Neurology (SA) Flashcards
1
Q
What occurs if the basal ganglia are damged?
A
Movement Disorders
2
Q
Which structures make up the ectomeninx?
A
Dura mater
3
Q
Which structures make up the endomeninx?
A
Arachnoid mater
Pia mater
4
Q
Which structures make up the endomeninx?
A
Arachnoid mater
Pia mater
5
Q
What is the Dura Mater fused to?
A
Periosteum of the skull
6
Q
What are the two folds of the dura mater?
A
Falx cerebri
Tentorium Cerebelli
7
Q
What is the space between the arachnoid and the dura mater known as?
A
The subdural space
8
Q
What is the space between the arachnoid and pia mater known as?
A
the subarachnoid space
9
Q
The space between which two meninges is filled with circulating CSF and trabeculae?
A
Arachnoid and Pia Mater (subarachnoid space)
10
Q
How does the pia mater differ from the other two meninges?
A
Highly Vascularised - merges with tunica adventitia of BVs in brain tissue
11
Q
What are the main functions of the CSF in relation to the CNS?
A
Provides Nutrition, physical support and a volume buffer to the CNS.
12
Q
How does the CNS affect neurons?
A
Transports neurotransmitters and maintains a stable environment for neurons
13
Q
What does the CSF contain (in low levels)?
A
amino-acids
K+
glucose
14
Q
What does the CSF not contain?
A
cells & protein
15
Q
Where is the CSF produced?
A
choroid plexi
16
Q
What type of substances can pass into the CSF?
A
lipid soluble
17
Q
List the 4 arteries that supply blood to the brain
A
Internal Carotid
Basilar
Maxillary
Vertebral
18
Q
Which are the two main blood supply arteries in the dog?
A
Internal Carotid/Basilar
19
Q
Which are the two main blood supply arteries in the cat?
A
Maxillary via rete mirabile
20
Q
Label the following diagram detailing venous drainage of the brain.
A
C1-C5
21
Q
Which spinal cord segments supply the thoracic limb?
A
C6-T2
22
Q
Which spinal cord segments supply the thorax and abdomen?
A
T3-L3
23
Q
Which spinal cord segments supply the pelvic limb/perineum?
A
L4-S3
24
Q
Which spinal cord segments supply the tail?
A
Cd1-Cd5
25
Which spinal cord segments supply the tail?
Cd1-Cd5
26
Where is a good region for sampling CSF?
lumbar cistern
27
What effect does an UMN usually have on a LMN?
inhibitory
28
where do UMNs supplying flexor muscles travel?
lateral funiculi
29
where do UMNs supplying extensor muscles travel?
ventral funiculi
30
which neurotransmitter is present at the NMJ?
Acetylcholine
31
What does a muscle need to contract?
An intact LMN
32
what do reflexes NOT require?
UMN input
33
what happens if there is a loss of UMN input in a reflex arc?
reflex will be exaggerated - less co-ordination, strength same
34
What happens to a muscle if a LMN is injured?
Loss of RAT (reflex, atrophy and tone)
35
Where does the pyramidal tract run?
caudally in the central medulla in triangular shape
36
What does the pyramidal tract control?
fine, voluntary movement
37
What does the extrapyramidal tract control?
posture, subconscious rhythmic movements
38
What can the cerebellum NOT do with regard to movement?
initiate movement
39
What is sensory adaptation?
constant stimulus > receptor potential decreases > impulses decrease freq > perception fades
40
What are 4 modalities of somatic sensation?
Tactile, Thermal, Pain, Proprioception
41
Give 2 examples of fast adapting touch receptor.
Meissners corpuscle (fine touch) & tactile hairs (crude touch)
42
Give 2 examples of slow adapting touch receptor
Merkels discs (fine) and Ruffinis end-organ (stretch)
43
Name a pressure receptor
Pacinian corpuscle
44
Describe the structure of a lamellated corpuscle.
multi-layered connective tissue capsule enclosing dendrite
45
What is an itch caused by?
stimulation of free-nerve endings by body chemicals
46
Where are cold receptors located?
epidermis
47
Where are warm receptors located?
dermis
48
Which type of fibres conduct chronic pain?
unmyelinated
49
What is nociceptive pain a response to?
harmful stimuli - extreme temperatures, strong mechanical/chemical stimuli
50
What is activated in nociceptive pain?
nociceptors on free nerve endings
51
What is activated in neurogenic pain?
impulses in other parts of the nervous pathway (not free nerve endings)
52
What is pain sensitisation?
With increased exposure to noxious stimuli, nerves become hypersensitive to weak stimuli.
53
What are the 3 ways in which analgesia may work to reduce pain?
Inhibit nociceptors
Block pain impulse conduction
Block signal transmission in CNS pain pathways
54
Name the two somatosensory pathways.
Dorsal Column
| Spinothalamic Tract
55
What does the dorsal column detect?
Skin: pressure/touch
Joints
Muscles
56
What does the spinothalamic column detect?
Pain
| Temperature
57
Describe the gate theory of pain.
gate neurons are stimulates by other branches of sensory nerves in skin and inhibit neurotransmitter release in the dorsal synapse of pain pathway.
58
What is proprioception?
sense of the relative position of body parts to ensure appropriate posture
59
What are signs of conscious proprioceptive deficits?
Stumbling, knuckling, intention tremors
60
What does subconscious proprioception control?
Sitting/standing, scratching, breathing, chewing, locomotion
61
What is the main sign of a deficit in subconscious proprioception?
Ataxia - differentiate from weakness!!
62
Name the Cranial Nerves
```
I Olfactory
II Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facial
VIII Vestibulocochlear
IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal
```
63
Which area of the brain coordinates homeostasis, motivation and emotion?
The limbic system
64
Which part of the limbic system determines memory?
The hippocampus
65
lesions in which brain region cause behavioural and emotional changes?
The frontal lobe
66
How does rabies affect the brain?
Produces inclusion bodies (negri bodies) in the hippocampus and cerebellar purkinje fibres.
67
Spontaneouss discharge of which area causes epileptic seizures?
The Hippocampus
68
Which part of the brainstem is responsible for vegetative function?
Ascending Reticular Activating System
69
What are the 4 main signs of hypothalamic lesion?
1. Abnormal water consumption
2. Abnormal appetite
3. Abnormal temperature regulation
4. heme-neglect
70
Label the following neuroepithelial cell.
1.
2.
3.
4.
71
Which part of a vestibular cell senses changes in head position?
Microvilli.
72
Where in the inner ear do sensory hairs in the endolymph form cupulae?
Semi-circular canals
73
In which sense organ do sensory hairs, endolymph and calcium carbonate crystals work in unison?
Otolith organ
74
Which cranial nerve works alongside otolith organs to provide information about head position?
VIII (vestibulocochlear)
75
How do the otolith organs provide a 3D image of head movement?
located in 3 semicircular canals which are in 3 planes at right angles to each other.
76
Which sense organ is responsible for static balance?
Otolith Organ (linear)
77
Which sense organ is responsible for dynamic balance?
Ampullae (circular)
78
What are the 3 main reflexes which govern posture?
1. Vestibular Reflexes
2. Tonic Neck Reflexes
3. Righting Reflexes
79
which reflexes co-ordinate flexion and extension of limb muscles to shift the centre of gravity?
Vestibular Relfexes
80
What is the difference between vestibular and tonic neck reflexes?
V: head position alters without change in head-neck angle
TN: head-neck angle changes but head position the same relative to the vertical axis.
81
Which receptors are involved in the righting reflex?
