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NEU2 > Neurology > Flashcards

Neurology Flashcards

Introduction, review of NEU1, neurological examination, head tilt

1
Q

What signs would be seen in the limbs of an animal with a cranial lesion CNS?

A

Forelimbs and hindlimbs UMN signs, i.e. spastic paralysis

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2
Q

What signs would be seen in the limbs of an animal with a lesion at the level of C1-C5?

A

Forelimbs and hindlimbs UMN i.e. spastic paralysis

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3
Q

What signs would be seen in the limbs of an animal with a lesion at the level of C6-T2?

A

Forelimbs LMN (flaccid paralysis), hindlimbs UMN (spastic paralysis)

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4
Q

What signs would be seen in the limbs of an animals with a lesion at the level of T3-L3?

A

Forelimbs normal, hindlimbs UMN (spastic paralysis)

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5
Q

What signs would be seen in the limbs of an animal with a lesion at the level of L4-S3?

A

Forelimbs normal, hindlimbs LMN (flaccid paralysis)

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6
Q

What are the roles of the forebrain?

A
  • Mentation
  • visual/auditory processing
  • Motor initiation
  • Sensory perception
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7
Q

Describe the signs of forebrain syndrome

A
  • Altered mental state
  • Central blindness/deafness
  • Inatention
  • Normal to paretic gait (large circles towards side of lesion)
  • Abnormal postural reactions (contralateral)
  • Abnormal movement/postures (head pressing)
  • Seizures
  • +/- papilledema
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8
Q

What is papilledema?

A

Swelling of the optic nerve head, may be seen with forebrain swelling

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9
Q

Describe the signs of cerebellar lesions

A
  • Ataxia
  • Wide based stance
  • Dysmetria (normal strength)
  • intention tremor (generalised and eyes)
  • Extensor hypertonus
  • May have absent menace, opisthotonus, vestibular signs
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10
Q

What is opisthotonus?

A

Muscle spasm leading to backwards arching of the head, neck and spine

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11
Q

Describe the signs of a diencephalic lesion

A
  • UMN signs in all 4 limbs or contralateral
  • Mental depression
  • Optic nerve deficit
  • Endocrine autonomic deficits
  • Inappetance
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12
Q

Describe the signs of a midbrain lesion

A
  • UMN signs in all 4 limbs or contralateral
  • Mental depression
  • Ipsilateral oculomotor (III) signs
  • May have hhperventilation and head pressing
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13
Q

Describe the signs of a pontomedullary lesion

A
  • UMN signs in all 4 limbs (ipsi or contralateral)
  • Postural reaction deficits
  • Cranial nerve IV-VII deficits
  • Altered mental state
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14
Q

Compare the signs of a central and a peripheral vestibular lesion

A
  • In both: head tilt, asymmetric ataxia, nystagmus
  • Only in central: positional nystagmus (+/- other central nerve deficits, decreased proprioception, paresis)
  • +/- in either: Horner’s, facial paralysis
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15
Q

Outline how the sign/time graph

A
  • Trauma and infection initially get worse, then get better with time (signs increase, then decrease with time)
  • Neoplastic and degenerative signs worsen with time
  • Anomalous diseases do not change over time so signs are constant
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16
Q

What is the main difference between botulism and tetanus?

A

Botulism is flaccid paralysis, tetanus is spastic paralysis

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17
Q

How does tetanus develop?

A

Entrance of bacteria through broken skin and colonise wound, but tentus will not develop in every would colonised by C. tetani - requires an anaerobic environment

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18
Q

where does the tetanus toxin have its effect?

A

Effect in the spinal cord, affecting the interneurons

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19
Q

Describe the treatment of tetanus

A
  • Vaccination
  • Flush wound in order to make it aerobic (more effective than antibiotics, need to get rid of the wound)
  • Antibiotics, antitoxin, antibodies
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20
Q

How does botulism develop?

