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ACVIM SAIM (2023) > Neurology | Musculoskeletal > Flashcards

Neurology | Musculoskeletal Flashcards

1
Q

Opening Na channels causes depolarization/hyperpolarization of the neuronal cell, while opening K channels causes depolarization/hyperpolarization of the neuronal cell.

A

Depolarization/hyperpolarization

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2
Q

What are three neurolocalizations for a completely recumbent animal?

A

Brainstem lesion, cervical lesion, neuromuscular

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3
Q

Opisthotonus with extensor rigidity of the limbs, but with the hips flexed localizes to where?

A

Severe cerebellar lesion

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4
Q

opisthotonus with rigid extension of the neck and all four limbs localizes to where?

A

Rostral cerebellar and/or midbrain

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5
Q

Contralateral CP deficits would be present in neuroanatomic localization where?

A

cerebrum and/or thalamus

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6
Q

What can cause delayed paw placement test?

A

Diminished CP, weakness, defect in other accessory sensory pathways (spinocerebellar tract), rarely normal pets

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7
Q

Patellar reflex is mediated by what nerve from which spinal cord segment?

A

femoral nerve through spinal
cord segments L4-L7

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8
Q

Nerve and spinal cord segments for bicep reflex? Tricep reflex?

A

The musculocutaneous
nerve mediates the biceps reflex through spinal cord segments C6-C8. The radial nerve mediates the triceps reflex through spinal cord segments C7-T2.

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9
Q

What nerve and segments mediate the pelvic limb withdrawal/flexor reflex?

A

sciatic nerve through spinal cord
segments L6-S1

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10
Q

Manifestation of CN IV abnormality in dog?

A

lateral deviation of retinal vein (in cats they have dorsomedial strabismus)

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11
Q

Which cranial nerve can manifest as megaesophagus with abnormalities (either as primary cause or in association with CN abnormality)?

A

CN 10 (vagus nerve)

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12
Q

Medial strabismus associated with abnormalities of which CN?

A

CN6

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13
Q

Localize the lesion:
Left pupil normal size, Light in left eye, only left pupil constricts, positive menace response
Right pupil complete dilation, Light in right eye, no pupil constricts, negative response

A

Right retrobulbar

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14
Q

Localize the lesion:
Left pupil dilated, light in left eye = only right pupil constricts, positive menace response
Right pupil normal, light in right eye = only right pupil constricts, positive menace response

A

Left oculomotor nerve

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15
Q

Gait is normal in forebrain lesions. T/F?

A

True - critical UMNs responsible for gait generation in domestic species (rubrospinal and reticulospinal tracts) are spared, being located more caudally in the midbrain, pons,
and medulla

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16
Q

With peripheral vestibular lesions, the fast phase of the nystagmus is away from
the lesion; the opposite is true for central lesions. T/F?

A

False -central lesions can be away or towards

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17
Q

Hypermetric gait is associated with a lesion where?

A

Cerebellar

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18
Q

What would be pelvic limb gait of a dog/cat with polyneuropathy and sciatic dysfunction?

A

Because sciatic dysfunction does not affect weight bearing, the pelvic limb gait is not short-strided. Despite being a LMN problem, an exaggerated pelvic limb gait is present in which the pet repeatedly initiates the gait from a plantigrade position and “flings” its pelvic limbs forward

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19
Q

Localization for fine, whole body tremor?

A

Diffuse CNS disease [dysmyelinogenesis, diffusemeningitis (idiopathic tremor syndrome, disseminated granulomatous meningoencephalomyelitis, infectious
meningitis) and various toxicoses (e.g., molds, algae, ethylene glycol).]

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20
Q

Cranial nerves associated with brainstem lesions?

A

CV5-12

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21
Q

Most metabolically demanding area of brain (thus metabolic differentials and toxicities usually result in these signs)

A

Forebrain

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22
Q

What type of central edema is generally treatable with steroids and osmotic therapies?

A

Vasogenic (not interstitial - from obstructive hydrocephalus or cytotoxic - from ischemia)

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23
Q

General treatments for hydrocephalus?