```
Vestibular Organs
Muscle Spindles (neck)
Pressure Sensors (skin)
```
82
What is the vestibule-ocular reflex?
stabilises retinal image during rapid acceleration of the head
83
What are the signs of vestibular syndrome?
Head tilt, Circling and Nystagmus
84
What are the two major categories of receptor in the PNS?
Adrenergic
| Cholinergic
85
Where are all of the sympathetic ganglia?
The spinal cord (sympathetic chain)
86
What are the two subtypes of cholinergic receptor?
Nicotinic (2 further divisions)
| Muscarinic (3 further divisions)
87
What are the two major subtypes of adrenergic receptor?
Alpha and Beta
88
What is the aim of anticonvulsant drugs?
to stabilise membranes in the CNS
89
How do anticonvulsants stabilise the CNS?
increase GABA (inhibitory neurotransmitter) or decrease Na influx
90
Which stimulant is used to stimulate chemoreceptors in the aorta/carotid body of neonates?
Doxapram (for sluggish neonates)
91
How do phenothiazine derivatives work?
block dopamine receptors and inhibit serotonin
92
How do Benzodiazepines work?
enhance GABA action
93
How do alpha 2 agonists work?
bind to presynaptic adrenergic receptors - reduce noradrenaline release
94
How do opioids work?
activate receptors associated with pain modulation
95
What are the 3 major types of opioid receptor?
Kappa, Mew and Delta
96
What are the 4 major effects of opioids?
Analgesia, Sedationm, euphoria and antitussives
97
How is neuroleptanalgesia produced?
Opioid + Sedative
98
How do local anaesthetics work?
Elevate threshold potential and reduce Na permeability --> decreases APs in nerves
99
Which local anaesthetic can be used to treat ventricular tachycardia?
Lidocaine
100
How do injectable anaesthetics work?
Enhance GABA activity
Reduce Glutamine activity
some unknown MOAs
101
What areas of the brain do anxiolytics (such as benzodiazepines) work on?
Cerebral cortex, limbic system, thalamus
102
How do antidepressants work?
increase monoamine activity
103
Influx of what triggers neurotransmitter exocytosis?
Calcium Ions
104
How is Ach inactivated?
Broken Down by AChE before reuptake at pre-synaptic neuron
105
How is Noradrenaline inactivated?
uptake at the pre-synaptic neurone
106
Which substance inhibits monoamine re-uptake?
fluoxetine
107
Which neurotransmitters are monoamines?
Noradrenaline, Dopamine, Serotonin
108
Which substance inhibits ACh breakdown?
neostigmine
109
What is the primary excitatory neurotransmitter in the brain?
Glutamate
110
What is the primary inhibitory neurotransmitter in the brain?
GABA
111
What is synaptic summation?
Multiple sub threshold inputs acting simultaneously to create an AP.
112
What is negative summation?
multiple inhibitory neurons firing to prevent an AP.
113
What does the vestibulaocerebellum affect?
Balance and eye movement
114
What does the spinocerebellum affect?
motor execution
115
what does the cerebrocerebellum affect?
motor planning
116
What are 3 major signs of cerebellar dysfunction?
Ataxia
Dysmetria
Intention Tremors
117
what are the 3 anatomical lobes of the cerebellum?
Anterior, Posterior and Flocconodular
118
What causes cognitive dysfunction syndrome in dogs?
Beta-amyloid plaque deposition
| Neurofibrillary Tangles
119
Which are the fastest opening nerve fibres?
Alpha adrenergic
120
Which are the slowest nerve fibres for pain?
C-fibres (unmyelinated)
121
What are the two ventrolateral ascending pain pathways?
Spinothalamic
| Spinoreticular
122
What is the role of the hypothalamus?
Homestasis
123
The hypothalamus releases neurohormones which act on what?
The pituitary gland
124
The portal venous system in the pituitary stalk links which 2 areas together?
Anterior pituitary and Hypothalamus
125
What causes narcolepsy?
Abnormal orexin receptor or protein
126
What is the FIRST component of a neurological exam?
Observation
127
What blood tests should be run on a potential neurological case?
Haem/Biochem
Endocrine
Serology - ID/AutoIm
Toxicology
128
What is Myasthenia Gravis?
Autoimmune condition - blockade of Ach receptor at NMJ
129
How can we test for Myasthenia Gravis?
Administer Edrophonium Chloride - temporary increase in Ach at synapses to overcome blockade
130
What is Horner's Syndrome?
Loss of sympathetic stimulation to the eye
131
How do we test for Horner's?
Phenylephrine in eye - causes pupil dilation if Horner's +
132
Name the 6 signals which modulate the satiety/appetite centres.
```
Glucose
CCK
GI filling
Smell
Vision
Body Fat Reserves
```
133
Which substance, produced by fat, inhibits appetite in the hypothalamus?
Leptin
134
Which substance stimulates feeding by acting on the brainstem?
Ghrelin
135
What effect do sedatives have which tranquillisers do not?
Cause Drowsiness (tranquillised patients and calm but alert)
136
Give two examples of a sedative
Xylazine
| Medetomodine
137
Give two examples of a tranquilliser
Diazepam (minor)
| ACP (major
138
What are the two major effects of Benzodiazepines?
Sedation
| Muscle Relaxation
139
How do Benzodiazepines work?
GABA agonism
140
Which drug is a benzodiazepine antagonist?
Flumazenil - used to reverse resp depression
141
What effects do alpha2 agonists have?
```
Calming
Drowsiness
Visceral Analgesia
Muscle Relaxation
Reduction in subsequent anaesthetic doses.
```
142
What is the primary side effect of an alpha 2 agonist?
CVS depression
143
Which alpha 2 antagonist can be used to reverse an agonist?
Atipamezole
144
Which receptors do phenothiazines antagonise?
Histamine H1
Adrenergic A1
Muscarinic
145
Give 2 uses for ACP
Strong Sedative
| Anaesthetic Pre-med
146
What must you be careful of with ACP?
enhances effects of other narcotics - REDUCE DOSES!
147
What class of drugs does Azaperone belong to?
Butyrophenones
148
What are the effects of azaperone?
Neuroleptic
Sedative
Potent anti-emetic
149
What is "Ictus"?
The epileptic seizure
150
What are the signs of a full brain (generalised) seizure?
Bilateral convulsions
Loss of consciousness
May be"absent"
151
What are the signs of a focal secure?
Automatisms
| Possible progression
152
What is epilepsy caused by?
Mass firing of APs in the brain
153
How can we depress the synaptic activity responsible for epilepsy?
```
Inc GABA release
Inc GABA efficacy
Dec GABA uptake
Use GABA analogues
Dec GLUT release
Dec GLUT efficacy
```
154
How does Phenobarbitone decrease epileptic seizures?
increases GABA efficacy at receptor
155
How does levatiracetam work?
Blocks Ca channels to prevent Ca influx & glutamate release
156
How does gabapentin work?
Blocks Ca channels to prevent Ca influx & glutamate release
157
How does KBr work?
Blocks Na channels to prevent Na influx & glutamate release
158
Who must not receive KBr?
CATS
159
Which is the longest acting anti-epileptic drug?
Phenobarbital (36h)
160
Which is the shortest acting anti-epileptic drug?
Gabapentin (3h)
161
What are the 3 main rules for anti-epileptic drugs?
DON'T:
Change drugs suddenly
Withdraw meds suddenly
Give phenothiazines
162
How does lidocaine work?
Blocks Voltage-gated Na channels in the post-synaptic membrane
163
What are the 4 main local anaesthetics used in veterinary medicine?
