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Veterinary Medicine > Neurology (SA) > Flashcards

Neurology (SA) Flashcards

1
Q

What occurs if the basal ganglia are damged?

A

Movement Disorders

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2
Q

Which structures make up the ectomeninx?

A

Dura mater

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3
Q

Which structures make up the endomeninx?

A

Arachnoid mater

Pia mater

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4
Q

Which structures make up the endomeninx?

A

Arachnoid mater

Pia mater

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5
Q

What is the Dura Mater fused to?

A

Periosteum of the skull

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6
Q

What are the two folds of the dura mater?

A

Falx cerebri

Tentorium Cerebelli

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7
Q

What is the space between the arachnoid and the dura mater known as?

A

The subdural space

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8
Q

What is the space between the arachnoid and pia mater known as?

A

the subarachnoid space

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9
Q

The space between which two meninges is filled with circulating CSF and trabeculae?

A

Arachnoid and Pia Mater (subarachnoid space)

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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

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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.

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12
Q

How does the CNS affect neurons?

A

Transports neurotransmitters and maintains a stable environment for neurons

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13
Q

What does the CSF contain (in low levels)?

A

amino-acids
K+
glucose

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14
Q

What does the CSF not contain?

A

cells & protein

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15
Q

Where is the CSF produced?

A

choroid plexi

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16
Q

What type of substances can pass into the CSF?

A

lipid soluble

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17
Q

List the 4 arteries that supply blood to the brain

A

Internal Carotid
Basilar
Maxillary
Vertebral

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18
Q

Which are the two main blood supply arteries in the dog?

A

Internal Carotid/Basilar

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19
Q

Which are the two main blood supply arteries in the cat?

A

Maxillary via rete mirabile

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20
Q

Label the following diagram detailing venous drainage of the brain.

A

C1-C5

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21
Q

Which spinal cord segments supply the thoracic limb?

A

C6-T2

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22
Q

Which spinal cord segments supply the thorax and abdomen?

A

T3-L3

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23
Q

Which spinal cord segments supply the pelvic limb/perineum?

A

L4-S3

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24
Q

Which spinal cord segments supply the tail?

A

Cd1-Cd5

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25
Q

Which spinal cord segments supply the tail?

A

Cd1-Cd5

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26
Q

Where is a good region for sampling CSF?

A

lumbar cistern

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27
Q

What effect does an UMN usually have on a LMN?

A

inhibitory

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28
Q

where do UMNs supplying flexor muscles travel?

A

lateral funiculi

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29
Q

where do UMNs supplying extensor muscles travel?

A

ventral funiculi

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30
Q

which neurotransmitter is present at the NMJ?

A

Acetylcholine

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31
Q

What does a muscle need to contract?

A

An intact LMN

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32
Q

what do reflexes NOT require?

A

UMN input

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33
Q

what happens if there is a loss of UMN input in a reflex arc?

A

reflex will be exaggerated - less co-ordination, strength same

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34
Q

What happens to a muscle if a LMN is injured?

A

Loss of RAT (reflex, atrophy and tone)

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35
Q

Where does the pyramidal tract run?

A

caudally in the central medulla in triangular shape

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36
Q

What does the pyramidal tract control?

A

fine, voluntary movement

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37
Q

What does the extrapyramidal tract control?

A

posture, subconscious rhythmic movements

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38
Q

What can the cerebellum NOT do with regard to movement?

A

initiate movement

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39
Q

What is sensory adaptation?

A

constant stimulus > receptor potential decreases > impulses decrease freq > perception fades

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40
Q

What are 4 modalities of somatic sensation?

A

Tactile, Thermal, Pain, Proprioception

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41
Q

Give 2 examples of fast adapting touch receptor.

A

Meissners corpuscle (fine touch) & tactile hairs (crude touch)

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42
Q

Give 2 examples of slow adapting touch receptor

A

Merkels discs (fine) and Ruffinis end-organ (stretch)

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43
Q

Name a pressure receptor

A

Pacinian corpuscle

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44
Q

Describe the structure of a lamellated corpuscle.

A

multi-layered connective tissue capsule enclosing dendrite

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45
Q

What is an itch caused by?

A

stimulation of free-nerve endings by body chemicals

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46
Q

Where are cold receptors located?

A

epidermis

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47
Q

Where are warm receptors located?

A

dermis

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48
Q

Which type of fibres conduct chronic pain?

A

unmyelinated

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49
Q

What is nociceptive pain a response to?

A

harmful stimuli - extreme temperatures, strong mechanical/chemical stimuli

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50
Q

What is activated in nociceptive pain?

A

nociceptors on free nerve endings

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51
Q

What is activated in neurogenic pain?

A

impulses in other parts of the nervous pathway (not free nerve endings)

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52
Q

What is pain sensitisation?

A

With increased exposure to noxious stimuli, nerves become hypersensitive to weak stimuli.

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53
Q

What are the 3 ways in which analgesia may work to reduce pain?

A

Inhibit nociceptors
Block pain impulse conduction
Block signal transmission in CNS pain pathways

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54
Q

Name the two somatosensory pathways.

A

Dorsal Column

Spinothalamic Tract

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55
Q

What does the dorsal column detect?

A

Skin: pressure/touch
Joints
Muscles

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56
Q

What does the spinothalamic column detect?

A

Pain

Temperature

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57
Q

Describe the gate theory of pain.

A

gate neurons are stimulates by other branches of sensory nerves in skin and inhibit neurotransmitter release in the dorsal synapse of pain pathway.

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58
Q

What is proprioception?

A

sense of the relative position of body parts to ensure appropriate posture

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59
Q

What are signs of conscious proprioceptive deficits?

A

Stumbling, knuckling, intention tremors

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60
Q

What does subconscious proprioception control?

A

Sitting/standing, scratching, breathing, chewing, locomotion

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61
Q

What is the main sign of a deficit in subconscious proprioception?

A

Ataxia - differentiate from weakness!!

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62
Q

Name the Cranial Nerves

A 
I Olfactory
II Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens 
VII Facial
VIII Vestibulocochlear
IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal
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63
Q

Which area of the brain coordinates homeostasis, motivation and emotion?

A

The limbic system

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64
Q

Which part of the limbic system determines memory?

A

The hippocampus

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65
Q

lesions in which brain region cause behavioural and emotional changes?

A

The frontal lobe

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66
Q

How does rabies affect the brain?

A

Produces inclusion bodies (negri bodies) in the hippocampus and cerebellar purkinje fibres.

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67
Q

Spontaneouss discharge of which area causes epileptic seizures?

A

The Hippocampus

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68
Q

Which part of the brainstem is responsible for vegetative function?

A

Ascending Reticular Activating System

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69
Q

What are the 4 main signs of hypothalamic lesion?

A
  1. Abnormal water consumption
  2. Abnormal appetite
  3. Abnormal temperature regulation
  4. heme-neglect
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70
Q

Label the following neuroepithelial cell.

A

1.
2.
3.
4.

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71
Q

Which part of a vestibular cell senses changes in head position?

A

Microvilli.

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72
Q

Where in the inner ear do sensory hairs in the endolymph form cupulae?

A

Semi-circular canals

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73
Q

In which sense organ do sensory hairs, endolymph and calcium carbonate crystals work in unison?

A

Otolith organ

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74
Q

Which cranial nerve works alongside otolith organs to provide information about head position?

A

VIII (vestibulocochlear)

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75
Q

How do the otolith organs provide a 3D image of head movement?

A

located in 3 semicircular canals which are in 3 planes at right angles to each other.

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76
Q

Which sense organ is responsible for static balance?

A

Otolith Organ (linear)

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77
Q

Which sense organ is responsible for dynamic balance?

A

Ampullae (circular)

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78
Q

What are the 3 main reflexes which govern posture?

A
  1. Vestibular Reflexes
  2. Tonic Neck Reflexes
  3. Righting Reflexes
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79
Q

which reflexes co-ordinate flexion and extension of limb muscles to shift the centre of gravity?

A

Vestibular Relfexes

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80
Q

What is the difference between vestibular and tonic neck reflexes?

A

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.

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81
Q

Which receptors are involved in the righting reflex?

A 
Vestibular Organs
Muscle Spindles (neck)
Pressure Sensors (skin)
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82
Q

What is the vestibule-ocular reflex?

A

stabilises retinal image during rapid acceleration of the head

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83
Q

What are the signs of vestibular syndrome?

A

Head tilt, Circling and Nystagmus

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84
Q

What are the two major categories of receptor in the PNS?