A

Ingestion of the toxin, commonly from bad tinned food or spoiled hay

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21
Q

How does botulism has its effect?

A

Action in the lower motor neurons, affecting the neuromuscular junction

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22
Q

Describe the treatment of botulism

A
  • Antibiotics no effect as only the toxin is ingested

- Need to consider source of ingestion and remove

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23
Q

How is botulism different in horses/foals compared to other animals?

A

Clostridium botulinum bacteria can be ingested and can colonise the intestinal system, so not just toxins causing disease

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24
Q

What is the main value of assessing proprioception in an animal presented with lameness?

A

Identify as fracture or neurological

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25
Q

What lesions would lead to proprioceptive deficits?

A

Damage to cerebellum, forebrain, brainstem, spinal cord

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26
Q

What are the main signs that would distinguish a forebrain lesion from another brain region?

A

With forebrain, would expect seizures, circling, head turn, behavioural changes

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27
Q

Compare the outflow of the parasymathetic and sympathic nervous system

A
  • Para out via cranial nerves mostly

- Sympathetic out via thoracolumbar and back up via vagosympathetic trunk through middle ear

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28
Q

What tests would you perform in an animal presented with asymmetry of the face and why?

A
  • Suggests cranial nerve VII affected
  • Test with palpebral response
  • Schirmer tear test (VII) controls lacrimation
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29
Q

What does a unilaterally constricted pupil suggest?

A

Loss of sympathetic innervation to that eye

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30
Q

Explain the use and appearance of contrast medium on MRI

A
  • Gadalinium, not iodine
  • IV administration
  • Usually will not cross BBB
  • Shows up white on T1 weighted images
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31
Q

Which tests are used to assess CNII?

A

(Optic)

  • Conscious vision (tracking)
  • Menace (also VII)
  • Visual placing
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32
Q

How is CNIII function assessed?

A

(Oculomotor)

  • PLR (also tests II): direct and indirect
  • Anisocoria
  • Fixating response (also II)
  • Strabismus
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33
Q

How is CNV function assessed?

A
  • Palpebral reflex
  • Corneal reflex
  • Skin sensation
  • Temporal/masseter muscle mass
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34
Q

What is the function of cranial nerve VI?

A

Abducens nerve, eye movement (motor)

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35
Q

How is CNVII function assessed?

A

(Facial)

  • Facial muscle symmetry
  • Lacrimal gland function
  • Nasal gland function
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36
Q

How is CNVIII function assessed?

A

(Vestibulocochlear)
Hearing
- Nystagmus (also III, IV, VI, VIII)

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37
Q

How is CNIX function assessed?

A

(Glossopharyngeal)

Swallowing (gag)

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38
Q

How is CNX function assessed?

A

(Vagus)

  • Laryngeal function (bark)
  • Gastrointestinal function
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39
Q

How is CNXI function assessed?

A

(Accessory)

Neck position/tone

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40
Q

How is CNXII function assessed?

A

(Hypoglossal)

- Tongue position and tone

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41
Q

Describe a normal mental status

A

Alert, with normal response to environmental stimuli

42
Q

Describe a confused and disorientated mental status

A

Responding to environmental stimuli in an appropriate manner

43
Q

Describe a depressed mental status

A

Drowsiness, inattention and less responsive to environmental stimuli

44
Q

Describe a stuporous mental status

A

State of unconsciousness with reduced responses to external stimuli, but can be roused by a painful stimulus

45
Q

Describe a comatose mental status

A

state of unconsciousness with absence of response to any environmental stimuli including pain

46
Q

What is indicated by a head tilt vs a head turn?

A
  • Head tilt indicates vestibular
  • Head turn indicates forebrain
  • Both present with circling towards the side of the lesion
47
Q

What is the function of cranial nerve I?

A

Olfactory, smell, sensory

48
Q

What is the function of cranial nerve II?

A

Optic, vision, sensory

49
Q

What is the function of cranial nerve III?