Procaine
Lidocaine
Mepivicaine
Bupivicaine
164
Which local anaesthetics cause vasodilation?
Procaine
| Lidocaine
165
Which local anaesthetics cause vasoconstriction?
Bupivicaine
166
Which local anaesthetic has high toxicity?
Bupivicaine
167
Place the 4 major veterinary local anaesthetics in order of DOA. (Short --> long)
Procaine (30min)
Lidocaine (30-45min)
Mepivicaine (90-120min)
Bupivicaine (4-6h)
168
Which local anaesthetics have a fast onset?
Lidocaine
| Mepivicaine
169
What are the 4 major systemic effects of opioid drugs
Neuroleptanalgesia
Restraint
Anti-diarrhoea
Anti-Jussive
170
Which is the gold standard opioid pre-med?
Morphine
171
What effect does morphine have on the cortex?
Sedation
172
What effect does morhpine have on the medulla?
Stimulation then depression
OR
Depression
173
Where is morphine metabolised?
Liver
174
Which short-acting opiate may cause histamine release if given IV?
Pethidine
175
Which opioid is highly fast and potent?
Fentanyl
176
Which opiate is long-acting but causes less euphoria than morphine?
Methadone
177
Which opioid has a slow onset and offset?
Buprenorphine
178
What are the 4 major side-effects of opioid drugs?
Resp Depression
Vagal stimulation
Constipation
Nausea
179
What are the 3 major opioid receptors?
Delta
Mew
Kappa
180
Which opiates are ONLY full mew agonists?
Morphine
Pethidine
Methadone
Fentanyl
181
Which opiates are full mew AND kappa agonists?
Etorphine
182
Which drugs are kappa agonists and mew antagonists?
Buprenorphine
| Butorphanol
183
Which drug is a full opioid receptor antagonist?
Naloxone
184
How do opiates effect the post-synaptic membrane?
Activation of inwardly rectifying K+ channels
185
How do opiates effect the pre-synaptic membrane?
Inhibition of Ca channels
186
Which two modes of pain do opiates block?
Psychological
AND
Nociception
187
How can we produce effective neuroleptanalgesia with two drug classes?
Opioid + Neuroleptic
| i.e. ACP + butorphanol
188
Which opioid is rapidly fatal to humans?
Etorphine
189
Which analeptic can be used to reduce resp depression of other opioids?
Doxapram
190
How does amitriptyline work?
Monoamine oxidase inhibitor
191
What is the MOA of amantidine?
NMDA blocker
192
What can be used to control neuropathic pain?
GABApentin
193
What are the two main components of the forebrain?
Cerebral cortex
| Diencephalon
194
What are the three main components of the brainstem?
Midbrain
Pons
Medulla Oblongata
195
Define the 4 functional divisions of the spine.
C1-C5
C6-T2
T3-L3
L4-S3
196
Where is grey matter located?
Brain - surface
| Spinal Cord - Centre
197
What does Grey Matter contain?
Cell Bodies
198
What is the function of Grey Matter?
Processing Information
199
Where is the white matter located?
Brain - deep parts
| Spinal Cord - superficial
200
What does white matter contain?
Myelinated axon tracts
201
What is the function of White Matter?
Connects neurons
202
What neuron is in the ventral horn?
Motor Neuron Cell Body
203
What neuron is in the dorsal horn?
Sensory Neuron Cell Body
204
Where is the sympathetic ANS located?
Craniosacral
205
Where is the parasympathetic ANS located?
Thoracolumbar
206
How does a UMN lesion affect the bladder?
Distended
| Hard to Express
207
How does an LMN lesion affect the bladder?
Distended
| Continually overflowing and dribbling
208
Testing the Flexor reflex in the thoracic limb allows you to assess which PN?
All TL PNs
209
Testing the Flexor reflex in the thoracic limb allows you to assess which SC segment?
C6 - T2
210
Testing the Biceps reflex in the thoracic limb allows you to assess which PN?
Musculocutaneous
211
Testing the Biceps reflex in the thoracic limb allows you to assess which SC segment?
C6-C8
212
Testing the Triceps reflex in the thoracic limb allows you to assess which PN?
Radial
213
Testing the Triceps reflex in the thoracic limb allows you to assess which SC segment?
C7 - T2
214
Testing the Ext Carpi Rad reflex in the thoracic limb allows you to assess which PN?
Radial
215
Testing the Ext Carpi Rad reflex in the thoracic limb allows you to assess which SC segment?
C7 - T2
216
Testing the Flexor reflex in the Pelvic limb allows you to assess which PN?
Sciatic
217
Testing the Flexor reflex in the Pelvic limb allows you to assess which SC segment?
L6 - S1
218
Testing the Patellar reflex in the Pelvic limb allows you to assess which PN?
Femoral
219
Testing the Patellar reflex in the Pelvic limb allows you to assess which SC segment?
L4 - L6
220
Testing the Gastroc reflex in the Pelvic limb allows you to assess which PN?
Tibial
221
Testing the Gastroc reflex in the Pelvic limb allows you to assess which SC segment?
L7 - S1
222
Where do pyramidal UMNs start?
Cerebral Cortex
223
Where do extrapyramidal UMNs start?
Brainstem
224
What do pyramidal UMNs control?
Skilled movement
225
What do Extrapyramidal UMNs control?
Tonic support against gravity.
| Initiate voluntary movement.
226
Where is conscious proprioception information transmitted to?
Cerebral cortex (contralateral)
227
Where is unconscious proprioception information transmitted to?
Cerebellum (ipsilateral)
228
What is proprioception?
Sensory detection of position and movement of muscles and joints
229
How many vestibular nuclei exist in the brain?
4 in either side of the pons and medulla
230
Where do the vestibular nuclei project to? (3 places)
Spinal Cord (facilitate ipsilateral extensor, inhibit contralateral extensor)
Brainstem (co-ordinate head/eye movement, vomit centre and balance)
Cerebellum (inhibitory)
231
What are the 4 main functions of the cerebellum?
Control motor activity
Co-ordinate UMN movement
Maintain balance
Regulate muscle tone (& therefore posture)
232
How do we assess conscious perception of vision?
Menace
233
How do we assess reflex visual perception?
PLR
234
What component of the CNS are we assessing with the menace response?
Forebrain
235
What component of the CNS are we assessing with the PLR?
CN II/CN III
236
What are the 4 things that we should observe from a distance on neurological exam?
Mentation
Posture
Gait
Behaviour
237
What are 5 key things to ask during a neuro history?
```
Trauma Hx?
Acute/Chronic?
Pain?
Progression?
Episodic?
```
238
What is the difference between stuporous and comatose?
Stuporous - can be roused by painful stimuli
comatose - unresponsive
BOTH = unconscious
239
An animal is showing hemineglect syndrome - where is its brain lesion located?
Forebrain
240
An animal is showing reduced palpebral reflex - where is its brain lesion located?
Trigeminal (v) or Facial Nerve (VII)
241
An animal is showing postural deficits - where is its brain lesion located?
ANYWHERE
242
An animal is showing dysmetria - where is its brain lesion located?
Cerebellum
243
An animal is showing subtle proprioceptive deficits - where is its brain lesion located?
Spine
244
An animal is showing compulsive walking/circling - where is its brain lesion located?
Forebrain
245
An animal is showing loss of head orientation - where is its brain lesion located?
Vestibular Sytem
246
An animal has become aggressive - where is its brain lesion located?
Forebrain
247
What is Schiff-Sherrington?
Hyperextension of TL
| Paralysis of PL
248
What causes Schiff-Sherrington?