A

Adrenergic

Cholinergic

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85
Q

Where are all of the sympathetic ganglia?

A

The spinal cord (sympathetic chain)

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86
Q

What are the two subtypes of cholinergic receptor?

A

Nicotinic (2 further divisions)

Muscarinic (3 further divisions)

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87
Q

What are the two major subtypes of adrenergic receptor?

A

Alpha and Beta

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88
Q

What is the aim of anticonvulsant drugs?

A

to stabilise membranes in the CNS

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89
Q

How do anticonvulsants stabilise the CNS?

A

increase GABA (inhibitory neurotransmitter) or decrease Na influx

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90
Q

Which stimulant is used to stimulate chemoreceptors in the aorta/carotid body of neonates?

A

Doxapram (for sluggish neonates)

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91
Q

How do phenothiazine derivatives work?

A

block dopamine receptors and inhibit serotonin

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92
Q

How do Benzodiazepines work?

A

enhance GABA action

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93
Q

How do alpha 2 agonists work?

A

bind to presynaptic adrenergic receptors - reduce noradrenaline release

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94
Q

How do opioids work?

A

activate receptors associated with pain modulation

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95
Q

What are the 3 major types of opioid receptor?

A

Kappa, Mew and Delta

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96
Q

What are the 4 major effects of opioids?

A

Analgesia, Sedationm, euphoria and antitussives

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97
Q

How is neuroleptanalgesia produced?

A

Opioid + Sedative

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98
Q

How do local anaesthetics work?

A

Elevate threshold potential and reduce Na permeability –> decreases APs in nerves

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99
Q

Which local anaesthetic can be used to treat ventricular tachycardia?

A

Lidocaine

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100
Q

How do injectable anaesthetics work?

A

Enhance GABA activity
Reduce Glutamine activity
some unknown MOAs

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101
Q

What areas of the brain do anxiolytics (such as benzodiazepines) work on?

A

Cerebral cortex, limbic system, thalamus

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102
Q

How do antidepressants work?

A

increase monoamine activity

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103
Q

Influx of what triggers neurotransmitter exocytosis?

A

Calcium Ions

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104
Q

How is Ach inactivated?

A

Broken Down by AChE before reuptake at pre-synaptic neuron

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105
Q

How is Noradrenaline inactivated?

A

uptake at the pre-synaptic neurone

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106
Q

Which substance inhibits monoamine re-uptake?

A

fluoxetine

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107
Q

Which neurotransmitters are monoamines?

A

Noradrenaline, Dopamine, Serotonin

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108
Q

Which substance inhibits ACh breakdown?

A

neostigmine

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109
Q

What is the primary excitatory neurotransmitter in the brain?

A

Glutamate

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110
Q

What is the primary inhibitory neurotransmitter in the brain?

A

GABA

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111
Q

What is synaptic summation?

A

Multiple sub threshold inputs acting simultaneously to create an AP.

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112
Q

What is negative summation?

A

multiple inhibitory neurons firing to prevent an AP.

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113
Q

What does the vestibulaocerebellum affect?

A

Balance and eye movement

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114
Q

What does the spinocerebellum affect?

A

motor execution

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115
Q

what does the cerebrocerebellum affect?

A

motor planning

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116
Q

What are 3 major signs of cerebellar dysfunction?

A

Ataxia
Dysmetria
Intention Tremors

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117
Q

what are the 3 anatomical lobes of the cerebellum?

A

Anterior, Posterior and Flocconodular

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118
Q

What causes cognitive dysfunction syndrome in dogs?

A

Beta-amyloid plaque deposition

Neurofibrillary Tangles

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119
Q

Which are the fastest opening nerve fibres?

A

Alpha adrenergic

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120
Q

Which are the slowest nerve fibres for pain?

A

C-fibres (unmyelinated)

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121
Q

What are the two ventrolateral ascending pain pathways?

A

Spinothalamic

Spinoreticular

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122
Q

What is the role of the hypothalamus?

A

Homestasis

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123
Q

The hypothalamus releases neurohormones which act on what?

A

The pituitary gland

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124
Q

The portal venous system in the pituitary stalk links which 2 areas together?

A

Anterior pituitary and Hypothalamus

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125
Q

What causes narcolepsy?

A

Abnormal orexin receptor or protein

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126
Q

What is the FIRST component of a neurological exam?

A

Observation

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127
Q

What blood tests should be run on a potential neurological case?

A

Haem/Biochem
Endocrine
Serology - ID/AutoIm
Toxicology

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128
Q

What is Myasthenia Gravis?

A

Autoimmune condition - blockade of Ach receptor at NMJ

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129
Q

How can we test for Myasthenia Gravis?

A

Administer Edrophonium Chloride - temporary increase in Ach at synapses to overcome blockade

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130
Q

What is Horner’s Syndrome?

A

Loss of sympathetic stimulation to the eye

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131
Q

How do we test for Horner’s?

A

Phenylephrine in eye - causes pupil dilation if Horner’s +

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132
Q

Name the 6 signals which modulate the satiety/appetite centres.

A 
Glucose
CCK
GI filling
Smell
Vision
Body Fat Reserves
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133
Q

Which substance, produced by fat, inhibits appetite in the hypothalamus?

A

Leptin

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134
Q

Which substance stimulates feeding by acting on the brainstem?

A

Ghrelin

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135
Q

What effect do sedatives have which tranquillisers do not?

A

Cause Drowsiness (tranquillised patients and calm but alert)

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136
Q

Give two examples of a sedative

A

Xylazine

Medetomodine

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137
Q

Give two examples of a tranquilliser

A

Diazepam (minor)

ACP (major

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138
Q

What are the two major effects of Benzodiazepines?

A

Sedation

Muscle Relaxation

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139
Q

How do Benzodiazepines work?

A

GABA agonism

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140
Q

Which drug is a benzodiazepine antagonist?

A

Flumazenil - used to reverse resp depression

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141
Q

What effects do alpha2 agonists have?

A 
Calming
Drowsiness
Visceral Analgesia
Muscle Relaxation
Reduction in subsequent anaesthetic doses.
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142
Q

What is the primary side effect of an alpha 2 agonist?

A

CVS depression

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143
Q

Which alpha 2 antagonist can be used to reverse an agonist?

A

Atipamezole

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144
Q

Which receptors do phenothiazines antagonise?

A

Histamine H1
Adrenergic A1
Muscarinic

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145
Q

Give 2 uses for ACP

A

Strong Sedative

Anaesthetic Pre-med

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146
Q

What must you be careful of with ACP?

A

enhances effects of other narcotics - REDUCE DOSES!

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147
Q

What class of drugs does Azaperone belong to?

A

Butyrophenones

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148
Q

What are the effects of azaperone?

A

Neuroleptic
Sedative
Potent anti-emetic

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149
Q

What is “Ictus”?

A

The epileptic seizure

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150
Q

What are the signs of a full brain (generalised) seizure?

A

Bilateral convulsions
Loss of consciousness
May be”absent”

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151
Q

What are the signs of a focal secure?

A

Automatisms

Possible progression

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152
Q

What is epilepsy caused by?

A

Mass firing of APs in the brain

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153
Q

How can we depress the synaptic activity responsible for epilepsy?

A 
Inc GABA release
Inc GABA efficacy
Dec GABA uptake
Use GABA analogues
Dec GLUT release
Dec GLUT efficacy
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154
Q

How does Phenobarbitone decrease epileptic seizures?

A

increases GABA efficacy at receptor

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155
Q

How does levatiracetam work?

A

Blocks Ca channels to prevent Ca influx & glutamate release

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156
Q

How does gabapentin work?

A

Blocks Ca channels to prevent Ca influx & glutamate release

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157
Q

How does KBr work?

A

Blocks Na channels to prevent Na influx & glutamate release

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158
Q

Who must not receive KBr?

A

CATS

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159
Q

Which is the longest acting anti-epileptic drug?

A

Phenobarbital (36h)

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160
Q

Which is the shortest acting anti-epileptic drug?

A

Gabapentin (3h)

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161
Q

What are the 3 main rules for anti-epileptic drugs?

A

DON’T:
Change drugs suddenly
Withdraw meds suddenly
Give phenothiazines

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162
Q

How does lidocaine work?

A

Blocks Voltage-gated Na channels in the post-synaptic membrane

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163
Q

What are the 4 main local anaesthetics used in veterinary medicine?

A

Procaine
Lidocaine
Mepivicaine
Bupivicaine

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164
Q

Which local anaesthetics cause vasodilation?