A

Steroids +/- seizure meds; or carbonic anhydrase inhibitors or proton pump inhibiitors; diuretics [mannitol for acute signs]

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24
Q

Excessive scratching of the neck
vocalization and facial rubbing with CP deficits in a Brussels Griffon should raise concern for what disease?

A

Chiari-like malformations (CM) and syringohydromyelias (other breed is CKCS)

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25
First signs of lysosomal storage diseases?
Cerebellar signs of dysmetria, truncal ataxia, and nystagmus
26
In terms of intracranial neoplasias, dolichocephalic breeds are more likely to have ____, while brachycephalic breeds are more likely to have _____
Meningioma, glioma
27
Secondary neoplasia accounts for how much of all canine intracranial tumors?
50%
28
When does consensus recommend epileptic treatment for dogs?
(1) identifiable structural lesion or prior history of brain disease or injury; (2) acute repetitive seizures (status epilepticus) has occurred; (3) interictal period is < 6 months (i.e., 2 or more seizures within 6 month period); (4) prolonged, severe or unusual post-ictal periods; and (5) epileptic seizure frequency and/or duration is increasing and/or seizure severity is worse over three interictal periods
29
Dog breeds least likely to go into remission or have > 50% decrease in seizure activity?
Border Collie, German Shepherd Dog and Staffordshire Terrier
30
Dog breed over-represented for ischemic stroke?
Greyhound
31
Diseases that predispose to nonhemorrhagic ischemic stroke?
metabolic disorders (hypothyroidism, pheochromocytoma, hypertension), sepsis, parasitism, cancer, or hypercoagulopathy (diabetes mellitus, hyperadrenocorticism, renal disease, protein-losing nephropathy)
32
Causes for hemorrhagic stroke?
coagulopathy (including Angiostrongylus vasorum), hypertension (can cause microbleeds), toxins, trauma, sepsis, inflammation, and metastasis (hemangiosarcoma) NOTE - hemorrhagic strokes can be hemorrhagic ischemic or hemorrhagic stroke
33
CSF that is typical of GME?
mainly mononuclear pleocytosis, with a variable percentage of neutrophils and elevated protein level
34
Difference in regions affected by NME vs NLE?
NME - most commonly cerebrum with meningeal involvement; NLE - most commonly cerebrum AND brainstem with less consistent involvement of the meninges and cerebral cortex (aka mainly white matter)
35
Most common breed affected by NLE? Most common (two) breeds affected by NME>
Yorkies - NLE ; Pug and Maltese - NME
36
Most common bacterial organisms in canine meningoencephalitis?
Escherichia coli, Streptococcus species, and Klebsiella
37
most common fungal organism responsible for fungal meningoencephalitis in dogs and cats?
Cryptococcus neoformans
38
Antifungal agents that cross BBB?
Fluconazole; flucytosine
39
What cranial nerves may be impacted in dogs with paralytic rabies?
dropped jaw (cranial nerve [CN] V) and swallowing difficulty with attendant ptyalism (CNs IX to XI).
40
What are hallmark traits of cognitive dysfunction?
Disorientation, altered Interactions with owners or other pets, Sleep-wake cycle alterations, Housesoiling, and Activity changes (which might be increased, repetitive, or reduced); also decreased ability to perform tasks
41
Treatments for cognitive dysfunction?
Selegilene for dogs, propentophylline in Europe for dogs, nutrition (antioxidants like Vitamins E and C, omega-3s)
42
Most common cause of dropped jaw in dogs. Treatment?
Idiopathic trigeminal neuritis; supportive care -should resolve in 2-4 weeks
43
In a dog with Horner's syndrome, mydriasis that occurs after 20 minutes of topical application of phenylephrine indicates pre-ganglionic or post-ganglionic lesion?
Pre-ganglionic
44
Paradoxical vestibular syndrome localizes to where?
lesions in the flocculonodular lobe of the cerebellum, the caudal cerebellar peduncle, and the rostral and medial vestibular nuclei in the medulla [aka cerebellum or brainstem]