Lesion in thoracic or lumbar spine
249
Decerebrate rigidity is caused by a lesion where?
Rostral Brainstem
250
Decerebellate rigidity is caused by a lesion where?
Rostral Cerebellum
251
What does Decerebrate rigidity present as?
Extension of all limbs and opisthotonus
| Stupor/comatose
252
How does Decerebrate rigidity present?
Extension of all limbs and opisthotonus
| Stupor/comatose
253
How does Decerebellate rigidity present?
Hyperextended TLs
| Normal mentation
254
What does "Paresis" mean?
Weakness - reduced voluntary movement
255
What does "Paralysis" mean?
Complete absence of voluntary movement
256
Name 6 different postural tests for the dog.
```
Paw Position
Hopping
Hip Sway
Wheelbarrow
Extensor Postural Thrust
Placing Responses
```
257
What are the thoracic spinal withdrawal reflex tests?
Digit pinch
| Extensor Carpi Radialis, Biceps, Triceps
258
What are the pelvic spinal withdrawal reflex tests?
Digit Pinch
| Patellar, Cranial tibial, Gastrocnemius, Perineal
259
Where does information from the cutaneous trunci reflex enter the spinal cord?
2 Vertebral Spaces cranially to test.
260
Name 3 behavioural responses to pain
Turning Head
Trying to bite
Vocalising
261
Apart from palpation, how can we assess for spinal pain?
Move neck in all directions.
Move tail
Palpate lumbosacral region.
262
Eye position at rest may tell us about the function of which cranial nerve(s)?
III (oculomotor), IV (trochlear) and VI (abducens)
263
Which cranial nerves does the PLR test for?
II (optic) and III (oculomotor)
264
Deficits in which CNs may cause a physiological nystagmus?
III (oculomotor), IV (trochlear) and VI (abducens)
265
the BAER tests which CN?
VIII (vestibulocochlear)
266
An inability to see objects, and reduced menace response indicates a problem with which CN?
II (optic)
267
At what age does the menace response become a valid test?
12 weeks old
268
Looking at the symmetry of mucous membranes can tell us about which cranial nerve?
V (Trigeminal)
269
The Corneal Reflex tells us about the function of which CN(s)?
V (trigeminal), VI (abducens and VII (facial)
270
A lack of gag reflex tells us about which CN(s)
IX (glossopharyngeal) and X (Vagus)
271
Nasal Mucosa Stim test assesses which CN?
V - ophthalmic branch
272
reduced physiological nystagmus indicates what?
Raised ICP
273
What are the 4 clinical signs of Horners?
Mitosis
Ptosis of upper eyelid
Protruded 3rd Eyelid
Enopthalmus
274
What causes Horners?
Compression of the sympathetic chain
275
Disorientation/Depression is a sign of a lesion in which part of the brain?
Forebrain
276
Depression/stupor/coma is a sign of a lesion in which part of the brain?
Brainstem
277
Vestibular Signs are a sign of a lesion in which part of the brain?
Brainstem or Cerebellum
278
Intention Tremors are a sign of a lesion in which part of the brain?
Cerebellum
279
Decerebellate rigidity is a sign of a lesion in which part of the brain?
Cerebellum
280
Contralateral blindness is a sign of a lesion in which part of the brain?
Forebrain
281
Ipsilateral abnormal menace with normal vision is a sign of a lesion in which part of the brain?
Cerebellum
282
Deficits in CN III-XII are a sign of a lesion in which part of the brain?
Brainstem
283
Ipsilateral/total paresis is a sign of a lesion in which part of the brain?
Brainstem
284
Ataxia with broad base and hypermetria is a sign of a lesion in which part of the brain?
Cerebellum
285
Circling is a sign of a lesion in which part of the brain?
Forebrain
286
Delayed movements with hypermetria is a sign of a lesion in which part of the brain?
Cerebellum
287
Respiratory/Cardiac abnormalities can be caused by a lesion in which part of the brain?
Brainstem
288
Decreased postural responses in all limbs is a sign of a lesion in which part of the brain?
Brainstem
289
Decreased postural responses in ipsilateral limbs is a sign of a lesion in which part of the brain?
Brainstem
290
Decreased postural responses in contralateral limbs is a sign of a lesion in which part of the brain?
Forebrain
291
Seizures are a sign of a lesion in which part of the brain?
Forebrain
292
Hemi-Neglect syndrome are a sign of a lesion in which part of the brain?
Forebrain
293
A ipsilateral head tilt is caused by a lesion in which part of the brain?
Vestibular System
294
A Paradoxical head tilt is caused by a lesion in which part of the brain?
Cerebellum
295
Vertical nystagmus is caused by a lesion where?
Central Nervous System
296
Horizontal nystagmus is caused by a lesion where?
PNS - fast phase away from lesion!
297
Where is the Cervical intumescence?
C6-T2
298
Where is the Lumbosacral intumescence?
L4-S3
299
What are the 3 signs of a lesion in C1-C5?
Tetra/hemi - paresis/plegia
Normal Spinal Reflexes
Normal Muscle Tone
300
What are the 3 signs of a lesion in C6-T2?
Tetra/hemi - paresis/plegia (POSSIBLE monoparesis)
Reduce TL reflexes +/- cutaneous trunci
Reduced muscle tone
301
What are the 3 signs of a lesion in T3-L3?
Paraparesis/Plegia
Normal Spinal Reflexes w/reduced cutaneous trunci
Normal muscle tone
302
What are the 3 signs of a lesion in L4-S3?
Paraparesis/Plegia (POSSIBLE mono paresis)
Dec reflexes in pelvic limbs
Reduced muscle tone/atrophy
303
What additional sign is present in a caudal lesion between L4 and S3?
Reduced anal tone/perineal reflex
304
What are 4 factors that may lead to a misleading reduction in spinal reflexes?
Pain
Subtle Lesion
Acute Spinal Shock
Old age
305
What Cx would you see in a Grade 1 Severity spinal injury?
Spinal Pain only
306
What Cx would you see in a Grade 2 Severity spinal injury?
Ambulatory Paresis
307
What Cx would you see in a Grade 3 Severity spinal injury?
Non-ambulatory Paresis
308
What Cx would you see in a Grade 4 Severity spinal injury?
Paralysis
309
What Cx would you see in a Grade 5 Severity spinal injury?
Paralysis + loss of pain sensation
310
How many pairs of Spinal Nerves are there in the dog?
36
311
How would a motor neuropathy present?
Flaccid Paresis
Reduced Tone
Muscle Atrophy
312
How would a sensory neuropathy present?
Decreases Sensation
| Paraesthesia
313
How do all neuropathies present?
Reduced spinal reflexes
OR
Reduced CN reflexes
314
A reduced in reflexes in all 4 limbs would be indicative of what lesion?
Polyneuropathy
315
Give an example of a pre-synaptic junctionopathy.
Botulism
316
Give an example of a post-synaptic junctionopathy.
Myasthenia Gravis
317
How do myopathies present?
Generalised weakness/exercise intolerance WITHOUT proprioceptive deficits
318
Acute, Non-progressive Central Vestibular signs are likely caused by what type of disease?
Cerebrovascular
319
How do cerebrovascular lesions appear on MRI?
Well-defined
Sharply Demarcated
Minimal/No mass effect
320
What are 3 conditions associated with cerebrovascular disease.
CKD
Hypertension
Hyperadrenocorticism
321
An acute, progressive CNS disease with multifocal signs is often caused by what?
Meningioencephalomyelitis of unknown origin
322
Which type of MUO is commonly found in young (3-8y) toy breeds?