A

Procaine

Lidocaine

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165
Q

Which local anaesthetics cause vasoconstriction?

A

Bupivicaine

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166
Q

Which local anaesthetic has high toxicity?

A

Bupivicaine

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167
Q

Place the 4 major veterinary local anaesthetics in order of DOA. (Short –> long)

A

Procaine (30min)
Lidocaine (30-45min)
Mepivicaine (90-120min)
Bupivicaine (4-6h)

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168
Q

Which local anaesthetics have a fast onset?

A

Lidocaine

Mepivicaine

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169
Q

What are the 4 major systemic effects of opioid drugs

A

Neuroleptanalgesia
Restraint
Anti-diarrhoea
Anti-Jussive

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170
Q

Which is the gold standard opioid pre-med?

A

Morphine

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171
Q

What effect does morphine have on the cortex?

A

Sedation

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172
Q

What effect does morhpine have on the medulla?

A

Stimulation then depression
OR
Depression

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173
Q

Where is morphine metabolised?

A

Liver

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174
Q

Which short-acting opiate may cause histamine release if given IV?

A

Pethidine

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175
Q

Which opioid is highly fast and potent?

A

Fentanyl

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176
Q

Which opiate is long-acting but causes less euphoria than morphine?

A

Methadone

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177
Q

Which opioid has a slow onset and offset?

A

Buprenorphine

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178
Q

What are the 4 major side-effects of opioid drugs?

A

Resp Depression
Vagal stimulation
Constipation
Nausea

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179
Q

What are the 3 major opioid receptors?

A

Delta
Mew
Kappa

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180
Q

Which opiates are ONLY full mew agonists?

A

Morphine
Pethidine
Methadone
Fentanyl

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181
Q

Which opiates are full mew AND kappa agonists?

A

Etorphine

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182
Q

Which drugs are kappa agonists and mew antagonists?

A

Buprenorphine

Butorphanol

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183
Q

Which drug is a full opioid receptor antagonist?

A

Naloxone

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184
Q

How do opiates effect the post-synaptic membrane?

A

Activation of inwardly rectifying K+ channels

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185
Q

How do opiates effect the pre-synaptic membrane?

A

Inhibition of Ca channels

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186
Q

Which two modes of pain do opiates block?

A

Psychological
AND
Nociception

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187
Q

How can we produce effective neuroleptanalgesia with two drug classes?

A

Opioid + Neuroleptic

i.e. ACP + butorphanol

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188
Q

Which opioid is rapidly fatal to humans?

A

Etorphine

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189
Q

Which analeptic can be used to reduce resp depression of other opioids?

A

Doxapram

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190
Q

How does amitriptyline work?

A

Monoamine oxidase inhibitor

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191
Q

What is the MOA of amantidine?

A

NMDA blocker

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192
Q

What can be used to control neuropathic pain?

A

GABApentin

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193
Q

What are the two main components of the forebrain?

A

Cerebral cortex

Diencephalon

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194
Q

What are the three main components of the brainstem?

A

Midbrain
Pons
Medulla Oblongata

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195
Q

Define the 4 functional divisions of the spine.

A

C1-C5
C6-T2
T3-L3
L4-S3

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196
Q

Where is grey matter located?

A

Brain - surface

Spinal Cord - Centre

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197
Q

What does Grey Matter contain?

A

Cell Bodies

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198
Q

What is the function of Grey Matter?

A

Processing Information

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199
Q

Where is the white matter located?

A

Brain - deep parts

Spinal Cord - superficial

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200
Q

What does white matter contain?

A

Myelinated axon tracts

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201
Q

What is the function of White Matter?

A

Connects neurons

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202
Q

What neuron is in the ventral horn?

A

Motor Neuron Cell Body

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203
Q

What neuron is in the dorsal horn?

A

Sensory Neuron Cell Body

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204
Q

Where is the sympathetic ANS located?

A

Craniosacral

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205
Q

Where is the parasympathetic ANS located?

A

Thoracolumbar

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206
Q

How does a UMN lesion affect the bladder?

A

Distended

Hard to Express

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207
Q

How does an LMN lesion affect the bladder?

A

Distended

Continually overflowing and dribbling

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208
Q

Testing the Flexor reflex in the thoracic limb allows you to assess which PN?

A

All TL PNs

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209
Q

Testing the Flexor reflex in the thoracic limb allows you to assess which SC segment?

A

C6 - T2

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210
Q

Testing the Biceps reflex in the thoracic limb allows you to assess which PN?

A

Musculocutaneous

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211
Q

Testing the Biceps reflex in the thoracic limb allows you to assess which SC segment?

A

C6-C8

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212
Q

Testing the Triceps reflex in the thoracic limb allows you to assess which PN?

A

Radial

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213
Q

Testing the Triceps reflex in the thoracic limb allows you to assess which SC segment?

A

C7 - T2

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214
Q

Testing the Ext Carpi Rad reflex in the thoracic limb allows you to assess which PN?

A

Radial

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215
Q

Testing the Ext Carpi Rad reflex in the thoracic limb allows you to assess which SC segment?

A

C7 - T2

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216
Q

Testing the Flexor reflex in the Pelvic limb allows you to assess which PN?

A

Sciatic

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217
Q

Testing the Flexor reflex in the Pelvic limb allows you to assess which SC segment?

A

L6 - S1

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218
Q

Testing the Patellar reflex in the Pelvic limb allows you to assess which PN?

A

Femoral

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219
Q

Testing the Patellar reflex in the Pelvic limb allows you to assess which SC segment?

A

L4 - L6

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220
Q

Testing the Gastroc reflex in the Pelvic limb allows you to assess which PN?

A

Tibial

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221
Q

Testing the Gastroc reflex in the Pelvic limb allows you to assess which SC segment?

A

L7 - S1

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222
Q

Where do pyramidal UMNs start?

A

Cerebral Cortex

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223
Q

Where do extrapyramidal UMNs start?

A

Brainstem

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224
Q

What do pyramidal UMNs control?

A

Skilled movement

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225
Q

What do Extrapyramidal UMNs control?

A

Tonic support against gravity.

Initiate voluntary movement.

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226
Q

Where is conscious proprioception information transmitted to?

A

Cerebral cortex (contralateral)

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227
Q

Where is unconscious proprioception information transmitted to?

A

Cerebellum (ipsilateral)

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228
Q

What is proprioception?

A

Sensory detection of position and movement of muscles and joints

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229
Q

How many vestibular nuclei exist in the brain?

A

4 in either side of the pons and medulla

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230
Q

Where do the vestibular nuclei project to? (3 places)

A

Spinal Cord (facilitate ipsilateral extensor, inhibit contralateral extensor)
Brainstem (co-ordinate head/eye movement, vomit centre and balance)
Cerebellum (inhibitory)

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231
Q

What are the 4 main functions of the cerebellum?

A

Control motor activity
Co-ordinate UMN movement
Maintain balance
Regulate muscle tone (& therefore posture)

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232
Q

How do we assess conscious perception of vision?

A

Menace

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233
Q

How do we assess reflex visual perception?

A

PLR

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234
Q

What component of the CNS are we assessing with the menace response?

A

Forebrain

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235
Q

What component of the CNS are we assessing with the PLR?

A

CN II/CN III

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236
Q

What are the 4 things that we should observe from a distance on neurological exam?

A

Mentation
Posture
Gait
Behaviour

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237
Q

What are 5 key things to ask during a neuro history?

A 
Trauma Hx?
Acute/Chronic?
Pain?
Progression?
Episodic?
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238
Q

What is the difference between stuporous and comatose?

A

Stuporous - can be roused by painful stimuli
comatose - unresponsive

BOTH = unconscious

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239
Q

An animal is showing hemineglect syndrome - where is its brain lesion located?

A

Forebrain

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240
Q

An animal is showing reduced palpebral reflex - where is its brain lesion located?

A

Trigeminal (v) or Facial Nerve (VII)

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241
Q

An animal is showing postural deficits - where is its brain lesion located?

A

ANYWHERE

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242
Q

An animal is showing dysmetria - where is its brain lesion located?

A

Cerebellum

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243
Q

An animal is showing subtle proprioceptive deficits - where is its brain lesion located?

A

Spine

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244
Q

An animal is showing compulsive walking/circling - where is its brain lesion located?

A

Forebrain

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245
Q

An animal is showing loss of head orientation - where is its brain lesion located?

