CKC's--hypertonicity with exercise Clonazepam and time

Neurology 4 Flashcards by Lindsey Fore

What is seen with vestibular disease?

Peripheral or central
- Head tilt
- Circling and falling
- Nystagmus
Most issues arise due to ear infections reaching middle ear
Brain itself is fine–info coming in is messed up
Signs will appear on the same side as the lesion

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How do you differentiate between peripheral and central lesions?

Peripheral
- No CP def/pares
- No depression
- Fac/Horner’s? (runs through ear)
- Nystagmus–horiz./rotational
  - Not variable with head movement
  - Eyes move together
Central
- Tetra or hemiparesis
- Depression (RAS)
- Other cranial nerves
- Nystagmus–vert too
  - Varies w/ head movement
  - Eyes move independently (dif. directions)

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What are the 4 causes of peripheral brain conditions?

Otitis media interna
Feline idiopathic vestibular disease
Canine geriatric vestibular disease
Miscellaneous (congenital)

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Otitis media-interna

Otoscopy/rads/CT
- Red lining, tympanic membrane destroyed = infection entered inner ear
Antibiotics–systemic/topical
Infection in vestibular system = treat systemically as well
Clinical signs: scratching, shaking head

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Feline idiopathic vestibular disease

Canine geriatric vestibular disease

Miscellaneous peripheral vestibular disease (congenital)

Feline
- Lack of physio nystagmus
- Tend to sway side to side
- Fall over to one side
- Recommend antihistamines–can increase blood supply in certain areas
Canine
- Dogs seem completely normal on neuro/physical exam
- Usually improve faster than cats
- Cosmetic problems can remain
Congenital
- Delayed development
  - GSD, beagle, dobes, siam., burm.
- Signs by 3 m. and resolve over 3m.

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Central peripheral diseases

Neoplasia (older animals)
Infectious
- Viral (distemper)
- Bacterial
- Crypto, toxo/neosporum
Toxicity–aminoglycosides, metronidazole (dose important)
Hypothyroidism–can cause any peripheral neuropathy
GME
Thiamine deficiency (cats fed all-fish diets)
Trauma
Strokes

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Paradoxical vestibular syndrome

Signs on OPPOSITE side of the lesion
Lack of inhibition on the vestibular nucleus on the side of the lesion in the cerebellum –> increased extensor muscle tone on that side of the body –> head tilt, circling, falling to opposite side (mimicking a vestibular lesion on the opposite side)
Animal has proprioceptive deficits on the side of the cerebellar lesion but vestibular signs on the opposite side
Lesion in the cerebellum is on the opposite side to that indicated by the head tilt, falling, and slow phase of nystagmus; it is on the same side as indicated by the proprioceptive deficits

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What does the cerebellum control? What are the common cerebellar signs (8)?

Cerebellum: fine-tune muscle activity/maintains equilibrium

Signs

Wide based stance
Truncal ataxia (sways)
Dystmetria–improper measuring (over-stepping)
Intention tremor–head bob (eating/drinking)
CP and reflexes ok
Signs with SC tract damage
Decerebellate rigidity–hind legs flex up tightly
Shiff-Sherrington syndrome (front legs extended out, back legs floppy)

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What is associated with cerebellar hypoplasia in cats vs. dogs? What are the signs?

Cats–in utero: panleuk (parvo)
Dogs
- Congenital hypo/aplasia
- Parvo
Signs–6 weeks
- Trunkal ataxia, dysmetria, tremor
- Non-progressive + may compensate
- Definitive diag: CT/MRI/necropsy

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Give examples of the following:

Cerebellar abiotrophies

Cerebellar infections

Neoplasia

Abiotrophies
- Early neuronal death–disrupted metabolism
- Almost every dog breed but rare in cats
- Signs progressive (old animals)
- Diagnose at necropsy
Infections
- Distemper/FIP + other neuro/syst signs
  - Cerebral, seizures, facial nerve paralysis, vestibular nerve signs
Neoplasia
- Primary–medullablastomas, gliomas
- Secondary–wide variety

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Shaker dog disease–tell me all the things, including differential diagnoses

Maltese– < 15kg
Tremors head + limbs
Worse with exercise/excitement
Not when asleep
Prednisone–2mg/kg
- Respond very well, taper off
DD’s
- Fear
- Hypomyelination
  - Born w/o myelin–> whole body trembling
- Tremorgens (toxins prod. by mold)
- Toxins
- Orthostatic tremor (large breed dogs)
- Head bobbing
- Old dog hind limb tremors

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Scotty cramp

Serotonin deficiency (brain) +/- PG abnormality
Animal folds up in ball
Stiffen with exercise
Tryptophan/serotonin-increasing drugs effective
Prozac–selective serotonin reuptake inhibitor

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Episodic falling

CKC’s–hypertonicity with exercise
Clonazepam and time

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Hydrocephalus (general)

Dilated ventricles of brain
Dec. CSF flow–cong, neoplasia, subarach. hem., meningitis
Inc. secretion (tumor choroid plexus)
Inc. pressure –> atrophy of surrounding cells –> dec. function

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Signs of hydrocephaly?