A

Oculomotor, eye movement, motor

50
Q

What is the function of cranial nerve IV?

A

Trochlear, eye movement, motor

51
Q

What is the function of cranial nerve V?

A

Trigeminal, 3 branches, facial sensation and integrity of masticatory muscles, sensory and motor

52
Q

What is the function of cranial nerve VI?

A

Abducend, eye movement, motor

53
Q

What is the function of cranial nerve VII?

A

Facial, facial expression, taste, functionality of rostral 2/3rd of tongue, lacrimation and salivation, sensory and motor

54
Q

What is the function of cranial nerve VIII?

A

Auditory/vestibulocochlear, hearing and vestibular function, sensory

55
Q

What is the function of cranial nerve IX?

A

Glossopharyngeal, pharyngeal sensory and muscular action, sensory and motor

56
Q

What is the function of cranial nerve X?

A

Vagus, purely parasympathetic, laryngeal sensation and motor control, sensory and motor

57
Q

What is the function of cranial nerve XI?

A

Accessory, controls neck muscles, motor

58
Q

What is the function of cranial nerve XII?

A

Hypoglossal, controls intrinsic tongue muscles, motor

59
Q

What is the afferent and efferent supplies that facilitate the palpebral response?

A

Afferent: trigeminal
Efferent: facial

60
Q

What are the afferent and efferent supplies for the PLR?

A

Afferent: optic nerve
Efferent: oculomotor nerve

61
Q

What are the afferent and efferent supplies for the menace response?

A

Afferent: optic nerve
Efferent: facial nerve

62
Q

What brain regions are involved in the menace response?

A

Conscious visual pathways, contralateral visual cortex, contralateral motor cortex, ipsilateral cerebellar hemisphere

63
Q

Describe the pathways of conscious vision

A
  • Light into eye, singal conducted by optic nerve to optic chiasm
  • Fibres cross and one travels to ipsipateral and one to contralateral lateral geniculate nucleus via optic tract
  • Optic radiation into visual cortex from the LGN
64
Q

Define strabismus and what nerves are involved?

A

Abnormal static position of the eye

Generated by lesions affecting CN III, IV, and VI

65
Q

What does a “dolls eye” movement suggest?

A

Physiological nystagmus

66
Q

Describe the signs of Horner’s syndrome in the small animal, horse and cow

A
  • Ptosis, meiosis, enophthalmus in most
  • Horse: ptosis and ipsilateral facial sweating
  • Cow: ipselateral dry nose
67
Q

What is assessed in the neurological examination of the trunk?

A
  • Spinal pain
  • Perineal reflex
  • Bladder function
  • Muscle tone/atrophy
  • Tail carriage
  • Aim to identify focal regions of pain or dysfunction
68
Q

Where should the panniculus reflex be demonstrable in the dog?

A

From the scapula to the pelvis

69
Q

What is assessed in the neurological examination of the limbs?

A
  • Proprioception
  • Sensation
  • Segmental reflexes
  • Muscle mass and tone
70
Q

Describe the assessment (method, nerve assessed) of the myotatic reflexes of the extensor carpi radialis (ECR)

A
  • Percuss muscle belly of ECR
  • Reflex extension of the carpus
  • Tests radial nerve
71
Q

Describe the assessment of the myotatic reflexes (method, nerve assessed) of the biceps

A
  • Percuss finger/thumb pressing into tendon of insertion of the biceps muscle
  • Reflex contraction of muscle generates flexion of elbow, more common felt as increased tension in tendon of insertion
  • Movement of skin over muscle belly/visible contraction
  • Tests musculocutaneous nerve
72
Q

Describe the assessment of the myotatic reflexes (method, nerve assessed) of the triceps muscle

A
  • Percuss finger/thumb which are pressing onto tendon of insertion of triceps
  • Reflex contraction of trips generates reflex extension of elbow, increased tension intendon of insertion, movemet of skin over muscle belly/visible contraction
  • tests radial nerve
73
Q