A

Vestibular Sytem

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246
Q

An animal has become aggressive - where is its brain lesion located?

A

Forebrain

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247
Q

What is Schiff-Sherrington?

A

Hyperextension of TL

Paralysis of PL

248
Q

What causes Schiff-Sherrington?

A

Lesion in thoracic or lumbar spine

249
Q

Decerebrate rigidity is caused by a lesion where?

A

Rostral Brainstem

250
Q

Decerebellate rigidity is caused by a lesion where?

A

Rostral Cerebellum

251
Q

What does Decerebrate rigidity present as?

A

Extension of all limbs and opisthotonus

Stupor/comatose

252
Q

How does Decerebrate rigidity present?

A

Extension of all limbs and opisthotonus

Stupor/comatose

253
Q

How does Decerebellate rigidity present?

A

Hyperextended TLs

Normal mentation

254
Q

What does “Paresis” mean?

A

Weakness - reduced voluntary movement

255
Q

What does “Paralysis” mean?

A

Complete absence of voluntary movement

256
Q

Name 6 different postural tests for the dog.

A 
Paw Position
Hopping
Hip Sway
Wheelbarrow
Extensor Postural Thrust
Placing Responses
257
Q

What are the thoracic spinal withdrawal reflex tests?

A

Digit pinch

Extensor Carpi Radialis, Biceps, Triceps

258
Q

What are the pelvic spinal withdrawal reflex tests?

A

Digit Pinch

Patellar, Cranial tibial, Gastrocnemius, Perineal

259
Q

Where does information from the cutaneous trunci reflex enter the spinal cord?

A

2 Vertebral Spaces cranially to test.

260
Q

Name 3 behavioural responses to pain

A

Turning Head
Trying to bite
Vocalising

261
Q

Apart from palpation, how can we assess for spinal pain?

A

Move neck in all directions.
Move tail
Palpate lumbosacral region.

262
Q

Eye position at rest may tell us about the function of which cranial nerve(s)?

A

III (oculomotor), IV (trochlear) and VI (abducens)

263
Q

Which cranial nerves does the PLR test for?

A

II (optic) and III (oculomotor)

264
Q

Deficits in which CNs may cause a physiological nystagmus?

A

III (oculomotor), IV (trochlear) and VI (abducens)

265
Q

the BAER tests which CN?

A

VIII (vestibulocochlear)

266
Q

An inability to see objects, and reduced menace response indicates a problem with which CN?

A

II (optic)

267
Q

At what age does the menace response become a valid test?

A

12 weeks old

268
Q

Looking at the symmetry of mucous membranes can tell us about which cranial nerve?

A

V (Trigeminal)

269
Q

The Corneal Reflex tells us about the function of which CN(s)?

A

V (trigeminal), VI (abducens and VII (facial)

270
Q

A lack of gag reflex tells us about which CN(s)

A

IX (glossopharyngeal) and X (Vagus)

271
Q

Nasal Mucosa Stim test assesses which CN?

A

V - ophthalmic branch

272
Q

reduced physiological nystagmus indicates what?

A

Raised ICP

273
Q

What are the 4 clinical signs of Horners?

A

Mitosis
Ptosis of upper eyelid
Protruded 3rd Eyelid
Enopthalmus

274
Q

What causes Horners?

A

Compression of the sympathetic chain

275
Q

Disorientation/Depression is a sign of a lesion in which part of the brain?

A

Forebrain

276
Q

Depression/stupor/coma is a sign of a lesion in which part of the brain?

A

Brainstem

277
Q

Vestibular Signs are a sign of a lesion in which part of the brain?

A

Brainstem or Cerebellum

278
Q

Intention Tremors are a sign of a lesion in which part of the brain?

A

Cerebellum

279
Q

Decerebellate rigidity is a sign of a lesion in which part of the brain?

A

Cerebellum

280
Q

Contralateral blindness is a sign of a lesion in which part of the brain?

A

Forebrain

281
Q

Ipsilateral abnormal menace with normal vision is a sign of a lesion in which part of the brain?

A

Cerebellum

282
Q

Deficits in CN III-XII are a sign of a lesion in which part of the brain?

A

Brainstem

283
Q

Ipsilateral/total paresis is a sign of a lesion in which part of the brain?

A

Brainstem

284
Q

Ataxia with broad base and hypermetria is a sign of a lesion in which part of the brain?

A

Cerebellum

285
Q

Circling is a sign of a lesion in which part of the brain?

A

Forebrain

286
Q

Delayed movements with hypermetria is a sign of a lesion in which part of the brain?

A

Cerebellum

287
Q

Respiratory/Cardiac abnormalities can be caused by a lesion in which part of the brain?

A

Brainstem

288
Q

Decreased postural responses in all limbs is a sign of a lesion in which part of the brain?

A

Brainstem

289
Q

Decreased postural responses in ipsilateral limbs is a sign of a lesion in which part of the brain?

A

Brainstem

290
Q

Decreased postural responses in contralateral limbs is a sign of a lesion in which part of the brain?

A

Forebrain

291
Q

Seizures are a sign of a lesion in which part of the brain?

A

Forebrain

292
Q

Hemi-Neglect syndrome are a sign of a lesion in which part of the brain?

A

Forebrain

293
Q

A ipsilateral head tilt is caused by a lesion in which part of the brain?

A

Vestibular System

294
Q

A Paradoxical head tilt is caused by a lesion in which part of the brain?

A

Cerebellum

295
Q

Vertical nystagmus is caused by a lesion where?

A

Central Nervous System

296
Q

Horizontal nystagmus is caused by a lesion where?

A

PNS - fast phase away from lesion!

297
Q

Where is the Cervical intumescence?

A

C6-T2

298
Q

Where is the Lumbosacral intumescence?

A

L4-S3

299
Q

What are the 3 signs of a lesion in C1-C5?

A

Tetra/hemi - paresis/plegia
Normal Spinal Reflexes
Normal Muscle Tone

300
Q

What are the 3 signs of a lesion in C6-T2?

A

Tetra/hemi - paresis/plegia (POSSIBLE monoparesis)
Reduce TL reflexes +/- cutaneous trunci
Reduced muscle tone

301
Q

What are the 3 signs of a lesion in T3-L3?

A

Paraparesis/Plegia
Normal Spinal Reflexes w/reduced cutaneous trunci
Normal muscle tone

302
Q

What are the 3 signs of a lesion in L4-S3?

A

Paraparesis/Plegia (POSSIBLE mono paresis)
Dec reflexes in pelvic limbs
Reduced muscle tone/atrophy

303
Q

What additional sign is present in a caudal lesion between L4 and S3?

A

Reduced anal tone/perineal reflex

304
Q

What are 4 factors that may lead to a misleading reduction in spinal reflexes?

A

Pain
Subtle Lesion
Acute Spinal Shock
Old age

305
Q

What Cx would you see in a Grade 1 Severity spinal injury?

A

Spinal Pain only

306
Q

What Cx would you see in a Grade 2 Severity spinal injury?

A

Ambulatory Paresis

307
Q

What Cx would you see in a Grade 3 Severity spinal injury?

A

Non-ambulatory Paresis

308
Q

What Cx would you see in a Grade 4 Severity spinal injury?

A

Paralysis

309
Q

What Cx would you see in a Grade 5 Severity spinal injury?

A

Paralysis + loss of pain sensation

310
Q

How many pairs of Spinal Nerves are there in the dog?

A

36

311
Q

How would a motor neuropathy present?

A

Flaccid Paresis
Reduced Tone
Muscle Atrophy

312
Q

How would a sensory neuropathy present?

A

Decreases Sensation

Paraesthesia

313
Q

How do all neuropathies present?

A

Reduced spinal reflexes
OR
Reduced CN reflexes

314
Q

A reduced in reflexes in all 4 limbs would be indicative of what lesion?

A

Polyneuropathy

315
Q

Give an example of a pre-synaptic junctionopathy.

A

Botulism

316
Q

Give an example of a post-synaptic junctionopathy.

A

Myasthenia Gravis

317
Q

How do myopathies present?

A

Generalised weakness/exercise intolerance WITHOUT proprioceptive deficits

318
Q

Acute, Non-progressive Central Vestibular signs are likely caused by what type of disease?

A

Cerebrovascular

319
Q

How do cerebrovascular lesions appear on MRI?

A

Well-defined
Sharply Demarcated
Minimal/No mass effect

320
Q

What are 3 conditions associated with cerebrovascular disease.

