostic accuracy?
A) Cerebellomedullary cistern
B) Lumbar subarachnoid space
C) Both
D) Either
SRMA:
Which informs likelihood of relapse?
A) CSF nucleated cell count
B) Treatment protocol
C) Both
D) Neither
C) Sample both sites; either is equally likely to be normal vs diagnostic, so gotta do both. Exception - TL myelopathy, may be fine to do lumbar only.
A) CSF nucleated cell count
JVIM 2019 Lau
JAVMA 2019 Carletti
JVIM 2020 Lampe
Dogs with SRMA frequently have concurrent cardiomyopathy. What is the most common finding on echo?
Do cardiac abnormalities typically resolve with tx for SRMA?
Spontaneous contrast
Yes – within 2 weeks
JSAP 2019 Spence
What is the difference between intracranial abscess vs empyema?
Do cats with either of these diseases do better with sx or med management?
Abscess - intra-axial collection of pus
Empyema - pus within a preexisting anatomical cavity
MST trended longer for surgical but did not reach statistical significance, and either sx or med can do quite well
JFMS 2019 Martin
True or False: CS of bacterial meningitis/meningoencephalitis in dogs is variable. Px with treatment is generally good.
True
JVIM 2023 Rawson
Intracranial surgery:
When are complications most common?
A) Immediately post op
B) Within a week post op
C) Long term
How often are they life threatening?
B) Half within a week (neuro deficits, sz, anemia, asp pneumonia)
C) 40% long term (neuro deficits, sz)
A) One third immediate post op (hypotension, anemia)
Usually not life threatening
JAVMA 2022 Morton
CNS histiocytic sarcoma:
–For which breed is this always disseminated, rather than a primary tumor?
–What is the utility of CSF and serum Neut:Lymph ratio? (Dfdx? Local vs disseminated HS?)
–Px depending on local vs disseminated dz and tx?
–Rottie
–Dfdx but not tumor subtype
–Px best with primary tumor and definitive RT (6 wks) but overall still poor
JVIM 2020 Toyoda
True or False: Altered consciousness is highly sensitive for brain herniation.
False
JFMS 2020 Kouno
Pituitary apoplexy in dogs:
–What is it?
–Top 3 PE findings?
–Treatment? How does this affect px?
–True or False: Dogs almost always present with rapidly progressive HAC signs.
Bleed or infarct in pituitary macroadenoma
Gait/posture change, mentation change, abnormal CN exam
Radiation better MST (2.6yrs) vs medical management (5mo)
False – 40% had no endocrinopathy signs at all
JVIM 2023 Woelfel
Which is a sensitive and specific predictor of incr intracranial pressure?
A) Clinical impression
B) MRI
C) Both
D) Neither
D) Neither
Clinical impression not good at all
MRI high sens but only moderate spec
JVIM 2020 Giannasi
Which can help predict mortality in dogs with TBI when measured at presentation?
A) BG
B) Modified Glasgow Coma Scale
C) Both
D) Neither
C) Both
Nonsurvivors:
–Higher BG (dogs only!)
–Higher MGCS
JVECC 2022 Cameron
15yr MN DSH with moderate PL ataxia and a shifting head tilt. His head tilts to the opposite side to which he is moving.
What abnormality are you expecting on bloodwork?
Hypokalemia –> hypokalemic myopathy, positioning head tilt
Should resolve with K+ supplementation
JFMS 2023 Tamura
CVA in CATS vs DOGS:
–Usually ischemic (clot) or hemorrhagic?
–Usually idiopathic or underlying disease?
Both: ischemic
Cats: usually underlying disease (HCM, pulmonary mass, hyperthyroid)
Dogs: Half underlying disease (usually heart)
JSAP 2022 Ozawa
JFMS 2019 Whittaker
Frunevetmab:
–What proportion of cats respond?
–List a few side effects.
75%
Derm stuff (alopecia, pruritus, etc)
JVIM 2021 Gruen
What medication could act as a substitute for the tensilon test?
Neostygmine
**Note – still had a few false positives, but was safe to give pending AChR titer results
JVECC 2021 Cridge
Muscle cramps:
–Often triggered by?
–Majority are due to?
–Idiopathic in what breed?
Prompting dog to move
Hypoparathyroidism
GSDs
JVIM 2020 Gagliardo
Common features of muscle stiffness in HAC dogs:
–Dog size
–Legs affected
–Timing of dx relative to HAC
–Improvement with trilostane?
–Effect on survival time?
Almost all <20kg
PLs»_space; all four > TLs
After»_space; before»_space;> at the same time
HAC signs improved as expected but not muscle stiffness. That usually persisted or progressed even with add’l therapies.
None
JVIM 2023 Golinelli
9mo FI Great dane with significant, high frequency tremors in all four limbs when standing. Goes away when she lays down.
–Likely ddx?
–Three tests to confirm?
–Treatment and response rate?
Orthostatic tremor - rare movement disorder, mostly young large/giant breed dogs, can be idiopathic or secondary to other disease
Resolution of tremors on weight bearing lifting test (WEBLT)
EMG
“Helicopter sign” (stethescope on tremoring leg sounds like a helicopter)
Antiepileptics +/- gaba, 75% improve
JVIM 2021 Liatis
2yr MI American staffordshire terrier with chronic inspiratory stridor. What hereditary condition is seen in this breed which could explain his CS? Prognosis?
Juvenile onset polyneuropathy - autosomal recessive
Slow progression in most dogs, most able to maintain good QoL and ambulatory status
Lar-par common, ME rare
JVIM 2018 Vandenberghe
6mo FI Siberian cat with chronic, progressive, waxing/waning muscle weakness. On PE, her withdrawal reflex is decreased.
What hereditary condition is seen in this breed which could explain her CS? Prognosis?
If this had been a 10mo MN cat, what inflammatory disease would you consider? Dx, tx, px?
Juvenile onset motor polyneuropathy
Will probably grow out of it by 1yr old. For episodes, can try onsior, pred, or benign neglect.
Immune mediated polyneuropathy (affects motor axons only). Male > female, almost all <3yrs old. Dx - electrodiagnostics, muscle/nerve bx. Most recover (though a quarter go on to have more episodes), similar rate with or without steroids.
JVIM 2020 Crawford
JVIM 2023 Van Caenegem
3yr FS Sphynx with short (<5min) episodes of abnormal walking due to muscle stiffness in all four limbs. Seems like episodes may be triggered when she suddenly gets up, or is excited.
What hereditary condition is seen in this breed which could explain her CS? One medication that may help? Prognosis?
A similar condition is seen in what dog breed?
Paroxysmal dyskinesia
Can try acetazolamide if you want, unclear if it helps since patients often go into spontaneous remission. Does not seem to affect QoL.
Maltese
JFMS 2022 James
JVIM 2020 Polidoro
True or False: Trazodone does not affect neuro exams in dogs.
False - 20% of dogs will have new/worse postural deficits. Ideally don’t give it.
JVIM 2022 Lueck