45
Which cranial nerve can be affected with peripheral vestibular disease (besides 8)?
CN7 (facial nerve)
46
Which endocrinopathy can result in vestibular disease?
hypothyroidism
47
Most common region to be affected by cerebrovascular accident (stroke) in dogs is
Cerebellum (areas supplied by the rostral cerebellar artery)
48
Toxicity of which antibiotic can manifest as vestibular signs in dogs? What are signs in cats?
Metronidazole. In cats - manifests as seizures, blindness, ataxia (more forebrain)
49
Strokes that occur due to disease (as opposed to idiopathic) are considered to have a better/worse prognosis and be less/more recurrent?
Worse prognosis; more recurrent
50
Degree of cauda equina compression seen on imaging does not correlate with presence of disease or its severity. T/F?
True
51
Degenerative myelopathy generally localizes where? What is the most effective supportive regimen for dogs with degenerative myelopathy?
T3-L3; physical therapy
52
Most common agent associated with canine discospondylitis?
Staph (pseud or aureus)
53
A young Basset Hound with discospondylitis may have what other underlying infectious disease?
systemic tuberculosis
54
Presentation of polyradiculoneuritis?
Ascending pelvic limb paresis, +/- hyperesthesia, reduced or absent pelvic limb reflexes with intact sensation
55
Tick paralysis is associated with what type of tick in N America? Difference with tick paralysis in N America vs Australia?
Dermacentor; Australian tick paralysis has poorer prognosis, demonstrates autonomic signs, and animals may decline for a few days after tick removal
56
Associated conditions with myasthenia gravis in dogs and cats?
Thymoma, hypothyroidism, hypoadrenocorticism, polymyositis, masticatory myositis, reported methimazole in cats
57
Risks of edrophonium administration to test for myasthenia?
salivation, tremors, vomiting, bradycardia, bronchoconstriction, and respiratory distress (can pretreat with atropine)
58
Congenital myasthenia gravis in what breed of dog is known to spontaneously resolve?
Miniature Dachshunds
59
Most common cause of myelopathy in cats < 2 years?
FIP
60
Breeds predisposed to immune mediated polymyositis?
Vizla, Newfoundland
61
What antibiotics might worsen signs with botulinism?
Aminoglycosides, ampicillin
62
Dysphagia and tongue hypertrophy can be an indication of what type of muscle disorder?
X-linked (dystrophin-deficient)Muscular dystrophy (CK should be extremely high)
63
Pseudomyotonia can develop in dogs with untreated Cushing's. This will resolve with treatment. T/F?
False- while it can develop with untreated Cushing's, it is poorly responsive
64
Kernicterus - definition, neuro effects?
Kernicterus = uncommon complication of hyperBIL (rarely reported in dogs). Bilirubin causes neuronal necrosis of selected brain nuclei --> acute neuro signs including seizures, opisthotonus, abnormalities in muscle tone, decreased feeding, lethargy. If TBIL [ ] not decreased --> permanent impairments in muscle tone, hearing & oculomotor function.
65
Canine degenerative myelopathy (DM) - pathogenesis & disease stages?
Late-onset progressive neurodegenerative disease affecting many pure and mixed-breed dogs. Homogenous clinical spectrum within and across breeds. 4 stages of disease progression (see table). CSx - multisystem neurodegeneration, resulting from progressive axonal degeneration of the central and peripheral NS. Superoxide dismutase 1 gene (SOD1) mutations (SOD1:c.118A, SOD1: c.52T) are risk factors for DM, mostly autosomal recessive inheritance. Note SOD1 mutations are incompletely penetrant, so genetic screening is insufficient for diagnosis - ideally need spinal cord histopath.
66
Paroxysmal dyskinesia (PD) - definition & classifications?