A

CKD
Hypertension
Hyperadrenocorticism

321
Q

An acute, progressive CNS disease with multifocal signs is often caused by what?

A

Meningioencephalomyelitis of unknown origin

322
Q

Which type of MUO is commonly found in young (3-8y) toy breeds?

A

Granulomatous

323
Q

What are the 3 forms of granulomatous meningioencephalomyelitis?

A

Disseminated (most common)
Focal
Ocular

324
Q

What may focal granulomatous meningioencephalomyelitis be confused with?

A

Neoplasia

325
Q

What are the common presenting signs of disseminated granulomatous meningioencephalomyelitis?

A

Multifocal - all brain regions affected

326
Q

What are the common presenting signs of Ocular granulomatous meningioencephalomyelitis?

A

Acute onset visual impairment.
Dilated, non-responsive pupils
optic disc oedema

327
Q

How does GME present on MRI?

A

Multiple Hyperintensities
Irregular Margins
WM > GM

328
Q

What does CSF analysis of a patient with GME show?

A

Pleocytosis
Increased Protein
(occasionally normal)

329
Q

Which breeds are commonly affected by Necrotising meningoencephalitis?

A

Pug
Chihuahua
Yorkie

330
Q

What type of MUO often presents with seizures, blindness, altered behaviour, circling and depression?

A

Necrotising Meningoencephalitis

331
Q

How do the signs of Necrotising meningoencephalitis occur?

A

Acute

Rapidly Progressive

332
Q

What is the primary aim of treatment for MUOs?

A

IMMUNOSUPPRESSION

333
Q

What is the primary drug used to treat an MUO?

A

Corticosteroids

334
Q

What can be used as a secondary therapy for MUOs?

A

Cytosine arabinoside

also azathioprine, ciclosprine, lomustine, procarbazine

335
Q

What is the MST for GME?

A

14 days

336
Q

How long will a NE dog live for untreated?

A

3m

337
Q

How long will a NE dog live for if receiving double immunosuppression?

A

180d

338
Q

What would you expect in a CSF sample from an FIP patient?

A

High Protein
Pleocytosis
FCoV RNA (PCR)

339
Q

How would the brain of an FIP cat appear on MRI?

A

Enhanced periventricular contrast
Ventricular Dilation
Hydrocephalus

340
Q

How would you relieve neurological signs in a hypothyroid patient?

A

Levothyroxine

341
Q

What neurological signs may be present in a hypothyroid patient?

A

Peripheral or Central Vestibular Disease

342
Q

Which antibiotic has been linked with neurotoxicity leading to CVS, seizures, tremors and rigidity?

A

Metronidazole

343
Q

How can you improve the record time for a patient with antibiotic-induced neurotoxicity?

A

Stop Antibiotic

Give Diazepam!

344
Q

What is the role of thiamine in the brain?

A

Oxidation of glucose in Krebs cycle

345
Q

Which patients may commonly present with thiamine deficiency?

A

Cats on an all-fish diet

346
Q

What are the clinical signs of thiamine deficiency?

A 
Anorexia
Lethargy
Vestibular Signs
Seizures
Mydriasis w/reduced PLR
347
Q

What is the most common primary brain tumour in the small animal?

A

Caudal Fossa Meningioma

348
Q

Which neurological structures pass the middle ear, and therefore can be affected by otitis?

A 
CN VII (Facial)
CN VIII (Vestibulocochlear)
Sympathetic Supply to the eye
349
Q

What are the Primary Factors for Otitis Media/Interna?

A

Hypersensitivity

Keratinisation Defects

350
Q

What are the Predisposing Factors for Otitis Media/Interna?

A

Conformation (hairy, narrow, pendulous)
Iatrogenic (over cleaning)
Swimming

351
Q

What are the Perpetuating Factors for Otitis Media/Interna?

A

Infections (Malassezia, Staphs, Pseudomonas, Proteus)

352
Q

How can you identify idiopathic vestibular disease from other peripheral vestibular diseases?

A

No central signs (proprioceptive deficits)
No vertical nystagmus
Multiple CNs affected

353
Q

How is idiopathic vestibular disease treated?

A

NO Tx - Spontaneous Recovery (3-4w)

354
Q

How does Idiopathic Vestibular Disease present in the dog?

A

Acute peripheral signs - roll, fall, vomit, ataxia
Head tilt
Horizontal/Rotatory Nystagmus

355
Q

How does Idiopathic Vestibular Disease present in the dog?

A

2 Forms:
Atypical: acute but Cx progressive
PVD: acute & non-progressive

356
Q

What are the 3 causes of Facial Nerve Paralysis?

A

Idiopathic
Brainstem Lesions
Middle Ear Disease

357
Q

What are the major signs of facial nerve paresis/paralysis?

A

Drooping of face, widened palpebral fissure,

absence/reduced corneal/palpebral reflex

358
Q

How do we treat Facial Nerve Paralysis?

A

Lubricate the eye & wait for recovery

359
Q

What are the 4 classifications for hearing issues?

A

Age of Onset
Underlying Cause
Location
Sensorineural or Conductive

360
Q

What are the 3 most common types of deafness in the dog?

A

Congenital sensorineural deafness
Acquired sensorineural deafness
Acquired Conductive Deafness

361
Q

Which type of deafness is most common in white pigmented, blue eyed dogs/cats?

A

Congenital sensorineural deafness

362
Q

Name 5 causes of Acquired Deafness

A 
Chronic Otitis (Int/Med)
Ototoxicity
Noise Trauma
Old Ace
Anaesthesia
363
Q

What does BAER stand for?

A

Brainstem Auditory Evoked Response

364
Q

What does OAE stand for?

A

OtoAcoustic Emissions

365
Q

What does the BAER test?

A

Electrical responses of CNVIII and auditory portion of brainstem

366
Q

What does OAE test?

A

Measures low-level sounds produced by ear as part of normal hearing

367
Q

Which test is the most reliable for deafness?

A

BAER

368
Q

Which is the cheapest, first-line test for deafness?

A

OAE

369
Q

What is ICP related to?

A

The volume of:
The brain
Blood supplying the brain
The CSF

370
Q

What is the formula for Cerebral Perfusion Pressure?

A

CPP = maBP - ICP

371
Q

To where does the forebrain herniate?

A

Under the tentorium

372
Q

To where does the cerebellum herniate?

A

Through the Foramen Magnum

373
Q

Name 5 signs of increased ICP

A 
Depression/Stupor
Cushings Reflex
Altered PLR
Vestibular Eye Movement
Abnormal posture
374
Q

What is the Cushings Reflex?

A

Increased ICP –> Bradycardia and Hypertension

375
Q

How does increased ICP cause hypertension?

A

alpha 1 adrenergic activation –> systemic vasoconstriction

376
Q

How does increased ICP cause bradycardia?

A

Carotid artery baroreceptors sense hypertension –> vagal activation

377
Q

What is the common presentation of Idiopathic Tremor Syndrome?

A

Small Breed Dog
Fine, rapid tremor (worsens with stress)
Head tilt & reduced menace
Ataxia

378
Q

How is Idiopathic Tremor Syndrome diagnosed?

A

CSF - inflammatory

+/- MRI to rule out other problems

379
Q

How is Idiopathic Tremor Syndrome treated?

A

CS for 4-6m
Diazepam initially
+/- other immunosuppressive drugs

380
Q

What are the 3 main routes of infection for Bacterial Meningoencephalitis?

A

Haematogenous
CSF
Direct (eyes, ear, nasal sinus, trauma)

381
Q

What are the Cx for Bacterial Meningoencephalitis?

A

Acute CNS (obtunded & deficits)
Neck Pain
Pyrexia

382
Q

How do we treat Bacterial Meningoencephalitis?

A

Antibiotics +/- surgical drainage

383
Q

What is the prognosis for Bacterial Meningoencephalitis?

A

Guarded!

384
Q

Name 2 protozoa which may infect the brain.

A

Toxoplasma Gondii

Neospora Caninum

385
Q

Name 3 viruses which may infect the brain

A

FIP (FeCoV)
FIV (retrovirus)
Canine Distemper

386
Q

Name 1 bacteria that may infect the brain

A

Cryptococcus

387
Q

What signs would an intoxicated dog show?

A

ACUTE seizures
+ GI/CV/Resp signs
+Muscle tremor/fasciculation

388
Q

Name 5 common substances which may cause neurotoxicity in dogs.

A 
OPs
Pyrethroids
Lead
Avermectins
Antidepressants
389
Q

What would classify a primary head injury?