Granulomatous
323
What are the 3 forms of granulomatous meningioencephalomyelitis?
Disseminated (most common)
Focal
Ocular
324
What may focal granulomatous meningioencephalomyelitis be confused with?
Neoplasia
325
What are the common presenting signs of disseminated granulomatous meningioencephalomyelitis?
Multifocal - all brain regions affected
326
What are the common presenting signs of Ocular granulomatous meningioencephalomyelitis?
Acute onset visual impairment.
Dilated, non-responsive pupils
optic disc oedema
327
How does GME present on MRI?
Multiple Hyperintensities
Irregular Margins
WM > GM
328
What does CSF analysis of a patient with GME show?
Pleocytosis
Increased Protein
(occasionally normal)
329
Which breeds are commonly affected by Necrotising meningoencephalitis?
Pug
Chihuahua
Yorkie
330
What type of MUO often presents with seizures, blindness, altered behaviour, circling and depression?
Necrotising Meningoencephalitis
331
How do the signs of Necrotising meningoencephalitis occur?
Acute
| Rapidly Progressive
332
What is the primary aim of treatment for MUOs?
IMMUNOSUPPRESSION
333
What is the primary drug used to treat an MUO?
Corticosteroids
334
What can be used as a secondary therapy for MUOs?
Cytosine arabinoside
| also azathioprine, ciclosprine, lomustine, procarbazine
335
What is the MST for GME?
14 days
336
How long will a NE dog live for untreated?
3m
337
How long will a NE dog live for if receiving double immunosuppression?
180d
338
What would you expect in a CSF sample from an FIP patient?
High Protein
Pleocytosis
FCoV RNA (PCR)
339
How would the brain of an FIP cat appear on MRI?
Enhanced periventricular contrast
Ventricular Dilation
Hydrocephalus
340
How would you relieve neurological signs in a hypothyroid patient?
Levothyroxine
341
What neurological signs may be present in a hypothyroid patient?
Peripheral or Central Vestibular Disease
342
Which antibiotic has been linked with neurotoxicity leading to CVS, seizures, tremors and rigidity?
Metronidazole
343
How can you improve the record time for a patient with antibiotic-induced neurotoxicity?
Stop Antibiotic
| Give Diazepam!
344
What is the role of thiamine in the brain?
Oxidation of glucose in Krebs cycle
345
Which patients may commonly present with thiamine deficiency?
Cats on an all-fish diet
346
What are the clinical signs of thiamine deficiency?
```
Anorexia
Lethargy
Vestibular Signs
Seizures
Mydriasis w/reduced PLR
```
347
What is the most common primary brain tumour in the small animal?
Caudal Fossa Meningioma
348
Which neurological structures pass the middle ear, and therefore can be affected by otitis?
```
CN VII (Facial)
CN VIII (Vestibulocochlear)
Sympathetic Supply to the eye
```
349
What are the Primary Factors for Otitis Media/Interna?
Hypersensitivity
| Keratinisation Defects
350
What are the Predisposing Factors for Otitis Media/Interna?
Conformation (hairy, narrow, pendulous)
Iatrogenic (over cleaning)
Swimming
351
What are the Perpetuating Factors for Otitis Media/Interna?
Infections (Malassezia, Staphs, Pseudomonas, Proteus)
352
How can you identify idiopathic vestibular disease from other peripheral vestibular diseases?
No central signs (proprioceptive deficits)
No vertical nystagmus
Multiple CNs affected
353
How is idiopathic vestibular disease treated?
NO Tx - Spontaneous Recovery (3-4w)
354
How does Idiopathic Vestibular Disease present in the dog?
Acute peripheral signs - roll, fall, vomit, ataxia
Head tilt
Horizontal/Rotatory Nystagmus
355
How does Idiopathic Vestibular Disease present in the dog?
2 Forms:
Atypical: acute but Cx progressive
PVD: acute & non-progressive
356
What are the 3 causes of Facial Nerve Paralysis?
Idiopathic
Brainstem Lesions
Middle Ear Disease
357
What are the major signs of facial nerve paresis/paralysis?
Drooping of face, widened palpebral fissure,
| absence/reduced corneal/palpebral reflex
358
How do we treat Facial Nerve Paralysis?
Lubricate the eye & wait for recovery
359
What are the 4 classifications for hearing issues?
Age of Onset
Underlying Cause
Location
Sensorineural or Conductive
360
What are the 3 most common types of deafness in the dog?
Congenital sensorineural deafness
Acquired sensorineural deafness
Acquired Conductive Deafness
361
Which type of deafness is most common in white pigmented, blue eyed dogs/cats?
Congenital sensorineural deafness
362
Name 5 causes of Acquired Deafness
```
Chronic Otitis (Int/Med)
Ototoxicity
Noise Trauma
Old Ace
Anaesthesia
```
363
What does BAER stand for?
Brainstem Auditory Evoked Response
364
What does OAE stand for?
OtoAcoustic Emissions
365
What does the BAER test?
Electrical responses of CNVIII and auditory portion of brainstem
366
What does OAE test?
Measures low-level sounds produced by ear as part of normal hearing
367
Which test is the most reliable for deafness?
BAER
368
Which is the cheapest, first-line test for deafness?
OAE
369
What is ICP related to?
The volume of:
The brain
Blood supplying the brain
The CSF
370
What is the formula for Cerebral Perfusion Pressure?
CPP = maBP - ICP
371
To where does the forebrain herniate?
Under the tentorium
372
To where does the cerebellum herniate?
Through the Foramen Magnum
373
Name 5 signs of increased ICP
```
Depression/Stupor
Cushings Reflex
Altered PLR
Vestibular Eye Movement
Abnormal posture
```
374
What is the Cushings Reflex?
Increased ICP --> Bradycardia and Hypertension
375
How does increased ICP cause hypertension?
alpha 1 adrenergic activation --> systemic vasoconstriction
376
How does increased ICP cause bradycardia?
Carotid artery baroreceptors sense hypertension --> vagal activation
377
What is the common presentation of Idiopathic Tremor Syndrome?
Small Breed Dog
Fine, rapid tremor (worsens with stress)
Head tilt & reduced menace
Ataxia
378
How is Idiopathic Tremor Syndrome diagnosed?
CSF - inflammatory
| +/- MRI to rule out other problems
379
How is Idiopathic Tremor Syndrome treated?
CS for 4-6m
Diazepam initially
+/- other immunosuppressive drugs
380
What are the 3 main routes of infection for Bacterial Meningoencephalitis?
Haematogenous
CSF
Direct (eyes, ear, nasal sinus, trauma)
381
What are the Cx for Bacterial Meningoencephalitis?
Acute CNS (obtunded & deficits)
Neck Pain
Pyrexia
382
How do we treat Bacterial Meningoencephalitis?
Antibiotics +/- surgical drainage
383
What is the prognosis for Bacterial Meningoencephalitis?
Guarded!
384
Name 2 protozoa which may infect the brain.
Toxoplasma Gondii
| Neospora Caninum
385
Name 3 viruses which may infect the brain
FIP (FeCoV)
FIV (retrovirus)
Canine Distemper
386
Name 1 bacteria that may infect the brain
Cryptococcus
387
What signs would an intoxicated dog show?
ACUTE seizures
+ GI/CV/Resp signs
+Muscle tremor/fasciculation
388
Name 5 common substances which may cause neurotoxicity in dogs.
```
OPs
Pyrethroids
Lead
Avermectins
Antidepressants
```
389
What would classify a primary head injury?
Physical disruption of parenchyma
390
What would classify a secondary head injury?
Inflammation/haemorrhage causing increased ICP
391
Which grade of head injury would we intervene with medically?
