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Doctor of Veterinary Medicine (Work in progress) > Veterinary Medicine - Neurology > Flashcards

Veterinary Medicine - Neurology Flashcards

1
Q

Dogs or Cats - Which of the 2 is more likely to suffer from Symptomatic Epilepsy?

A

Cats

50-60% of Epilepsy cases in cats are symptomatic, as opposed to dogs who in the majority of cases suffer from Idiopathic Epilepsy

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2
Q

Symptomatic Epilepsy - Causes

A

Congenital (e.g. Hydrocephalus \ Lyssaencephaly \ Storage diseases)

Inflammatory (e.g. MUE \ SRME), Infectious (e.g. Neospora \ Toxoplasmosis \ CDV \ FIP \ Rabies\ FIV \ FeLV \ Ehrlichiosis \ Aspergillosis \ Cryptococcosis \ Protothecosis \ Bacterial)

Metabolic (e.g. Hyperammonemia \ Hypoglycemia \ Hypocalcemia \ Thiamine Deficiency)

Vascular event (e.g. Septic emboli \ Thrombus \ Hemorrhagic stroke)

Trauma

Toxins (e.g. Organic phosphates \ Methylxanthines \ Methyl aldehyde \ Permethrin)

Neoplasia

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3
Q

Idiopathic Epilepsy - What percentage of patients are refractory to treatment

A

20-30%

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4
Q

What are the 2 main objectives of anti-epileptic treatment in terms of neurophysiology?

A
  1. Making the epileptic center fire less frequently (by decreasing Glutamate concentration)
  2. Making the surrounding brain tissue less excitable (by increasing GABA concentration)
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5
Q

What drug can we give to epileptic dog owners to administer during a generalized tonic-clonic seizure? When should they administer it? Route of administration?

A

Diazepam (Valium)

After 3 minutes of seizuring

Rectally

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6
Q

What is the Definition of Status Epilepticus?

A

In 2 cases:

1) Grand mal seizure lasting >5 minutes

2) Two or more seizures in 24 hours without full recovery in between.

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7
Q

What is the definition of Cluster Seizures

A

Two or more sequential seizures WITH full recovery in between

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8
Q

After a suspected seizure - When is it recommended to perform a neurological exam? (or at the very least a recheck) Why?

A

48-72h After the event

In severe seizures - There can be residual neurological deficits do to diffuse metabolic changes in the brain, that can cause diffuse \ bilateral symmetric deficits that are possibly temporary

*However - if before or after 72h unilateral \ asymmetric deficits are seen - probability of Symptomatic epilepsy is high (e.g. Neoplasia, Infarct, Infectious diseases etc.)

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9
Q

What is the difference between neurological deficits seen after Symptomatic Seizures as opposed to seizures due to Idiopathic Epilepsy?

A

Idiopathic - Diffuse \ Bilateral symmetric, Temporary deficits

Symptomatic - Can be anything - Diffuse\Multi-focal\Focal\Symmetric\Asymmetric - But in most cases it will remain until the underlying issue is resolved

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10
Q

Idiopathic Epilepsy - Signalment

A

Dogs \ Cats - 6 Months - 6 Years old

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11
Q

What are some appropriate diagnostic testing that can be done to try and rule out Symptomatic Epilepsy? (Name some indications for each test)

A

-Blood pressure (Vascular events)

-CBC

-Panel (Hypoglycemia \ Hypocalcemia \ Urea \ Hyperglobulinemia \ Liver Functions)

-Bile Acids \ Ammonia

-Abdominal US (e.g. Liver shunting, Neoplasia)

-Screening for infectious diseases (e.g. CDV \ Neospora \ Toxoplasmia \ Cryptococcus \ Aspargillosis \ FIV \ FeLV)

-Choline Esterase Levels (Organic phosphates poisoning)

-Coagulation panel\TEM\TEG (Hemorrhagic stroke/Thrombus)

-X-Rays (Metastasis / Granulomas)

-CSF (e.g. Inflammation, Infections)

-MRI \ CT (e.g. Neoplasia, Abscesses, Granulomas, Congenital anomalies, Inflammation, Vascular events)

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12
Q

When is there an indication to start anti-epileptic treatment?