A

Physical disruption of parenchyma

390
Q

What would classify a secondary head injury?

A

Inflammation/haemorrhage causing increased ICP

391
Q

Which grade of head injury would we intervene with medically?

A

Secondary

392
Q

What can we use for monitoring prognosis in a head trauma patient?

A

Modified Glasgow Coma Scale

393
Q

What may indicate the need for surgery in a head trauma patient?

A

Fractures with compression or contamination
Haematomas
Severely Raised ICP

394
Q

What is the aim of IVFT in a head trauma case?

A

Restore intravascular volume to ensure adequate CPP

395
Q

What should be avoided in fluids for the head trauma patient?

A

Glucose - causes poor outcome

396
Q

What are the 3 effects of giving 7.5% saline to a head trauma patient?

A

Reverse Shock
Decrease ICP
Increase CBF/blood delivery

397
Q

How does mannitol decrease ICP?

A

Dec Blood Viscosity
> Inc CBF
> Inc Free Radical Scavenging

398
Q

What are the two principles for mannitol administration?

A

0.5-1g/kg slow bolus over 20min

Follow with crystalloids (prevent dehydration)

399
Q

When is mannitol contraindicated?

A

Hypovolaemia

400
Q

When is Hypertonic Saline contraindicated?

A

Hyponatraemia

Cardiac/Resp Disease

401
Q

Outside what BP range is cerebral blood flow affected?

A

90-140mmhg

402
Q

How does pain affect ICP?

A

pain = inc BP = inc ICP

403
Q

How does hypothermia affect the head trauma patient?

A

shivering increases O2 demands

404
Q

How does hyperthermia affect the head trauma patient?

A

affects metabolic rate

405
Q

How should a head trauma patient be positioned in their kennel?

A

Raise Head!
Avoid jugular compression
Turn q4-6h

406
Q

What supportive treatment should be given to a head trauma patient?

A 
Urinary Catheter
Nutritional support (NG/oesoph tube)
407
Q

Which drugs should NEVER be used in head trauma cases?

A

Steroids

408
Q

How do hydrocephalus cases present?

A 
Domed Head
Persistent Fontanelle
Abnormal Behaviour
?Seizures
Vestibular Signs
409
Q

How do corpus callous abnormalities present?

A 
Adipsia + HyperNa
Seizures
Abnormal behaviour
Tremor
Circling
410
Q

How do hydraencephaly cases present?

A

circling
abnormal behaviour
seizures (later)

411
Q

What are the four pathogenic components of hepatic encephalopathy?

A

Hyperammonaemia
Neuroinflammation
Dec Neurotransmission
Cerebral Oedema

412
Q

What is the most common underlying cause of hepatic encephalopathy?

A

PSS

413
Q

What are the 2 major & 2 minor categories of presenting sign in hepatic encephalopathy?

A

Major: Vague/Forebrain
Minor: brainstem/cerebellar

414
Q

What vague signs may be present for hepatic encephalopathy?

A

Failure to thrive
Weight loss
PUPD
GI signs

415
Q

What forebrain signs may be present for hepatic encephalopathy?

A

Behaviour change
Pacing
Blindness
Seizure

416
Q

How is hepatic encephalopathy diagnosed?

A

BAST
Fasting Ammonia
US
CT angiography

417
Q

What 5 treatments should be used in combination for hepatic encephalopathy?

A 
Lactulose
Antibiotics
Low protein diet
Seizure control
Minimise contributing factors
418
Q

What are the possible underlying causes for hypoglycaemia?

A 
Insulinoma
Insulin Overdose
Liver Disease
Glycogen Storage Disease
Juvenile Hypoglycaemia
419
Q

What are the clinical signs of hypoglycaemia?

A 
Lethargy/Hunger
Depression/anxiety
Weakness/temors
Reduced Vision
Seizures
420
Q

How is hypoglycaemia diagnosed?

A

Blood Glucose <3mmol/L

Clinical Signs

421
Q

What are the clinical signs for sodium derangement?

A

Altered Mentation
Blindness
Seizures
Coma/Death

422
Q

What is the role of calcium in the brain?

A

Presynaptic Neurotransmitter - stabilise nerve/muscle membranes

423
Q

What are the clinical signs of hypocalcaemia?

A 
muscle spasm/cramp/twitch
trembling
stiffness
tonic-clonic spasm
seizures
424
Q

What is the pathogenesis of hypocalcaemia?

A

spontaneous discharge due to inc excitability from inc permeability to Na

425
Q

What are the most common primary brain tumours in the dog?

A

intra-axial: glioma

Extra-axial: meningioma/choroid plexus tumour

426
Q

Which tumours commonly metastasise to the brain?

A

Haemangiosarcoma

427
Q

What is the most common sign in supratentorial tumours?

A

Seizure

428
Q

What is the most common sign in infratentorial tumours?

A

Vestibular Dysfunction

429
Q

What is the MST for infratentorial tumours?

A

28d

430
Q

What is the MST for supratentorial tumours?

A

178d

431
Q

how can you treat CNS neoplasia in the dog?

A

AEDs (min sedative)
anti-inflm dose of preds
analgesia

432
Q

Name common inflammatory spinal diseases.

A 
SRMA
MUO
Discospondylitis
Toxoplasma
Neospora
FIP/FeLV
433
Q

Name some common degenerative spinal disease of the SA.

A

IVDD
CSM
LSDS
DM

434
Q

What dogs are commonly affected by SRMA?

A

Young (6-18m)

435
Q

What are the clinical signs of SRMA?

A

Lethargy/Anorexia
Stiffness & fever
cervical rigidity
neurological deficits

436
Q

Which disease is often concurrent with SRMA?

A

IMPA

437
Q

What does SRMA stand for?

A

Steroid Responsive Meningitis - Arteritis

438
Q

How is SRMA diagnosed?

A

CSF:
acute - neutrophilic pleocytosis
Chronic - mononuclear pleocytosis

439
Q

What is the best Tx for SRMA?

A

Corticosteroids 6-9m

+/-azathioprine/cyclosporine

440
Q

What is the Px for SRMA?

A

Good - but potential relapse

441
Q

What is discospondylitis?

A

IVD/adjacent vertebrae infection

442
Q

How does discospondylitis present?

A

Marked Spinal Pain

1/3 have systemic illness

443
Q

How would you diagnose discospondylitis from imaging?

A

Rx/MRI/CT
Narrowing of IVD space
Rough endplates

444
Q

How would you treat Discospondylitis?

A

8w Antibiotics

analgesia

445
Q

What does MUO stand for?

A

Meningiomyelitis of Unknown Origin

446
Q

How does MUO present?

A

Subacute
Progressive
Painful
?asymmetrical/multifocal

447
Q

What are the 2 methods for diagnosis of an MUO?

A

MRI - variable

CT - pleocytosis

448
Q

Name 3 common causes for spinal fractures in the canine patient.

A

RTA
Bite
Falling From Height

449
Q

How are spinal fractures diagnosed?

A 
Neuro exam (CARE)
Rx - Thorax/Abdo w/ orthogonal views
450
Q

What is an important Ddx for an MUO?

A

IVDD

451
Q

What is the 3 compartment rule of spinal fractures?

A

If fracture affects 2+ compartments –> unstable and therefore surgical

452
Q

What is contained in the dorsal spinal compartment?

A

articular processes
laminae
pedicles
spinous processes

453
Q

What is contained in the middle spinal compartment?

A

Dorsal longitudinal ligament
Dorsal Vertebral body
Dorsal Annulus Fibrosus

454
Q

What is contained in the ventral spinal compartment?

A

Ventral Vertebral Body
Lat/Vental AF
Nucleus pulposus

455
Q

What is contained in the ventral spinal compartment?

A

Ventral Vertebral Body
Lat/Vental AF
Nucleus pulposus
Ventral Longitudinal ligament

456
Q

What should our PRIMARY Tx for spinal fractures be?

A

Stabilise and Analgesia

457
Q

What is the prognosis for a spinal fracture without deep pain present?

A

<5%

458
Q

Which dogs are commonly affected by AA instability?

A

young dogs

toy breeds

459
Q

Describe the onset of AA instability.

A

Acute OR Chronic

Waxing/waning

460
Q

What are 2 common causes of AA instability?

A

Aplasia/hypoplasia of dens
or
Trauma

461
Q

What are the clinical signs of AA instability?

A

Neck pain

Ataxia/Tetraparesis

462
Q

How is an AA instability managed conservatively?