Secondary
392
What can we use for monitoring prognosis in a head trauma patient?
Modified Glasgow Coma Scale
393
What may indicate the need for surgery in a head trauma patient?
Fractures with compression or contamination
Haematomas
Severely Raised ICP
394
What is the aim of IVFT in a head trauma case?
Restore intravascular volume to ensure adequate CPP
395
What should be avoided in fluids for the head trauma patient?
Glucose - causes poor outcome
396
What are the 3 effects of giving 7.5% saline to a head trauma patient?
Reverse Shock
Decrease ICP
Increase CBF/blood delivery
397
How does mannitol decrease ICP?
Dec Blood Viscosity
> Inc CBF
> Inc Free Radical Scavenging
398
What are the two principles for mannitol administration?
0.5-1g/kg slow bolus over 20min
| Follow with crystalloids (prevent dehydration)
399
When is mannitol contraindicated?
Hypovolaemia
400
When is Hypertonic Saline contraindicated?
Hyponatraemia
| Cardiac/Resp Disease
401
Outside what BP range is cerebral blood flow affected?
90-140mmhg
402
How does pain affect ICP?
pain = inc BP = inc ICP
403
How does hypothermia affect the head trauma patient?
shivering increases O2 demands
404
How does hyperthermia affect the head trauma patient?
affects metabolic rate
405
How should a head trauma patient be positioned in their kennel?
Raise Head!
Avoid jugular compression
Turn q4-6h
406
What supportive treatment should be given to a head trauma patient?
```
Urinary Catheter
Nutritional support (NG/oesoph tube)
```
407
Which drugs should NEVER be used in head trauma cases?
Steroids
408
How do hydrocephalus cases present?
```
Domed Head
Persistent Fontanelle
Abnormal Behaviour
?Seizures
Vestibular Signs
```
409
How do corpus callous abnormalities present?
```
Adipsia + HyperNa
Seizures
Abnormal behaviour
Tremor
Circling
```
410
How do hydraencephaly cases present?
circling
abnormal behaviour
seizures (later)
411
What are the four pathogenic components of hepatic encephalopathy?
Hyperammonaemia
Neuroinflammation
Dec Neurotransmission
Cerebral Oedema
412
What is the most common underlying cause of hepatic encephalopathy?
PSS
413
What are the 2 major & 2 minor categories of presenting sign in hepatic encephalopathy?
Major: Vague/Forebrain
Minor: brainstem/cerebellar
414
What vague signs may be present for hepatic encephalopathy?
Failure to thrive
Weight loss
PUPD
GI signs
415
What forebrain signs may be present for hepatic encephalopathy?
Behaviour change
Pacing
Blindness
Seizure
416
How is hepatic encephalopathy diagnosed?
BAST
Fasting Ammonia
US
CT angiography
417
What 5 treatments should be used in combination for hepatic encephalopathy?
```
Lactulose
Antibiotics
Low protein diet
Seizure control
Minimise contributing factors
```
418
What are the possible underlying causes for hypoglycaemia?
```
Insulinoma
Insulin Overdose
Liver Disease
Glycogen Storage Disease
Juvenile Hypoglycaemia
```
419
What are the clinical signs of hypoglycaemia?
```
Lethargy/Hunger
Depression/anxiety
Weakness/temors
Reduced Vision
Seizures
```
420
How is hypoglycaemia diagnosed?
Blood Glucose <3mmol/L
| Clinical Signs
421
What are the clinical signs for sodium derangement?
Altered Mentation
Blindness
Seizures
Coma/Death
422
What is the role of calcium in the brain?
Presynaptic Neurotransmitter - stabilise nerve/muscle membranes
423
What are the clinical signs of hypocalcaemia?
```
muscle spasm/cramp/twitch
trembling
stiffness
tonic-clonic spasm
seizures
```
424
What is the pathogenesis of hypocalcaemia?
spontaneous discharge due to inc excitability from inc permeability to Na
425
What are the most common primary brain tumours in the dog?
intra-axial: glioma
| Extra-axial: meningioma/choroid plexus tumour
426
Which tumours commonly metastasise to the brain?
Haemangiosarcoma
427
What is the most common sign in supratentorial tumours?
Seizure
428
What is the most common sign in infratentorial tumours?
Vestibular Dysfunction
429
What is the MST for infratentorial tumours?
28d
430
What is the MST for supratentorial tumours?
178d
431
how can you treat CNS neoplasia in the dog?
AEDs (min sedative)
anti-inflm dose of preds
analgesia
432
Name common inflammatory spinal diseases.
```
SRMA
MUO
Discospondylitis
Toxoplasma
Neospora
FIP/FeLV
```
433
Name some common degenerative spinal disease of the SA.
IVDD
CSM
LSDS
DM
434
What dogs are commonly affected by SRMA?
Young (6-18m)
435
What are the clinical signs of SRMA?
Lethargy/Anorexia
Stiffness & fever
cervical rigidity
neurological deficits
436
Which disease is often concurrent with SRMA?
IMPA
437
What does SRMA stand for?
Steroid Responsive Meningitis - Arteritis
438
How is SRMA diagnosed?
CSF:
acute - neutrophilic pleocytosis
Chronic - mononuclear pleocytosis
439
What is the best Tx for SRMA?
Corticosteroids 6-9m
| +/-azathioprine/cyclosporine
440
What is the Px for SRMA?
Good - but potential relapse
441
What is discospondylitis?
IVD/adjacent vertebrae infection
442
How does discospondylitis present?
Marked Spinal Pain
| 1/3 have systemic illness
443
How would you diagnose discospondylitis from imaging?
Rx/MRI/CT
Narrowing of IVD space
Rough endplates
444
How would you treat Discospondylitis?
8w Antibiotics
| analgesia
445
What does MUO stand for?
Meningiomyelitis of Unknown Origin
446
How does MUO present?
Subacute
Progressive
Painful
?asymmetrical/multifocal
447
What are the 2 methods for diagnosis of an MUO?
MRI - variable
| CT - pleocytosis
448
Name 3 common causes for spinal fractures in the canine patient.
RTA
Bite
Falling From Height
449
How are spinal fractures diagnosed?
```
Neuro exam (CARE)
Rx - Thorax/Abdo w/ orthogonal views
```
450
What is an important Ddx for an MUO?
IVDD
451
What is the 3 compartment rule of spinal fractures?
If fracture affects 2+ compartments --> unstable and therefore surgical
452
What is contained in the dorsal spinal compartment?
articular processes
laminae
pedicles
spinous processes
453
What is contained in the middle spinal compartment?
Dorsal longitudinal ligament
Dorsal Vertebral body
Dorsal Annulus Fibrosus
454
What is contained in the ventral spinal compartment?
Ventral Vertebral Body
Lat/Vental AF
Nucleus pulposus
455
What is contained in the ventral spinal compartment?
Ventral Vertebral Body
Lat/Vental AF
Nucleus pulposus
Ventral Longitudinal ligament
456
What should our PRIMARY Tx for spinal fractures be?
Stabilise and Analgesia
457
What is the prognosis for a spinal fracture without deep pain present?
<5%
458
Which dogs are commonly affected by AA instability?
young dogs
| toy breeds
459
Describe the onset of AA instability.
Acute OR Chronic
| Waxing/waning
460
What are 2 common causes of AA instability?
Aplasia/hypoplasia of dens
or
Trauma
461
What are the clinical signs of AA instability?
Neck pain
| Ataxia/Tetraparesis
462
How is an AA instability managed conservatively?