A

1) More than one seizure a month

2) Status epilepticus

3) Severe \ Violent seizures (even if infrequent\Not status epilepticus

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13
Q

What are the goals that define a successful anti-epileptic treatment

A

1) Reduction of >50% in frequency of seizures

2) No more than one seizure every 3 months. Tolerable - one seizure every 1-3 Months

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14
Q

What do you do when you want to draw CSF but you also suspect an increase in ICP?

A

1) MRI \ CT first - Diagnostic cut also to confirm an increase in ICP

2) Decrease ICP (e.g. Mannitol / Hypertonic Saline)

*Drawing CSF from the Sacro-Lumber region instead of the atlantooccipital region can be considered

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15
Q

What are the three important aspects we need to establish before forming a DD List for diseases of the nervous system [Including the Brain, Spinal cord, PNS]

A

1) Location

2) Onset

3) Progression of neurological signs

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16
Q

C1-C5: Acute neurological presentation - DDs

A

IVDD (Hansen Type 1 & 3)

Trauma

Atlanto-Axial subluxation

Inflammation/Infection

Discospndylitis

FCE

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17
Q

C1-C5: Chronic neurological presentation - DDs

A

IVDD (Hansen Type 2)

Discospondylitis

Neoplasia

Inflammation

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18
Q

IVDD Hansen Type 1 - Signalment

A

Chondrodystrophic breeds (e.g. French bulldog, Dachshund, Pekingese)

Ages: 3-7 years

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19
Q

IVDD Hansen Type 2 - Signalment

A

Large Breeds, Ages: 5-10 years

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20
Q

IVDD Type 1 - Classic history \ Clinical signs

A

Ain’t doing well

Not jumping on sofas \ Climb stairs anymore

Abrupt screams of pain

Ventroflexion

Reluctance to move neck

Ataxia / Paraparesis / Paraplegia

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21
Q

IVDD Hansen Type 1 - In cervical disease, usually the main clinical sign is..?

A

Pain

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22
Q

IVDD Hansen Type 1 - Diagnosis

A

X-Rays (Narrowing of intervertebral spaces, mineralized intervertebral discs) - NOT DIAGNOSTIC! But helpful in ruling other DDs such as trauma, give clues to IVDD as mentioned above and for future reference).

Myelography \ Myelo-CT \ MRI (Gold standard)

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23
Q

IVDD Hansen Type 1 - Treatment

A

Depending on clinical signs:

1) Back pain\Loss of CP\Paresis: Cage rest for a month (The anulus undergoes healing).
Future recommendations: Change in life style and less activity\Jumping\climbing stairs\Sofas.

2) Plegia\Loss of deep pain: Surgery as soon as possible.

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24
Q

IVDD Hansen Type 1 - Common locations in the spinal cord

A

Cervical vertebrae

Thoraco-Lumbar junction (T12-L2)

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25
Q

IVDD Hansen Type 1 - Name of the surgical procedures (2)

A

Hemilaminectomy (Thoraco-Lumbar)

Ventral slot (Cervical)

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26
Q

Atlanto-Axial Subluxation - Signalment

A

Congenital - Toy breeds under 1 year (Mostly after 6 months) - e.g. Miniature Poodle \ Pomeranian \ Pekingese \ Yorkshire terrier.

Traumatic - Any age \ breed

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27
Q

Atlanto-Axial Subluxation - Clinical signs

A

Sudden screams of pain

4 Limb Ataxia \ Occasional falling and lying down

Quadriplegia

Dyspnea (Phrenic N. Involvement)

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28
Q

Atlanto-Axial Subluxation - Diagnosis

A

Cervical X-ray:
>50% overlap between the Axial spinal process and the Atlas. Can do a slight flexion of the neck to confirm (Must be done very carefully by an experienced vet/neurologist as can compress the spinal cord if done excessively)

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29
Q

Atlanto-Axial Subluxation - Treatment

A

If too young for surgery - Splint the neck. Otherwise - Surgery

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30
Q

Discospondylitis - Common Causes (Dogs and Cats)

A

Dogs:
Iatrogenic (Injections)
Immunosuppression (Usually older dogs)
Intact males/females - Brucella Canis

Cats - Bites

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31
Q

Discospondylitis - Signalment

A

Dogs - Puppies \ Young adults. Large breeds mostly

Cats - Any age/breed

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32
Q

Discospondylitis - Clinical Signs

A

Lethargy

Depression

Fever

Reluctance to move

Severe back pain

Mostly only light neurological deficits (CPD), Unless chronic and subluxated / 2nd disk protrusion

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33
Q

Discospondylitis - Diagnosis

A

X-rays - Lysis and proliferation of the Cranial\Caudal borders of the Vertebral bodies (can involve multiple vertebras).