Most congenital–toys + brachycephalics
Signs at weeks/months–progressive
- Mental attitude–depressed/excited
- Learning, seizures, blind, deaf
- Tetraparesis–clumsy, uncoordinated
- Strabismus–lateral divergent
Skull domed, fontanel’s open often
Acquired–signs of cause–FIP, toxo

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How do you diagnose hydrocephalus? What is the treatment?

CT/MRI imaging
Ultrasound if fontanelles open
CSF–herniation
- Do NOT collect CSF–> brainstem herniation from decreased pressure
Treatment
- Shunts: CSF —> abdominal/jug
  - Tube runs from ventricles to abdomen
  - When brain gets to full, empties into tube –> abdomen –> reabsorbed
- Dex–temp, dec. signs
- Pred, diuretics, promethesol (temporary)
- Surgery ASAP–control pressure and dec. possible damage to ventricles

Brain neoplasia

Primary–gliomas (20%) and meningiomas (45%–cats)
Secondary–range of mets
- HAs, lymph (cats), carcino
Older dogs (> 7yr) and cats (8-10)
Signs depend on site/rate
- Cortex = behavior, seizures, circling (af), vision/nasal (con)
- Stem = depression, paresis, cranial nerve abnormalities; slow, no seizures
Diagnosis–imaging, CSF (biopsy)

Treatment of brain neoplasias? Prognosis?

Benign superficial (meningiomas)–surgery
- Remove skull, scoop tumor out
Dexamethazone/mannitol to reduce edema
- Take away inflammation
- Temporarily dec. tumor
Radiation?
Prognosis–metastasize; nothing you can really do
- Meningiomas 4m-1-3y
- Gliomas (secondaries) 4-12m

Brain herniation

Space-occupying lesion
Decrease CSF outflow –> increasing intracranial pressure
Falx cerebri or tentorium cerebelli
Most severe when cerebellum pushed out of foramen magnum
- Rapidly fatal (compress brainstem)

What are the signs of a brain herniation?

Underlying cause–CSF tap/volatile anesth.
Increased ICP:
- Depression
- Poor PLRs
- Breathing abnormalities (cyclic)
- Cranial nerve deficits
Herniation–acute, rapidly prog. tetraparesis (motor tract compression)
Coma
Respiratory arrest
Always look at ICP before anesthetizing animal w/ brain problems–can give steroids, block CSF prod.–>reduce swelling/pressure, THEN perform CSF tap after

Diagnosis and treatment of brain herniation?

Diagnosis
- Clinical suspicion
- MRI
- Necropsy diagnosis
Treatment
- Remove underlying cause
- Dex may reduce edema + herniation
- Manitol

Cranial trauma

Increased in cats
Dysfunction with:
- Concussion
  - No morphological lesion
  - Transient unconsciousness
  - Confusion/ataxia for a few days
- Contusion = focal hemorrhage + edema
  - More confused and ataxic
  - CP deficits
  - Unconscious longer
- More severe hemorrhage
  - Meningeal (extracerebral) = cortex
    - Develop slowly, can remove
  - Brain vessels (intracerebral) = stem

What are the signs of cranial trauma?

Depends on site

Cortex
- Decreased consciousness
- Normal cranial nerves (menace + nostril stimulation)
- Seizures
- Contralateral hemiparesis
Brain stem
- Decreased consciousness
- Abnormal cranial nerves
- Irregular respiration
- Bradycardia
- Abnormal PLRs–mydriasis
- UMN signs–extensor rigidity

What occurs when an animal is decerebrate?

Unconscious
Forelimbs extended
Hindlimbs extended

What is the difference between primary and secondary damage with cranial trauma?

* Primary * Primary damage to parenchyma and vessels from the trauma * No control over this * Secondary * Abnormal metabolic processes * Leads to decreased perfusion, increased ICP * Can be treated--make sure no complications arise

How do you diagnose cranial trauma?