A

Conservative splint for 6-12w

463
Q

What is the prognosis for surgical Tx of AA instability?

A

Guarded: High preoperative morbidity/mortality

464
Q

What is a chiari-like malformation?

A

mismatched caudal fossa volume/contents w/ caudal displacement of the cerebellum via foramen magnum

465
Q

What are the 3 types of chair-like malformation?

A

Hydromyelia
Syringomyelia
Syringohydromyelia

466
Q

What are the clinical signs of CLM?

A

Neck pain
Neck scratching
torticollis
TL weakness

467
Q

How can we Tx CLM medically?

A

Gabapentin
NSAID
Furosemide
C/S, paracetamol/opioids

468
Q

Can we Tx CLM surgically?

A

Yes - 50% of cases will improve BUT high recurrence

469
Q

How do ischaemic myelopathies present?

A

Per-Acute
Non-painful
Lateralised

470
Q

What is a key exacerbating factor for ischaemic myelopathy?

A

Exercise

471
Q

What is the underlying pathogenesis for ischaemic myelopathy?

A

nucleus pulposus fibrocartilage embolises in SC vasculature

472
Q

What may cause a traumatic disc extrusion?

A

RTA, Fall, Exercise

473
Q

How do TDEs present?

A

Acute
Non-Painful
Non-progressive

474
Q

What is the underlying pathogenesis of a TDE?

A

herniated N. pulpous is non-mineralised > cord contusion w/min compression

475
Q

How can we treat TDEs?

A

Supportive care & physiotherapy

476
Q

When does IVDD present in chondrodystrophic breeds?

A

1st 2y of life

477
Q

When does IVDD present in non-chondrodystrophic breeds?

A

After middle age

478
Q

What type of metamorphosis is present in IVDD of non-chondrodystrophic breeds

A

Fibroid

479
Q

What type of metamorphosis is present in IVDD of chondrodystrophic breeds?

A

Chondroid

480
Q

What is a type 1 disc extrusion?

A

Extrusion - N. pulposus herniates through annular fibres

481
Q

What is a type 2 disc extrusion?

A

Protrusion of annular ligament & shifted N. pulp

482
Q

how does T1 IVDD present?

A

Acute
Progressive
Painful

483
Q

how does T2 IVDD present?

A

Slowly progressive

Chronic

484
Q

What age of dog is affected by T1 IVDD?

A

3-6y chondrodystrophic

6-8 otherwise

485
Q

What age of dog is affected by T2 IVDD?

A

Older dogs

486
Q

What is the nucleus invaded by in IVDD of chondrodystrophic breeds?

A

hyaline cartilage

487
Q

What is the nucleus invaded by in IVDD of non-chondrodystrophic breeds?

A

fibrocartilage

488
Q

Is IVDD type 1 a protrusion or extrusion?

A

extrusion

489
Q

Is IVDD type 2 a protrusion or extrusion?

A

protrusion

490
Q

What is conservative Tx for IVDD?

A

Rest 4-6w

Analgesia

491
Q

When should surgery be used for IVDD?

A

Grade 3-5 neuro deficits
severe pain
lack of improvement

492
Q

What signs of wobblers are present in the pelvic limbs?

A

paresis/ataxia (worse)

493
Q

What signs of wobblers are present in the thoracic limbs?

A

Short gait

Atrophy

494
Q

What is the cause of CSM?

A 
Multifactorial:
Type II IVDD
Hypertrophy of ligaments or synovial membrane
Spinal Canal Stenosis
DJD of facets
495
Q

How can CSM be treated conservatively?

A

Anti-inflammatories

Rest

496
Q

How can CSM be treated surgically?

A

Decompression
OR
Distraction-stabilisation

497
Q

What is the main presenting sign for lumbosacral degenerative stenosis?

A

reluctant to exercise, rise, jump, do stairs

498
Q

How is lumbosacral degenerative stenosis treated?

A

Anti-inflammatories/gabapentin
OR
Surgery

499
Q

How do vertebral body abnormalities present?

A

Chronic & slow progression

non-painful

500
Q

How are vertebral body abnormalities diagnosed?

A

Myelography

501
Q

How are vertebral body abnormalities treated?

A

Decompression +/- stabilisation

502
Q

How does spinal neoplasia present?

A

Chronic
Progressive
Painful

503
Q

Where are the 3 possible locations for a spinal neoplasia?

A

Extradural
Intradural Extramedullary
Intramural Intramedullary

504
Q

How are spinal neoplasms treated?

A

Decompression
Radiation
Palliate

505
Q

How does Degenerative Myelopathy present?

A

Progressive ataxia/paresis of PLs leading to paralysis

NO Tx!

506
Q

What is a hemilaminectomy?

A

Removal of half of the vertebral arch

Allows IVD fenestration

507
Q

Where is a hemilaminectomy used?

A

TL spine

508
Q

What is a Dorsal Laminectomy?

A

Removal of DSPs and laminae

509
Q

When should a Dorsal Laminectomy be used?

A

Anywhere - mostly at LS area.

IVDD, malformations and neoplasia common uses

510
Q

What is a ventral slot surgery?

A

slot ventrally through IVD and cranial/caudal endplates of cervical vertebrae

511
Q

What is the limitation to a ventral slot surgery?

A

Limited View

512
Q

What analgesia may be used post-spinal surgery?

A 
NSAID
Gabapentin
Paracetamol
Tramadol
Opioids
513
Q

How does a UMN bladder lesion present?

A

Distended

Difficult to express

514
Q

How does a LMN bladder lesion present?

A

Distended

Continually dribbling

515
Q

Where is the lesion for a UMN bladder lesion commonly found?

A

Cranial to Sacral SC

516
Q

Where is the lesion for a LMN bladder lesion commonly found?

A

Within sacral SC/plexus

or in pelvic/pudendal nerve

517
Q

Which drugs increase detrusor contraction?

A

Bethanecol

Cisapride

518
Q

Which drugs decrease detrusor hyperreflexia?

A

Propantheline

Oxybutinin

519
Q

Which drugs increase urethral tone?

A

phenylpropanolamine
imipramine
diethylstilbestrol
testosterone

520
Q

Which drugs decrease urethral tone?

A

phenoxybenzamine
prazosin
diazepam
dantrolene

521
Q

What is a seizure?

A

transient symptoms of an abnormal excessive/synchronus neuronal activity in the brain

522
Q

Where in the brain would a lesion cause seizures?

A

Forebrain

523
Q

Explain the pathogenesis of a seizure.

A

Imbalance in excitation and inhibition.
Excitation inc
|nhibition dec

524
Q

What is the Prodrome phase of a seizure?

A

A predicting event

525
Q

What is the Aura phase of a seizure?

A

The initial manifestation

526
Q

What is the Ictal phase of a seizure?

A

the seizure event: involuntary tone/movement/behaviour

527
Q

What is the Post-ictal phase of a seizure?

A

mins to days after: strange behaviour/neuro deficits

528
Q

How long is the ictal event normally?

A

60-90s

529
Q

When do ictal events commonly occur?

A

at sleep or rest

530
Q

What are the two major phenotypic categories of seizure?

A

Generalised

Focal

531
Q

What are the two major phenotypic categories of seizure?

A

Generalised

Focal

532
Q

Which generalised seizure activity is most common?

A

tonic-clonic

533
Q

What is the characteristic feature of a generalised seizure?

A

loss of consciousness

534
Q

What is a focal seizure?

A

Activation of one part of one cerebral hemisphere/forebrain region

535
Q

What are the 3 forms of focal seizure?

A

Motor
Autonomic
Behavioural

536
Q

What are the 5 forms of Generalised seizure?

A 
Tonic-clonic
Tonic
Clonic
Myoclonic
Atonic
537
Q

What are the main predisposing factors for audiogenic reflex seizure?

A 
Cat
Late onset (15y+)
538
Q

What are the characteristics of an audiogenic reflex seizure?

A

Myoclonic progressing to tonic-clonic in some

539
Q

Which drug is best used to control audiogenic reflex seizures in cats?

A

Levetiracetam

540
Q

Which seizure drugs are licensed in cats?

A

none

541
Q

What are common Ddx for seizures?

A 
Narcolepsy/cataplexy
Neuromuscular collapse
Syncope
Movement Disorders
Metabolic /vestibular disease
542
Q

What are the 3 categories of seizure cause?

A

Reactive Seizure
Idiopathic epilepsy
Structural Epilepsy

543
Q

What two things usually cause reactive seizures?