*Lesions only appear on X-rays 10-14 days after clinical signs have started - high rates of false negative during that time! Therefore initially diagnosis is based on history and signs - Send home with antibiotics and if clinical sign resolve - diagnosis is achieved and can perform confirmatory x-rays afterwards

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34
Q

Discospondylitis - Treatment

A

Antibiotics: 1st Gen. Cephalosporins \ Clindamycin.

After 5-7 days of treatment:

A) Gets better - Take X-rays 2 weeks after to confirm and treat with antibiotics for 8 weeks

B) Doesn’t get better - Switch to Fluoroquinolones

Still no improvement - Possible fungal infection\Brucella Canis\wrong diagnosis - perform additional testing (Aspirate\CT\MRI)

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35
Q

Degenerative Myelopathy - Common Signalment + Presentation

A

Adult - old dogs (>7-8 Years)

Predisposed breeds: German shepherd \ Pugs. Also: Boxers \ Welsh Corgi \ Ridgeback

Chronic, slowly progressive (Months)

Initially - CPD , Paraparesis, Tail hanging down

As disease progresses - Quardriparesis, Urinary incontinence (UMN), Constipation. 15% of cases - No patella reflex

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36
Q

Degenerative Myelopathy - What is an important clinical sign that is not associated with the disease?

A

Back pain

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37
Q

Degenerative Myelopathy - What diagnostic tool is contraindicated in Degenerative myelopathy

A

Myelography

Can cause severe worsening of clinical signs

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38
Q

Degenerative Myelopathy - Diagnosis

A

Exclusion of other conditions (e.g. Neoplasia, Degenerative changes, IVDD Hansen type 2)

Genetic testing

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39
Q

Degenerative Myelopathy - Treatment

A

Supportive

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40
Q

T3-L3 - Acute neurological presentation - DDs

A

IVDD (Hansen Type 1 & 3)

Trauma

FCE

Inflammation\Infection

Discospondylitis

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41
Q

T3-L3 - Chronic neurological presentation - DDs

A

IVDD (Hansen Type 2)

Discospondylitis

Degenerative myelopathy

Neoplasia

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42
Q

Fibrocartilaginous Emboli - Common Location

A

T3-L3 (But can happen throughout the spinal cord)

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43
Q

Fibrocartilaginous Emboli - Signalment, History, Clinical presentation

A

Young, large , active dogs (1-2 years)

Sudden scream of pain preceding clinical signs

CP deficit

Acute asymmetric paraparesis (that can progress but stays asymmetric)

At the time of injury - painful, but usually no pain on exam (due to necrosis of the spinal cord)

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44
Q

Fibrocartilaginous Emboli - Diagnosis

A

Exclusion of Other DDs (e.g. Trauma / IVDD)

MRI (Gold standard)

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45
Q

Fibrocartilaginous Emboli - Treatment

A

Steroids (reduce inflammation and edema in the spinal cord

Physical therapy

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46
Q

Aberrant migration of S.Lupi - Clinical presentation

A

CP deficit

Acute (or sub-acute) asymmetric paraparesis

Biting of lumbo-sacral region

Back pain

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47
Q

Aberrant migration of S.Lupi - Diagnosis

A

CSF (Predominantly Eosinophils)

PCR on CSF

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48
Q

Aberrant migration of S.Lupi - Treatment

A

Short course Glucocorticoids (for 2nd inflammation)