Conservative splint for 6-12w
463
What is the prognosis for surgical Tx of AA instability?
Guarded: High preoperative morbidity/mortality
464
What is a chiari-like malformation?
mismatched caudal fossa volume/contents w/ caudal displacement of the cerebellum via foramen magnum
465
What are the 3 types of chair-like malformation?
Hydromyelia
Syringomyelia
Syringohydromyelia
466
What are the clinical signs of CLM?
Neck pain
Neck scratching
torticollis
TL weakness
467
How can we Tx CLM medically?
Gabapentin
NSAID
Furosemide
C/S, paracetamol/opioids
468
Can we Tx CLM surgically?
Yes - 50% of cases will improve BUT high recurrence
469
How do ischaemic myelopathies present?
Per-Acute
Non-painful
Lateralised
470
What is a key exacerbating factor for ischaemic myelopathy?
Exercise
471
What is the underlying pathogenesis for ischaemic myelopathy?
nucleus pulposus fibrocartilage embolises in SC vasculature
472
What may cause a traumatic disc extrusion?
RTA, Fall, Exercise
473
How do TDEs present?
Acute
Non-Painful
Non-progressive
474
What is the underlying pathogenesis of a TDE?
herniated N. pulpous is non-mineralised > cord contusion w/min compression
475
How can we treat TDEs?
Supportive care & physiotherapy
476
When does IVDD present in chondrodystrophic breeds?
1st 2y of life
477
When does IVDD present in non-chondrodystrophic breeds?
After middle age
478
What type of metamorphosis is present in IVDD of non-chondrodystrophic breeds
Fibroid
479
What type of metamorphosis is present in IVDD of chondrodystrophic breeds?
Chondroid
480
What is a type 1 disc extrusion?
Extrusion - N. pulposus herniates through annular fibres
481
What is a type 2 disc extrusion?
Protrusion of annular ligament & shifted N. pulp
482
how does T1 IVDD present?
Acute
Progressive
Painful
483
how does T2 IVDD present?
Slowly progressive
| Chronic
484
What age of dog is affected by T1 IVDD?
3-6y chondrodystrophic
| 6-8 otherwise
485
What age of dog is affected by T2 IVDD?
Older dogs
486
What is the nucleus invaded by in IVDD of chondrodystrophic breeds?
hyaline cartilage
487
What is the nucleus invaded by in IVDD of non-chondrodystrophic breeds?
fibrocartilage
488
Is IVDD type 1 a protrusion or extrusion?
extrusion
489
Is IVDD type 2 a protrusion or extrusion?
protrusion
490
What is conservative Tx for IVDD?
Rest 4-6w
| Analgesia
491
When should surgery be used for IVDD?
Grade 3-5 neuro deficits
severe pain
lack of improvement
492
What signs of wobblers are present in the pelvic limbs?
paresis/ataxia (worse)
493
What signs of wobblers are present in the thoracic limbs?
Short gait
| Atrophy
494
What is the cause of CSM?
```
Multifactorial:
Type II IVDD
Hypertrophy of ligaments or synovial membrane
Spinal Canal Stenosis
DJD of facets
```
495
How can CSM be treated conservatively?
Anti-inflammatories
| Rest
496
How can CSM be treated surgically?
Decompression
OR
Distraction-stabilisation
497
What is the main presenting sign for lumbosacral degenerative stenosis?
reluctant to exercise, rise, jump, do stairs
498
How is lumbosacral degenerative stenosis treated?
Anti-inflammatories/gabapentin
OR
Surgery
499
How do vertebral body abnormalities present?
Chronic & slow progression
| non-painful
500
How are vertebral body abnormalities diagnosed?
Myelography
501
How are vertebral body abnormalities treated?
Decompression +/- stabilisation
502
How does spinal neoplasia present?
Chronic
Progressive
Painful
503
Where are the 3 possible locations for a spinal neoplasia?
Extradural
Intradural Extramedullary
Intramural Intramedullary
504
How are spinal neoplasms treated?
Decompression
Radiation
Palliate
505
How does Degenerative Myelopathy present?
Progressive ataxia/paresis of PLs leading to paralysis
| NO Tx!
506
What is a hemilaminectomy?
Removal of half of the vertebral arch
| Allows IVD fenestration
507
Where is a hemilaminectomy used?
TL spine
508
What is a Dorsal Laminectomy?
Removal of DSPs and laminae
509
When should a Dorsal Laminectomy be used?
Anywhere - mostly at LS area.
| IVDD, malformations and neoplasia common uses
510
What is a ventral slot surgery?
slot ventrally through IVD and cranial/caudal endplates of cervical vertebrae
511
What is the limitation to a ventral slot surgery?
Limited View
512
What analgesia may be used post-spinal surgery?
```
NSAID
Gabapentin
Paracetamol
Tramadol
Opioids
```
513
How does a UMN bladder lesion present?
Distended
| Difficult to express
514
How does a LMN bladder lesion present?
Distended
| Continually dribbling
515
Where is the lesion for a UMN bladder lesion commonly found?
Cranial to Sacral SC
516
Where is the lesion for a LMN bladder lesion commonly found?
Within sacral SC/plexus
| or in pelvic/pudendal nerve
517
Which drugs increase detrusor contraction?
Bethanecol
| Cisapride
518
Which drugs decrease detrusor hyperreflexia?
Propantheline
| Oxybutinin
519
Which drugs increase urethral tone?
phenylpropanolamine
imipramine
diethylstilbestrol
testosterone
520
Which drugs decrease urethral tone?
phenoxybenzamine
prazosin
diazepam
dantrolene
521
What is a seizure?
transient symptoms of an abnormal excessive/synchronus neuronal activity in the brain
522
Where in the brain would a lesion cause seizures?
Forebrain
523
Explain the pathogenesis of a seizure.
Imbalance in excitation and inhibition.
Excitation inc
|nhibition dec
524
What is the Prodrome phase of a seizure?
A predicting event
525
What is the Aura phase of a seizure?
The initial manifestation
526
What is the Ictal phase of a seizure?
the seizure event: involuntary tone/movement/behaviour
527
What is the Post-ictal phase of a seizure?
mins to days after: strange behaviour/neuro deficits
528
How long is the ictal event normally?
60-90s
529
When do ictal events commonly occur?
at sleep or rest
530
What are the two major phenotypic categories of seizure?
Generalised
| Focal
531
What are the two major phenotypic categories of seizure?
Generalised
| Focal
532
Which generalised seizure activity is most common?
tonic-clonic
533
What is the characteristic feature of a generalised seizure?
loss of consciousness
534
What is a focal seizure?
Activation of one part of one cerebral hemisphere/forebrain region
535
What are the 3 forms of focal seizure?
Motor
Autonomic
Behavioural
536
What are the 5 forms of Generalised seizure?
```
Tonic-clonic
Tonic
Clonic
Myoclonic
Atonic
```
537
What are the main predisposing factors for audiogenic reflex seizure?
```
Cat
Late onset (15y+)
```
538
What are the characteristics of an audiogenic reflex seizure?
Myoclonic progressing to tonic-clonic in some
539
Which drug is best used to control audiogenic reflex seizures in cats?
Levetiracetam
540
Which seizure drugs are licensed in cats?
none
541
What are common Ddx for seizures?
```
Narcolepsy/cataplexy
Neuromuscular collapse
Syncope
Movement Disorders
Metabolic /vestibular disease
```
542
What are the 3 categories of seizure cause?
Reactive Seizure
Idiopathic epilepsy
Structural Epilepsy
543
What two things usually cause reactive seizures?