Describe the assessment of the myotatic reflexes (method, nerve assessed) of the patella

A
  • Percuss straight patellar tendon, resulting in reflex extension of stifle
  • Tests the femoral nerve
74
Q

Describe the assessment of the myotatic reflexes (method, nerve assessed) of the cranial tibial muscle

A
  • Percuss muscle belly of cranial tibial muscle
  • Reflex flexion of hock
  • Tests sciatic nerve
75
Q

How is the lumbosacral spinal cord assessed?

A
  • Perineal reflex (stimulation of perineal region should elicit winking or constriction of anal sphincter)
  • Anal sphincter should exhibit good tone
  • Good tail tone and function with no reduction in tail carriage
76
Q

Compare the appearance of upper and lower motor neuron lesions

A
  • UMN: increased/normal reflexes, high tone, slow muscle atrophy
  • LMN: rapid muscle atrophy, reduced reflexes, low tone
77
Q

Compare the neurological examination of dogs and cats

A
  • Cats same as dogs in terms of tests that can be performed and interpretation of tests
  • Cats often do not tolerate restraint and manipulation required
  • Cats will often tolerate 3 tests, so choose 3 that are most likely to confirm suspicions re. lesion localisation and severity
78
Q

List the differentials for a cat with sudden onset left sided head tilt with no history of trauma or previous related clinical problems, and no other clinical signs

A
  • Most likely peripheral, central would show other cranial nerve deficits
  • Otitis media/interna
  • Idiopathic vestibular disease
  • Pharyngeal polyps
  • Oral neroplasia
  • Toxicity
  • Inflammatory or traumatic brainstem lesion
  • Ear mites
  • Hypothyroidism
79
Q

List the differential diagnoses for a cat presented with central vestibular disease

A
  • Vascular lesions
  • Brainstem neoplasia
  • FIP (dry form)
  • Toxoplasmosis
  • GME
  • Thymine deficiency
  • Forebrain lesion
80
Q

Outline the diagnosis of a peripheral vestibular problem in cats

A
  • Full neuroexam
  • Aural exam, esp. for OM, ear parasites
  • Advanced imaging for OI, neoplasia, thymine deficiency, vascular disease
  • Pharyngeal examination for polyps
  • CSF or serology for toxoplasmosis, but common infection that does not commonly cause problems
  • CSF for GME
  • Idiopathic vestibular diagnosis by exclusion
  • Leave and watch for improvement/worsening
81
Q

List the degenerative causes of central vestibular disease in dogs

A
  • Lysosomal storage disorders

- Neurodegenerative diseases

82
Q

List the anomalous causes of peripheral and central vestibular disease in dogs

A
  • Central: Chiari-like malformation

- Congenital vestibular disease

83
Q

List the metabolic causes of vestibular disease in dogs

A

Hypothyroidism (peripheral vestibular)

84
Q

List the nutritional causes of vestibular disease in dogs

A

Thiamine deficiency (central vestibular)

85
Q

List the inflammatory causes of peripheral and central vestibular disease in dogs

A
  • Central: meningoencephalitis

- Peripheral: otitis media/interna, nasopharyngeal polps

86
Q

List the idiopathic causes of peripheral and central vestibular disease in dogs

A
  • Central: arachnoid cysts

- Peripheral: idiopathic vestibular disease

87
Q

List the toxic causes of peripheral and central vestibular disease in dogs

A
  • Central: metronidazole

- Peripheral: aminoglycosides, topical iodophors, chlorhexidine and others

88
Q

List the traumatic causes of peripheral and central vestibular disease in dogs

A
  • Central: head trauma

- Peripheral: trauma to middle or inner ear

89
Q

List the vascular causes of vestibular disease in dogs

A

Cerebrovascular disease (central), lungworm most common cause of vascular disease