Antibiotics (for secondary infections) - Clindamycin

Doramectin - q24h for 3 days, then once a week for 6 weeks

Physical therapy

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49
Q

Cauda Equina Syndrome - Signalment & Clinical Presentation

A

Old, large breed dog

Down-pointing tail

CP deficit

Paraparesis

Pain in Lumbo-Sacral region

Urinary incontinence

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49
Q

Cauda Equina Syndrome - Common causes

A

IVDD

Neoplasia

Discospondylitis

Luxation/sub-luxation

Degenerative changes (e.g. stenosis, synovial cysts)

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49
Q

Cauda Equina Syndrome - Diagnosis

A

CT / MRI

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50
Q

Meningomyelitis - Clinical signs

A

Fever

Lethargy, Anorexia

Back pain

Neurological deficits: Ranging from CP deficit up to loss of deep pain

Location: Focal\Multi-focal

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51
Q

Meningitis/Meningomyelitis - Possible CBC finding

A

High WBC

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52
Q

Meningitis/Meningomyelitis - Diagnosis

A

CSF

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53
Q

Caudal Cervical Spondylomyelopathy - Signalment/Clinical signs

A

Large adult breed dog
Commonly: Great Dane (2-4y) \ Doberman (6-9y).

Ataxia - Hind Limbs > Front Limbs

Hind Legs - Hypermetria

Front Legs - Hypometria

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54
Q

Caudal Cervical Spondylomyelopathy - Treatment

A

Surgery

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54
Q

What are the Defining Characteristics of a Meningioma on MRI Imaging (With Contrast)

A

-Occupying lesion with mass effect

-Large common border with the meninges

-Grows slowly

-Dural tail

-Consistent contrast uptake

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54
Q

What would we expect in terms of Cells/Protein levels from a CSF of an animal with a brain neoplasia

A

Protein > Cells

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54
Q

What are 2 important post-op drugs that should be given after tumor excision from the brain?

A

Anti-seizures

GC

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55
Q

Brain Gliomas - Signalment

A

Brachycephalic breeds

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56
Q

Brain Meningiomas - Signalment

A

Dolichocephalic breeds

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57
Q

You diagnosed metastasis in the brain - What are some common neoplasia that can cause it?

A

Prostatic Adenocarcinoma

Mammary Adenocarcinoma

Lymphosarcoma

Hemangiosarcoma

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58
Q

3 DDs for Multifocal lesions in the brain

A

Metastasis

Micro-abscesses

Inflammation\Infection

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59
Q

Infectious Meningoencephalitis - Common causative agents (Dogs)

A

Viral (e.g. Distemper, Rabies)

Parasitic (e.g. Toxoplasmosis, Neosporosis)

Fungal (e.g. Cryptococcus, Aspergillosis)

Protothecosis

Bacterial

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60
Q

Infectious Meningoencephalitis - Common causative agents (Cats)

A

Viral (e.g. FIP, FeLV, FIV)

Fungal (Cryptococcus, Aspergillosis)

Parasitic (e.g. Toxoplasmosis)

Bacterial

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60
Q

Bacterial Meningoencephalitis - Treatment

A

3rd Gen. Cephalosporins \ Fluoroquinolones

Short course GC

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60
Q

Infectious Meningoencephalitis - Diagnosis

A

CSF Serology\PCR

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60
Q

Sterile Encephalitis - What is the difference between Meningitis and Meningoencephalitis in terms of clinical signs?

A

Meningitis will manifest with Fever \ Lethargy \ Neck Pain but with no neurological deficits!

as opposed to Meningoencephalitis which can present with additional more severe neurological signs (e.g. CP deficit, Head tilt, Circling etc.)

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60
Q

Meningoencephalitis of unknown etiology (MUE) - Common breeds and their associated type of MUE

A

Pug \ Yorkshire \ Maltese \ Chihuahua - Necrotizing Meningoencephalitis (NME)

Granulomatous Meningoencephalitis (GME) - No associated breeds

Yorkshire terriers \ French bulldogs - Necrotizing Leukoencephalitis (NLE)

*Golden Retrievers - Eosinophilic Meningoencephalitis (EME) - Though not considered part of the MUE complex of diseases.