Green JVIM 2021 Group of movement disorders (MDs) characterized by recurring episodes of involuntary hyperkinetic movements, ballism, dystonia, athetosis, or chorea. Irregular muscle movements typically involve the limbs, trunk, neck and/or face, last minutes to several hours, and occur without a loss of consciousness. 3 main types: 1) Paroxysmal kinesigenic dyskinesia (PKD) - episode is induced by an abrupt, voluntary physical movement 2) Paroxysmal non-kinesigenic dyskinesia - episodes not preceded by sudden movement or exercise 3) Paroxysmal exertion-induced dyskinesia (PED) - episodes triggered by prolonged exercise. Can be difficult to distinguish from focal epileptic seizures.
67
Define Lafora disease, its causal gene mutation and affected dog breeds.
Flegel JVIM 2021 Lafora disease is a neurological storage disease caused by an autosomal recessive genetic defect resulting in myoclonus, focal and generalized seizures. CSx – spontaneous and myoclonic events triggered by noises or visual stimuli, hypnic myoclonus as well as generalized tonic-clonic seizures. Usually develop in dogs 6-9yo. Defect in canine NHLRC1 (EPM2B) gene – encodes proteins laforin (carbohydrate binding phosphatase) and malin (ubiquitine ligase) --> absence of either protein results in poorly branched, hyperphosphorylated glycogen, which precipitates, aggregates and accumulates into Lafora bodies in neurons of all brain regions, reaching the highest densities in the substantia nigra, dentate nucleus and thalamic nuclei, causing neuronal malfunction --> myoclonic epilepsy. (info based on human studies) Breeds - Wirehaired Dachshunds & Beagles (gene mutation identified). Also Basset hound, Chihuahua, French bulldog, Pointer, Miniature poodle, Welsh corgi.
68
Tremor ddx Idiopathic head tremor: a) Definition b) Predisposed breeds
a) Idiopathic paroxysmal movement disorder. Sudden onset of short episodes with horizontal or vertical rhythmical tremor-like movements of the head without loss of responsiveness; usually episodes can be interrupted by distractors (e.g. food). Stress can exacerbate episodes. b) Dobers (early-onset familial + late-onset sporadic forms), Bulldogs, Boxers, Labs
69
Edrophonium a) MOA b) Indications c) AE d) Drugs with similar MOA
a) Short-acting anticholinesterase agent. Inhibits AChE by reversible electrostatic attachment to the enzyme, thereby blocking its hydrolytic activity on ACh --> ACh accumulates in the synaptic cleft to prolong cholinergic stimulation. b) - Presumptive MG (Tensilon response test). *NB for focal MG e.g. facial twitching - assess palpebral reflex after giving drug. - Reversal of non-depolarizing neuromuscular blocking agents c) Cholinergic signs (salivation, lacrimation, urination, defecation, GI distress, emesis aka “SLUDGE”). Have atropine 0.02 – 0.04 mg/kg IV on hand, some recommend to give it immediately before edrophonium. *Cholinergic crisis: - Respiratory effects (increased bronchial secretions, bronchospasm, pulmonary edema, respiratory paralysis) - Ophthalmic effects (miosis, blurred vision, lacrimation) - CVS effects (bradycardia or tachycardia, hypotension, cardiac arrest) - Muscle cramps, weakness. d) - Pyridostigmine PO - directly competes with ACh for attachment to AchE. Vs neostigmine - 4.4x less potent, slower onset & longer DOA, fewer adverse GI effects. - Neostigmine SQ/IV - competes with ACh for AchE binding --> forms a carbamyl-ester complex that is hydrolyzed at a slower rate than that of an Ach-AchE complex --> ACh accumulation with a resultant exaggeration & prolongation of its effects.
70
a) List 3 brain MRI features which can aid in identifying dogs with intracranial hypertension. b) A direct ICP threshold of .....mmHg had 90% sens & 69% spec for predicting intracranial hypertension.
Giannasi JVIM 2020 a) MRI features - brain herniation (structural anatomical shift), mass effect (larger tumor size) & optic nerve size (larger optic nerve sheath diameter). b) 15 mmHg
71