Metabolic or toxic derrangements
544
What is often present with a reactive seizure or structural epilepsy?
concurrent neurological signs
545
What is the cause of idiopathic epilepsy?
Genetic
546
What neurological signs are associated with idiopathic epilepsy?
NONE
| No inter-ictal signs
547
What are the causes of structural epilepsy?
Inflammatory
Neoplastic
Traumatic
548
What are the causes of structural epilepsy?
Inflammatory
Neoplastic
Traumatic
549
How is idiopathic epilepsy diagnosed?
Exclusion
550
How does idiopathic epilepsy commonly present?
6m-6y
| Normal between seizures
551
What are the tier I confidence intervals for idiopathic epilepsy?
2+ seizueres 24h apart
6m-6y onset
Normal inter-ictal exam
Haem/biochem normal
552
What are the tier II confidence intervals for idiopathic epilepsy diagnosis?
Unremarkable fasting/bile acids
MRI of brain
CSF analysis
+ tier I
553
When is KBr NOT licensed?
Cats
| Mono therapy in dogs
554
When is KBr NOT licensed?
Cats
| Monotherapy in Dogs
555
What 2 seizure types are an emergency?
Cluster Seizures
| Status Epilepticus
556
What are the tier III confidence intervals for idiopathic epilepsy diagnosis?
Tier I & II PLUS
| Ictal or inter ictal ECG abnormalities
557
At what age should a dog with idiopathic epilepsy have an MRI?
<6m or >6y
558
What abnormal seizure patterns may make an MRI an appropriate investigation?
Inter-Ictal abnormalities
Status Epilepticus
Cluster Seizure
559
What seizure features would warrant Tx initiation?
SE/Cluster seizures
| post-ictal signs >24h
560
Which are the 3 anti-seizure drugs licenced in dogs?
Phenobarbitone
KBr
Imepitoin
561
Which anti-seizure drugs are licenced in cats?
NONE
562
What is the MOA of phenobarbitone?
Augments GABA - prolongs Cl channel opening
563
What is the appropriate dose of phenobarb for seizures in:
a) Cats
b) Dogs?
a) 2mg/kg BID
| b) 3 mg/kg BID
564
When should we monitor phenobarbitone levels?
2w, 3m, and 6m after starting
565
What level of phenobarbitone in the blood is ideal?
25-30mg/L
566
What are common SEs of phenobarbitone?
Sedation/Ataxia
PUPD & polyphagia
Neutropenia/Anaemia/TCP
567
When is phenobarbitone CI'ed?
Liver disease due to Cp450 metabolism
568
What is the MOA of KBr?
Competes with Cl- at nerve, inhibts Na (membrane hyperpolarisation, seizure threshold raised)
569
What is the appropriate dose of KBr for seizures in:
a) Cats
b) Dogs?
a) DO NOT GIVE
| b) 30mg/kg SID
570
When do we monitor KBr levels?
12w PLAIN SERUM
571
What is our therapeutic level of KBr in the blood?
10-15mmol/L if w/pheno
| 12.5-37.5 if monotherapy
572
What are the SEs of KBr?
Sedation, Ataxia, PL weakness
573
How is KBr metabolised/excreted?
Unchanged in urine.
574
What is the MOA of Imepitoin?
GABA Benzodiazepine receptor partial agonist
575
What is the therapeutic dose for Impeitoin in dogs?
10-30mg/kg BID
576
When should we monitor imepitoin?
N/A - not required
577
What are the SE's of imepitoin?
Same as pheno but lesser
578
Which 2 AEDs are not licenced but commonly used?
Levetiracetam
| Zonisamide
579
Which unlicenced AED must be given at a dose of 20mg/kg TID?
Levetiracetam
580
What is the MOA of levetiracetam?
SV2a modulator - prevents vesicle mobilisation
581
What is the AE dose for zonisamide?
10mg/kg BID
582
What must be done if giving phenobarbitone and zonisamide concurrently?
reduce phenobarbitone dose by 25%
583
What is the MOA of zonisamide?
Blocks Na and Cl- channels.
584
What are the SEs of diazepam in cats?
Fulminant Hepatic Necrosis
585
What are the SEs of Propofol in cats?
Heinz Body Anaemia
586
What are the SEs of KBr in cats?
Eosinophilic Bronchitis
587
How do we classify a cluster seizure?
2+ in 24h
588
how common are cluster seizures in IE?
1/3-2/3 of dogs with IE
589
How do we classify status epilepticus?
seizure lasting >5min
| >2 seizure w/o recovery
590
Why are Clusters and Status E emergencies?
irreversible neuronal damage after 30-60min due to excitotoxic cell injury
591
What is Stage 1 in the pathogenesis of excitotoxic cell injury?
Inc Autonomic Activity
592
What is Stage 2 in the pathogenesis of excitotoxic cell injury?
Irreversible neuronal damage due to increased glutamate
593
What are 6 major causes of Canine Status Epilepticus?
```
Idiopathic Epilepsy
Neoplasia
CNS inflammatory Dz
Trauma
Metabolic Disorders
Toxicities
```
594
What is the FIRST thing you do with a case of status epilepticus?
STOP SEIZURE:
| rectal diazepam 1mg/kg
595
What should you do whilst assessing a case of status epilepticus?
IV catheter placement
Examine
Bloods (Glucose, Na, Ca, Renal/Hepatic Fct)
596
What is the primary medical Tx for a stable patient that has been in status epilepticus?
Phenobarbital
597
What is the secondary medical Tx for a stable patient that has been in status epilepticus?
Levetiracetam
598
Which 3 drugs can be given as infusions to seizure cases?
Diazepam
Midazolam (not hep dysfct)
Propofol
599
What unique management changes should be but in place for seizure patients?
Monitor for pressure sores
| Lubricate Eyes
600
What Neuropathy may cause sudden tetraparesis?
Polyradiculoneuritis
601
What Junctionopathy may cause sudden tetraparesis?
Myasthenia Gravis
Botulism
OP toxicity
602
What Myopathy may cause sudden tetraparesis?
Polymyositis
| Electrolyte abnormalities
603
What is Polyradiculoneuritis?
Inflammation of nerves and roots
604
Which breed is predisposed to Polyradiculoneuritis?
Bengal Cats
605
Where is most of the pathology located in Polyradiculoneuritis?
Ventral Spinal Roots (causes pure motor deficits)
606
Apart from Cx, how can Polyradiculoneuritis be diagnosed?
Electrophysiology (f waves)
607
How is Polyradiculoneuritis treated?
Spintaneous recovery - give supportive care over days-weeks
608
What are the two forms of myasthenia gravis?
Generalised
Fulminant (fast onset)
Focal
609
What is the underlying pathology of myasthenia gravis?
Acquired/Congenital antibodies against AChR
610
how common is megaoesophagus in dogs with myasthenia gravis?
80% of dogs with Mg have megaoesoph
611
What is the gold standard tests for MG?
nAChR Ab
612
Apart from the gold standard, what two tests are available for MG?
Electrodiagnosis
| Tensilon edrophonium response test
613
How is MG treated?
ACh-esterase
Immunosuppression
Postural Feeding
614
What is the pathogenesis of botulism?
Blocks vesicle fusion of pre-synaptic membrane & Ach Release
615
What are the two categories of clinical presentation of botulism?
Nicotinic - Junctionopathy
| Muscarinic - Dysautonomia
616
How does nicotinic botuloism present?
Acute onset tetraparesis
Poss CN involvement
Poss resp muscle involvement
617
How does muscarinic botulism present?
urinary dysfunction
GI dysmotility
mydriasis
reduced tear production