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60
Q

Steroid Responsive Meningitis Arthritis (SRMA) - Common Signalment

A

Weimaraner \ Beagle \ Bernese \ Boxer. Young - <1.5 years

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61
Q

Meningoencephalitis of unknown etiology (MUE) - Typical Signalment

A

Young to middle aged

Females more than males

Small breeds more than large breeds (e.g. Maltese \ Pug \ Yorkshire \ Chihuahua )

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62
Q

You draw CSF from a young dog and the predominant cells are Neutrophils - DDs and next step?

A

Bacterial Encephalitis and SRME\A

Look for presence of bacteria inside\outside of the neutrophils. If no bacteria is identified (And signalment, History and clinical signs correlate) - Start GC \ Immunosuppression.

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63
Q

You draw CSF from a dog and there is a heterogenous population of WBC - Monocytes\Lymphocytes\Maybe Some Neutrophils) - Mononuclear Pleocytosis - DDs and next step

A

Infectious diseases - (e.g. Aspergillosis \ Cryptococcosis \ Neospora \ Toxoplasma \ CDV)

=>PCR / Serology.

Suspicion of MUE => GC / Immunosuppression

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63
Q

Vestibular Signs - Horner Syndrome - What are the clinical signs? What is the pathology?

A

Miosis

3rd Eyelid elevation

Smaller palpebral opening

Pathology Involving the sympathetic innervation traversing the tympanic bulla

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63
Q

Vestibular Signs - What combination of neurological deficits would imply peripheral pathology involving CN 8 (vestibulocochlear N.) In an animal showing vestibular signs? Where would you localize the pathology?

A

1) Facial paralysis (Cranial nerve 7 - Facial nerve)

2) Horner Syndrome (Sympathetic nerve). Pathology involving the middle\inner ear (e.g. Otitis media\interna)

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64
Q

Vestibular Signs - What type of nystagmus is associated exclusively with a central lesion? (i.e. medullary)

A

Vertical nystagmus

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65
Q

Vestibular Signs - What cerebellar lobes are commonly associated with central vestibular signs?

A

Caudal Lobe

Flocculonodular Lobe

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66
Q

Peripheral Vestibular Pathology - What are important to look for In the physical examination, additional diagnostics & Blood works in a vestibular patient suspected with peripheral disease

A

Otoscopic examination (e.g. intact Tympanic Membrane)

Oral cavity examination (e.g. Inflammation \ Abscess \ Teeth problems) - Lesions can involve the ear

CBC + Panel (look for signs for hypothyroidism)

MRI \ CT

CSF

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67
Q

Geriatric / Idiopathic Vestibular Syndrome (“Old Dog Vestibular Syndrome”) - Central / Peripheral Syndrome

A

Peripheral

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68
Q

Geriatric / Idiopathic Vestibular Syndrome - Approach / Treatment

A

Tentative diagnosis based on Signalment and clinical signs. If diagnosis is correct - in 72 hours signs will resolve (Head tilt can remain)

Meanwhile - Fluids \ Anti-emetics \ Sedation

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69
Q

Paradoxical Vestibular Pathology - Location of the lesion

A

Flocculonodular Lobe \ Cerebello-Pontine Angle

70
Q

Pathological Nystagmus - High frequency usually indicative of..? (Peripheral / Central lesion)

A

Peripheral

71
Q

Pathological Nystagmus - low frequency usually indicative of..? (Peripheral / Central lesion)

A

Central lesion

72
Q

Positional Nystagmus - Define what it is, and the location of the lesion if present?

A

Vestibular animal that does not have pathological nystagmus but develops it as soon as we change the animal’s position (i.e. Lateral recumbency)

Central lesion

73
Q

Animal with Symmetric / Diffuse neurological deficits pointing to the cerebrums. DDs?

A

Metabolic etiologies:
Hypocalcemia

Hyperammonemia (Hepatic encephalopathy)

Uremia

Hypoglycemia

Low Thiamine (Vitamin B1)

74
Q

Withdrawal Reflex - Assess which spinal segments?

A

Forelimb - C6-T2

Hindlimb - L4-S1

75
Q

Patellar Reflex (Femoral N.) - Assess which spinal segments?

A

L4-L5 (L6)

76
Q

Sciatic N. - Assess which spinal segments?

A

L6-S1

77
Q

What is the difference between a Paretic/Plegic animal with UMN Lesion as opposed to a LMN lesion in terms of muscle tonicity?