What is diffusion weighted imaging (DWI)? Which 2 parameters were assessed on DWI to help detect microstructural spinal cord lesions in dogs with degenerative myelopathy? What DWI changes were observed with DM dogs?
Johnson JVIM 2020 DWI = MRI method of signal contrast generation based on the differences in Brownian motion (of water molecules). Useful in identifying acute ischemic brain lesions. Fractional anisotropy (FA) & mean diffusivity (MD). *Decreased FA indicates disrupted fiber tracts and demyelination - more sensitive in the early detection of white matter microstructural changes. Significant decreases in FA within SC regions with most severe lesions. FA decrease correlated with disease severity & neurological grade.
72
Name the patterns of clinical presentation seen with dogs with muscle cramps (MCs). Main clinical feature of MC in dogs? What were the main causes of MCs identified in dogs?
Gagliardo JVIM 2020 3 patterns. 1) Migrating pattern (stiffness/abduction of FL, followed by sustained HL flexion & fall in lateral recumbency) 2) Pelvic limbs pattern (HL flexion, prolonged muscle contraction, no FL involvement) 3) Single-limb pattern Episodes triggered by prompting movement. Variably painful (58% dogs painful with 42% mild discomfort). Hypocalcemia (79% dogs). Most commonly 2’ to primary hypoPTH > intestinal LSA & PLE. Unknown cause in 21% dogs (all GSDs) - ddx idiopathic, paroxysmal dyskinesia
73
Effects of sex hormones on epileptic activity?
Oestrogen is pro-convulsant. Progesterone is anti-convulsant 2015 study found a pattern of seizure onset during heat & at end of diestrus (when P4 starts to decline to basal levels).
74
Excitatory or inhibitory neurotransmitters? - Glutamate - Glutamine - Glycine
Glutamate & glutamine (precursor) = excitatory Glycine = inhibitory
75
What are the proposed indications for immunosuppressive therapy in acquired myasthenia gravis in dogs?
Dogs with persistently increased AChR antibody titres despite time & supportive care Dogs poorly responsive or poorly tolerant of anti-cholinesterase tx Dogs with positive AChR Ab titres but negative edrophonium challenge tests - may respond poorly to other anticholinesterase drugs
76
Which antibiotics may worsen NM blockade in dogs with acquired MG?
Aminoglycosides, ampicillin, ciprofloxacin, erythromycin, imipenem
77
List breeds affected by primary/inherited paroxysmal dyskinesia?
ACVIM consensus CKCS (episodic hypertonicity), Border Terriers (gluten-sensitive), Scottish Terriers (Scotty cramp), SCWTs, Chinooks, Doberman, SGP, Labs & JRTs
78
A hypokinetic paroxysmal dyskinesia has been described in which 2 dog breeds? Causal gene mutation?
Canine multiple system degeneration Kerry Blue Terriers & Chinese crested dogs SERAC1 mutation
79
What neurological pathways are involved in micturition? Include structures innervated.
LS spinal cord - L1-L4 (dogs), L2-L5 (cats): hypogastric - efferent motor to detrusor > relaxation (B3 adrenergic-R) + IUS > s.m. contraction (A1 adrenergic-R) - S1-S3: pelvic (PS) - efferent sensory + motor to detrusor s.m > contraction/voiding (muscarinic-R) - S1-S3: pudendal (somatic) - afferent sensory + efferent motor to EUS > skeletal m. contraction (nicotinic R) CNS - Micturition centre (pons) - stimulatory & inhibitory - Cerebral cortex - inhibitory > excitatory centres
80
What lesions & clinical signs are noted with hypertrophic osteopathy? List 2 tumors and 2 infectious causes associated with this condition.
Periosteal new bone proliferation along the shafts of long bones, typically in the distal extremities & associated soft tissue swelling of the limbs. Affects all 4 limbs, starts distally and moves proximally; often presents as shifting lameness and reluctance to move. Primary intrathoracic masses, renal tumors (TCC, nephroblastoma). HWD, Spirocerca lupi oesophageal granuloma

ACVIM SAIM (2023) (19 decks)

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