* History + physical + neuro exam * Cranial nerves * Pupils * Respiration * Stabilize, then take skull rads * CRI/MRI--intra vs. extracerebral

How do you treat cranial trauma?

* Shock/life-threatening injuries = ABC (airways, breathing, cardiovascular) * Hetastarch/hypertonic--BP/ICP * Increased PaCO₂ + decreased PO₂ --vasodilation - increased ICP * Body \< 30^o -- venous + CSF outflow * Soluble corticosteroids? * Deteriorating/severe--mannitol * MUST wait til animal is stabilized * Seizures--diazepam (best/safest), phenobarb, propofol (put animal to sleep--\> brain works less) * Hematomas/wounds/deep fractures--surgery--prop + isoflurane

What are the different prognoses of cranial trauma?

* Response to medical therapy in 4-6hrs--promising prognosis * Coma \> 2d = grave prognosis * Irregular respiration + unresponsive bilateral mydriasis = poor prognosis * Euth--intractable seizures/resp failure * Coma score--monitoring and prognosis * Motor activity * Brain stem reflexes * Consciousness

Narcolepsy--all the things

* Sudden attacks of sleep +/- cataplexy * Excitement * Can awaken * Classical sleep EEG * Autonomic imbalances * Orexin (sleep neurotransmitter), hypocretins * Amphetamines (Ritalin)--decrease excitement receptors * Antidepress--imipramine

What are some conditions with multiple neurological signs?

* Rabies * Distemper * Parvo * Neospora * Herpes * Toxo * FIV encephalitis 30% neurotrophic, behavior +/- focal

Feline ischemic encephalopathy

* Acute ischemic necrosis--*Cuterebra* migration * Accidental migration to brain * Non-progressive signs of behavior changes, seizures, unilateral blindness, circling, hemiparesis, head tilt * Usually recover, seizures may persist * **Steroids not a good idea--can get anaphylactic rxn when larvae die**

Granulomatous meningoencephalomyelitis

* Inflammatory--cell-mediated * Middle aged, small breeds * Focal form--chronic * Resembles tumor--only 1 part of brain, slow-growing * Disseminated form--acute * Dangerous--can die w/in hours after appearing normal * Diagnosis--CSF, MRI (25% normal), histopathology * No treatment--1w-2m; 1 year seizures usually * Prednisone--1w-3m (doesn't respond to pred) * Cytosine arabinoside (anti-metabolism), ciclosporin, procarbazine (anti-neoplastic agent)--1yr

What are the signs in the following? FIP FeLV Feline polioencephalomyelitis Bacterial meningioencephalitis

* FIP * Dry form--CNS + eye signs * FeLV * Degenerative myelopathy * Feline polioencephalomyelitis ("Staggering disease") * Staggers, circles, nystagmus, paresis, psychoseizures, BORNA * Bacterial meingioencephalitis * Rare--*S. intermedius--*hematogenous, direct spread * Fever, neck pain + rigidity, seizures * Diagnosis--CSF--pleocytosis, protein * Poor prognosis * Antibiotics--chloro? 6 weeks

Steroid-responsive meningitis-arteritis

* Cervical area--meningeal arteritis, hemorrhage, and inflammation * Young dogs \< 2yrs--Beagles, boxers, Bernese, etc. * Acute onset, fever, neck pain--recurs/chronic * Peripheral neutrophilia + CSF pleocytosis + IgA * IgA levels raised in steroid-responsive meningitis (relatively level in bacterial meningitis) * Immunosuppressive prednisone * Should only be stopped 6 months after all findings are normal

Dysautonomia

* Degeneration of sym + para ganglia * *C. botulinum* * Extremely potent * Antibodies against organism suggests animal has it growing inside them * Autonomic signs * Parasympathetic dysfunction * 3rd eyelid prolapse * 30% survive * Anorexia, wt. loss, obtundation

What are the signs of dysautonomia in dogs?

* Dysuria * Distended bladder * Mydriasis * Absent PLR * Dry mm * Weight loss * Dec. tears * Dec. anal reflex * Dec. appetite * Vomit/regurg * 70% mortality

What are the 3 types of deafness?

1. Conductive--from continuous infections 2. Central--rare 3. Sensorineural--cochlear congenital * Congenital * Pigment * Dalmations * Cats white coat + blue eyes * Acquired * Noise, toxic--antibiotics * Antibiotics, ceruminolytics, antiseptics (chlorhex 0.2%) * Presbycusis * Diagnosis--BAEP, euth/neuter--hearing aids?