90
Q

List the differential diagnoses for a dog presented with progressive left sided head tilt, which has progresseed over preceding month

A
  • Vascular (lungowrm most common cause)
  • Brain neoplasia
  • Otitis media
  • Hypothyroidism
  • Autoimmne
  • Lysosomal storage disorders
  • Neurodegenerative diseases
  • Toxins
  • Ear parasites
  • Neospora caninum
  • Polyps (rare in dogs)
  • GME (common)
91
Q

Outline a diagnostic plan for a dog with progressive left sided head tilt, which has progresseed over preceding month

A
  • Thorough history
  • Observation, full general and full neuro exam
  • Otoscopy
  • CSF, MRI for neoplasia with inflammation or infectious with inflammation
  • Serology (lungowrm)
  • CBC, urinalysis, thyroid panel: primary bleeding disorder (also haemorrhages elsewhere), metabolic disease
  • Radiography of tympanic bullae for OI
  • Refer for CT, MRI
  • Trial clindamycin for Toxo/Neospora
92
Q

List the differential diagnoses for a rabbit presented with central vestibular dysfunction

A
  • Bacterial infection
  • Listeriosis
  • Herpesvirus encephalitis
  • Visceral larval migrans
  • Encephalotozoon
  • Toxoplasmosis
  • Neoplasia
  • cerebrovascular accident
  • Degenerative changes
  • Trauma
  • Rabies (not UK)
  • Toxins
93
Q

List the differential diagnoses for a rabbit presented with peripheral vestibular dysfunction

A
  • Bacterial otitis interma/media e.g. Pasteurella multocida, Bordatella bronchiseptica, Pseudomonas aeruginosa, Staphylococcus aureus
  • Toxins e.g. aminoglycosides
  • Idiopathic vestibular syndrome
94
Q

List the differential diagnoses for paresis/paralysis in rabbis

A
  • Vertebral fracture/luxation
  • Spondylosis
  • osteoarthritis
  • Intervertbral disc disease
  • encephalitozoonosis
  • Toxoplasmosis
  • Splay leg
  • Hypovitaminosis A
  • Neoplasia
  • Ulcerative pododermatitis
95
Q

Outline the approach to the diagnosis of a rabbit presented with sudden onset left sided head tilt

A
  • Swab and culture for infection of ear canal
  • Once stabilised, sedate and x-ray of base of skull for inner ear and vestibular canal
  • Blood test for E. cuniculi infection (IgG and IgM antibodies)
  • CT scan
96
Q

Outline the treatment of a rabbit with sudden onset left sided head tilt

A
  • Stabilise, ensure eating and drinking, treat gut stasis
  • Anti-inflammatory and antibiotics
  • E. cuniculi treat with 28 day course of fenbendazole, but will not reverse neurological signs
97
Q

Outline the advice that should be given to an owner with a rabbit with E cuniculi

A
  • isolate negative rabbits from positive
  • Can be zoonotic
  • Can infect cats and cause neurological and ophthalmic disease
  • Treat all rabbits prophylactically with fenbendazole in feed, implement good hygiene and routine disinfection, raise food bowls and bottles
98
Q

What is the main cause of head tilt in sheep and cattle?

A

Listerial encephalitis due to Listeria monocytogenes

99
Q

What are the differentials for head tilt in sheep and cattle

A
  • Sheep: polioencephalomalacia, coenurosis (Gid), vestibular disease (OM/OI)
  • Cattle: coenurosis, vestibular disease due to OM/OI
100
Q

List the common clinical signs of listeriosis in cattle and sheep

A
  • Anterior uveitis (more important in cows)
  • Placentitis, abortion (more important in sheep)
  • Pneumonia
  • Neonatal septicaemia ( more important in sheep)
  • Meningeal encephalitis (more important in cows)
  • Nystagmus
  • Head tilt
  • Loss of menace response

NEU2 (23 decks)

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