A

Metabolic or toxic derrangements

544
Q

What is often present with a reactive seizure or structural epilepsy?

A

concurrent neurological signs

545
Q

What is the cause of idiopathic epilepsy?

A

Genetic

546
Q

What neurological signs are associated with idiopathic epilepsy?

A

NONE

No inter-ictal signs

547
Q

What are the causes of structural epilepsy?

A

Inflammatory
Neoplastic
Traumatic

548
Q

What are the causes of structural epilepsy?

A

Inflammatory
Neoplastic
Traumatic

549
Q

How is idiopathic epilepsy diagnosed?

A

Exclusion

550
Q

How does idiopathic epilepsy commonly present?

A

6m-6y

Normal between seizures

551
Q

What are the tier I confidence intervals for idiopathic epilepsy?

A

2+ seizueres 24h apart
6m-6y onset
Normal inter-ictal exam
Haem/biochem normal

552
Q

What are the tier II confidence intervals for idiopathic epilepsy diagnosis?

A

Unremarkable fasting/bile acids
MRI of brain
CSF analysis
+ tier I

553
Q

When is KBr NOT licensed?

A

Cats

Mono therapy in dogs

554
Q

When is KBr NOT licensed?

A

Cats

Monotherapy in Dogs

555
Q

What 2 seizure types are an emergency?

A

Cluster Seizures

Status Epilepticus

556
Q

What are the tier III confidence intervals for idiopathic epilepsy diagnosis?

A

Tier I & II PLUS

Ictal or inter ictal ECG abnormalities

557
Q

At what age should a dog with idiopathic epilepsy have an MRI?

A

<6m or >6y

558
Q

What abnormal seizure patterns may make an MRI an appropriate investigation?

A

Inter-Ictal abnormalities
Status Epilepticus
Cluster Seizure

559
Q

What seizure features would warrant Tx initiation?

A

SE/Cluster seizures

post-ictal signs >24h

560
Q

Which are the 3 anti-seizure drugs licenced in dogs?

A

Phenobarbitone
KBr
Imepitoin

561
Q

Which anti-seizure drugs are licenced in cats?

A

NONE

562
Q

What is the MOA of phenobarbitone?

A

Augments GABA - prolongs Cl channel opening

563
Q

What is the appropriate dose of phenobarb for seizures in:

a) Cats
b) Dogs?

A

a) 2mg/kg BID

b) 3 mg/kg BID

564
Q

When should we monitor phenobarbitone levels?

A

2w, 3m, and 6m after starting

565
Q

What level of phenobarbitone in the blood is ideal?

A

25-30mg/L

566
Q

What are common SEs of phenobarbitone?

A

Sedation/Ataxia
PUPD & polyphagia
Neutropenia/Anaemia/TCP

567
Q

When is phenobarbitone CI’ed?

A

Liver disease due to Cp450 metabolism

568
Q

What is the MOA of KBr?

A

Competes with Cl- at nerve, inhibts Na (membrane hyperpolarisation, seizure threshold raised)

569
Q

What is the appropriate dose of KBr for seizures in:

a) Cats
b) Dogs?

A

a) DO NOT GIVE

b) 30mg/kg SID

570
Q

When do we monitor KBr levels?

A

12w PLAIN SERUM

571
Q

What is our therapeutic level of KBr in the blood?

A

10-15mmol/L if w/pheno

12.5-37.5 if monotherapy

572
Q

What are the SEs of KBr?

A

Sedation, Ataxia, PL weakness

573
Q

How is KBr metabolised/excreted?

A

Unchanged in urine.

574
Q

What is the MOA of Imepitoin?

A

GABA Benzodiazepine receptor partial agonist

575
Q

What is the therapeutic dose for Impeitoin in dogs?

A

10-30mg/kg BID

576
Q

When should we monitor imepitoin?

A

N/A - not required

577
Q

What are the SE’s of imepitoin?

A

Same as pheno but lesser

578
Q

Which 2 AEDs are not licenced but commonly used?

A

Levetiracetam

Zonisamide

579
Q

Which unlicenced AED must be given at a dose of 20mg/kg TID?

A

Levetiracetam

580
Q

What is the MOA of levetiracetam?

A

SV2a modulator - prevents vesicle mobilisation

581
Q

What is the AE dose for zonisamide?

A

10mg/kg BID

582
Q

What must be done if giving phenobarbitone and zonisamide concurrently?

A

reduce phenobarbitone dose by 25%

583
Q

What is the MOA of zonisamide?

A

Blocks Na and Cl- channels.

584
Q

What are the SEs of diazepam in cats?

A

Fulminant Hepatic Necrosis

585
Q

What are the SEs of Propofol in cats?

A

Heinz Body Anaemia

586
Q

What are the SEs of KBr in cats?

A

Eosinophilic Bronchitis

587
Q

How do we classify a cluster seizure?

A

2+ in 24h

588
Q

how common are cluster seizures in IE?

A

1/3-2/3 of dogs with IE

589
Q

How do we classify status epilepticus?

A

seizure lasting >5min

>2 seizure w/o recovery

590
Q

Why are Clusters and Status E emergencies?

A

irreversible neuronal damage after 30-60min due to excitotoxic cell injury

591
Q

What is Stage 1 in the pathogenesis of excitotoxic cell injury?

A

Inc Autonomic Activity

592
Q

What is Stage 2 in the pathogenesis of excitotoxic cell injury?

A

Irreversible neuronal damage due to increased glutamate

593
Q

What are 6 major causes of Canine Status Epilepticus?

A 
Idiopathic Epilepsy
Neoplasia
CNS inflammatory Dz
Trauma
Metabolic Disorders
Toxicities
594
Q

What is the FIRST thing you do with a case of status epilepticus?

A

STOP SEIZURE:

rectal diazepam 1mg/kg

595
Q

What should you do whilst assessing a case of status epilepticus?

A

IV catheter placement
Examine
Bloods (Glucose, Na, Ca, Renal/Hepatic Fct)

596
Q

What is the primary medical Tx for a stable patient that has been in status epilepticus?

A

Phenobarbital

597
Q

What is the secondary medical Tx for a stable patient that has been in status epilepticus?

A

Levetiracetam

598
Q

Which 3 drugs can be given as infusions to seizure cases?

A

Diazepam
Midazolam (not hep dysfct)
Propofol

599
Q

What unique management changes should be but in place for seizure patients?

A

Monitor for pressure sores

Lubricate Eyes

600
Q

What Neuropathy may cause sudden tetraparesis?

A

Polyradiculoneuritis

601
Q

What Junctionopathy may cause sudden tetraparesis?

A

Myasthenia Gravis
Botulism
OP toxicity

602
Q

What Myopathy may cause sudden tetraparesis?

A

Polymyositis

Electrolyte abnormalities

603
Q

What is Polyradiculoneuritis?

A

Inflammation of nerves and roots

604
Q

Which breed is predisposed to Polyradiculoneuritis?

A

Bengal Cats

605
Q

Where is most of the pathology located in Polyradiculoneuritis?

A

Ventral Spinal Roots (causes pure motor deficits)

606
Q

Apart from Cx, how can Polyradiculoneuritis be diagnosed?

A

Electrophysiology (f waves)

607
Q

How is Polyradiculoneuritis treated?

A

Spintaneous recovery - give supportive care over days-weeks

608
Q

What are the two forms of myasthenia gravis?

A

Generalised
Fulminant (fast onset)
Focal

609
Q

What is the underlying pathology of myasthenia gravis?

A

Acquired/Congenital antibodies against AChR

610
Q

how common is megaoesophagus in dogs with myasthenia gravis?

A

80% of dogs with Mg have megaoesoph

611
Q

What is the gold standard tests for MG?

A

nAChR Ab

612
Q

Apart from the gold standard, what two tests are available for MG?

A

Electrodiagnosis

Tensilon edrophonium response test

613
Q

How is MG treated?

A

ACh-esterase
Immunosuppression
Postural Feeding

614
Q

What is the pathogenesis of botulism?

A

Blocks vesicle fusion of pre-synaptic membrane & Ach Release

615
Q

What are the two categories of clinical presentation of botulism?

A

Nicotinic - Junctionopathy

Muscarinic - Dysautonomia

616
Q

How does nicotinic botuloism present?

A

Acute onset tetraparesis
Poss CN involvement
Poss resp muscle involvement

617
Q

How does muscarinic botulism present?

A

urinary dysfunction
GI dysmotility
mydriasis
reduced tear production

Veterinary Medicine (68 decks)

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