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NSB II > Vestibular and Cerebellar Disease > Flashcards

Vestibular and Cerebellar Disease Flashcards

1
Q

describe what would be seen in a patient with left peripheral vestibular localization

A
  1. left head tilt
  2. left vestibular ataxia
  3. spontaneous nystagmus fast phase to the right
  4. left miosis and ptosis
  5. normal mentation
  6. normal postural reactions
  7. other CN normal
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2
Q

using VITAMIND what are possible differentials for a cat with left peripheral localization?

A

V: no vascular disease of inner ear exists

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3
Q

describe otitis media/interna

A
  1. infection of middle (tympanic cavity/bulla) and inner ear
    -only otitis internal will cause vestibular signs!!
  2. commonly associated with otitis externa, but not always!
  3. can be occult (extend up eustachian/auditory tube)
  4. COMMON IN:
    -cats
    -brachycephalic dogs
    -dogs with crazy ears (hairy or heavy)
  5. often secondary to something:
    -breed conformation (see above!!)
    -allergies
    -ear mites: cats
    -inflammatory polyp: cats
    -neoplasia
    -swimming
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4
Q

describe the etiology of otitis media/interna

A

typically bacterial, rarely fungal!

staph, strep, pseudomonas, pasteurella, proteus, E.coli, etc.

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5
Q

describe diagnosis of otitis media/interna

A
  1. presumptive in SA practice
    -signalment, presentation, otic exam
    -otic exam can support but NOT definitive
  2. definitive: cross sectional imaging
    -CT, MRI
    -infectious material in bullae (should be black and full of fluid normally)
  3. myringotomy: anesthetize, take an otoscope, use to stick a needle down through tympanic membrane, flush sterile saline and then culture it
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6
Q

describe treatment of otitis media/interna

A
  1. systemic antibiotics:
    -ideally based on culture
    –if can’t culture, treat empirically for what you know is commonly present
    -MUST penetrate bone
    -minimum 8 weeks
  2. treat underlying cause (allergies)
  3. NO!!! SYSTEMIC STEROIDS!!!
    -topical only if need steroids
  4. +/- surgery (bulla osteotomy)
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7
Q

describe nasopharyngeal polyps

A
  1. cats > dogs; 1-5 years old
  2. inflammation of eustachian (auditory) tube leads to mass lesion
  3. associated with secondary OMI
  4. oral/otic exam +/- imaging with CT/MRI
  5. treatment:
    -manual removal + anti-inflammatory steroids; recurrence uncommon
    -bulla osteotomy if involves middle ear
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8
Q

describe ototoxic meds

A
  1. over 200 compounds are ototoxic; prescribed when otitis externa
  2. often concurrent hearing loss; reversible or permanent
  3. caution with ear meds if tympanic membrane ruptured!
  4. most common
    -ear meds with aminoglycoside antibiotics
    –otomax: GENTAMICIN, betamethasone, and clotrimazole
    –tri-otic: GENTAMICIN, betamethasone, clotrimazole
    –mometamax: GENTIMICIN, momentasone, clotrizamole

-ear flush (chlorhexidine)

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9
Q

describe canine vestibular hypothyroidism

A
  1. test ALL peripheral vestibular cases for T4, free T4, and TSH!!!
  2. rule out ear disease as best you can (otoscope)
  3. treat if blood work suggests hypothyroidism
  4. neuro cases don’t always have traditional signs; lethargy, weight gain
  5. hypothyroidism can also be a cause of DIFFUSE neuromuscular disease!!!! (one of those metabolic causes that if you see diffuse LMN you should metabolic test ALWAYS first to rule out!!)
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10
Q

describe peripheral vestibular neoplasia

A
  1. diagnosis:
    -palpation: not always feel it but worth trying
    -otoscopic exam!!
    -radiographs may reveal destruction of tympanic bulla
    -CT/MRI
  2. treatment:
    -total ear canal ablation
    -radiation if complete surgical resection not possible
    -TREATMENT not for exam!!!!
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11
Q

what is a common history for idiopathic peripheral vestibular disease?

A

difficulty walking after waking up from a nap

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12
Q

describe idiopathic vestibular disease

A
  1. ALWAYS PERIPHERAL
  2. peracute to acute onset (minutes to hours)
  3. not always older patients!
    -but typically >6 years
  4. diagnosis of exclusion
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13
Q

describe treatment of idiopathic vestibular disease

A
  1. supportive care
  2. meclizine 6.25-25mg once daily
    -anti-histamine for vertigo/motion sickness
  3. ondansetron or cerenia if vomiting
    -CN 8 goes to vomit center in brain so if acutely vestibular will also commonly be vomiting
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14
Q

describe improvement from idiopathic vestibular disease

A
  1. nystagmus resolves in 3 days
  2. ataxia resolves in 3 weeks
  3. head tilt resolves over 3 months
    -but could be residual!
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15
Q

describe idiopathic vestibular disease in cats

A
  1. cats can get it too!!
  2. ANY AGE: median 4 years
  3. ANY breed
  4. indoor/outdoor
  5. any time of year (july, august)
  6. slower recovery than dog
    -complete recovery 4-6 weeks
    -residual deficits (25%)
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16
Q

compare and contrast idiopathic and OMI peripheral vestibular disease in dogs

A

idiopathic:
1. peracute onset (hours); vomiting
2. no concurent signs
3. resolution
-nystagmus: 1-3 days
-complete: 1-3 weeks
-head tilt: 1-3 months

OMI:
1. onset: days to 3 weeks
2. +/- clinical ear disease (otitis externa)
3. many have facial nerve deficits and Horner’s
4. resolution: recurrent/persistent

if unsure, give time for peracute (wait 3 days and then reassess)
-empirical antibiotic treatment for 8 weeks!

DO NOT GIVE ANTI-INFLAMMATORY STEROIDS
-if ear disease, could spread to the brain
-IS okay to give NSAIDs

17
Q

describe strokes

A
  1. peracute to acute onset (minutes to hours)
  2. non-progressive
  3. require MRI to confirm and rule out inflammation and neoplasia
  4. supportive care
    -most do well and return to good QOL
  5. NOT ALL OLD DOGS WITH ACUTE ONSET VESTIBULAR SIGNS HAVE CANCER
18
Q

describe neoplasia

A
  1. vestibular disease in old dog does not ALWAYS mean neoplasia (just most likely)
  2. typically chronic, progressive but may be peracute or acute
  3. treatment options:
    -sometimes surgery
    -radiation
    -palliative
19
Q

what is MUE? (will have a whole lecture on this)

A
  1. meningoencephalitis of unknown etiology
  2. autoimmune inflammation of brain and/or spinal cord
    -acute to chronic (<3 months) progressine
    -young to middle aged toy and small breed dogs
    -any CNS localization; often multifocal and aysmmetrical; typically brain, can just be myelopathy, can just be neck or back pain
  3. disease of dogs, not cats!!
  4. treatment:
    -steroids and second immunosuppressive
    -1/3 do not respond
    -1/3 respond and relapse
    -1/3 do well long term
20
Q

what to do with central vestibular disease in private practice?

A
  1. ideally refer
  2. always check ears! could be extension of OMI
  3. peracute, non-progressive history consistent with stroke
    -time
  4. breed consistent with MUE
    -rule out infection with titers
    -antinflammatory steroids
    -consult
  5. neoplasia typically chronic and progressive (may be acute but should be progressive)
    -rule out infection
    -steroids palliative for weeks to months
21
Q

describe metronidazole toxicity

A
  1. ALWAYS CENTRAL
    -get better once remove metronidazole
  2. reported >66mg/kg/day
    -recommend: <30mg/kg/day
    -Barber doesn’t give more than 20mg/kg/day
  3. do NOT give metronidazole to that patient again; causes changes in brain that makes them more susceptible again
  4. can also happen with ronidazole
22
Q

describe neospora caninum

A

predilection for cerebellum, in dogs

(other places too but will have a whole lecture on)

23
Q

describe neuronal ceroid lipofuscinosis (likely not on exam)

A
  1. middle aged staffordshire and pit bull terriers
  2. symmetrical
  3. SLOWLY progressive (yearish history)
  4. genetic test; no treatment but can live like this for years
    -DONT LET THEM SWIM (any vestibulocerebellar animal)
  5. vestibulocerebellar
    -mild to mod cerebellar ataxia
    -may delay postural reactions
    -positional nystagmus, mostly vertical

NSB II (50 decks)

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