A

UMN - Hypertonicity

LMN - Hypotonicity

78
Q

Peripheral Pathologies / Neuromuscular Diseases - DDs

A

Neurological (e.g. Polyradiculoneuritis), Junctionopathies (e.g. Myasthenia Gravis \ Organic Phosphates (Chronic) / Botulism \ Tetanus)

Muscles: Dermatomyositis \ Polymyositis \ Myopathies \ Storage Diseases

Infectious: Neospora \ Toxoplasmosis \ Hepatozoon Americanum

Endocrine: Hypothyroidism \ Cushing’s disease \ DM \ Addison’s disease

Metabolic: Hypoglycemia \ Hypocalcemia \ Hypokalemia

79
Q

Polymyositis and Myasthenia Gravis - What are 2 clinical signs that in high probability rule out the diseases

A

Plegia Decreased \ Missing spinal reflexes

80
Q

Peripheral neuropathies due to Endocrine disease usually result in at most…? (Which neurological deficit)

A

Paresis

81
Q

EMG - When can the test be used in terms of disease time line (Least false negatives)

A

5-7 Days after onset

82
Q

LMND - Botulism - What is a diagnostic tool in the clinic that can give a clue to the disease? Why?

A

X-Rays

In small animals - Botulism is usually the result of eating dead animals => X-Ray of the stomach - May see the Carcass \ Bones

83
Q

Polyradiculoneuritis - Common EMG finding

A

Spontaneous muscle electrical activity at Rest

84
Q

Polyradiculoneuritis - Diagnosis

A

Rule out other peripheral neuropathies

EMG

85
Q

Polyradiculoneuritis - Pathology

A

Sterile autoimmune inflammation of the LMN

86
Q

Polyradiculoneuritis - Treatment

A

Supportive (Change recumbency \ watch for Aspiration Pneumonia)

Physical therapy

IVIG (If physical therapy isn’t working)

87
Q

Polyradiculoneuritis - Prognosis

A

Most dogs undergo full recovery (usually takes a few weeks, can be months)

Prognosis worsens in cases of aspiration pneumonia

88
Q

Steroid Responsive Tremor Syndrome - Signalment & Clinical Presentation

A

Small breed dogs

Constant fine tremors with ataxia and falling

89
Q

Steroid Responsive Tremor Syndrome - Location of lesion

A

Diffuse Cerebellar

90
Q

Steroid Responsive Tremor Syndrome - Diagnosis

A

Clinical signs

CSF - Lymphocytes predominate

91
Q

Steroid Responsive Tremor Syndrome - Treatment

A

Steroids

92
Q

Cutaneous Trunci deficit can point to damage up to..? (Range)

A

Up to 4 vertebrae cranially from point of pressure

93
Q

Monoparesis / Plegia (Involvement of one foot) - Usually the lesion will be…? (Location)

A

Outside the spinal cord (Peripheral) (Brachial\Lumbosacral plexus, Spinal nerves)

94
Q

Describe Sympathetic Nerve Pathway

A

Hypothalamus => Spinal cord => T1-T3 => Brachial Plexus => Cranial Cervical Ganglion => Tympanic bulla => Eye

95
Q

Autoimmune Neuritis - Can involve only one nerve (T/F)

A

True

96
Q

Vestibular Signs - Swaying from side to side is more associated with Peripheral / Cerebellar lesion?

A

Cerebellar

97
Q

IVDD Type 2 - Always accompanied with pain on palpation (T/F)

A

False

98
Q

Degenerative changes in the spinal column - Give 4 types of pathologies

A

Ligament thickening

Joint cysts

Facet hypertrophy

Osteophytes

99
Q

Spinal Arachnoid Diverticulum - Common breeds

A

Pugs \ French Bulldog \ Rottweiler

100
Q

Name 5 chronic pathologies of the spinal cord/column that can present without pain

A

Degenerative Myelopathy

Degenerative changes to the spinal cord

Spinal Arachnoid Diverticulum

IVDD Type 2

FCE

101
Q

DDs for acute spinal cord pathologies

A

IVDD Type 1 & 3

Fractures \ Luxation

FCE

Meningitis\Meningomyelitis

Discospondylitis

102
Q

Animal presents with history of trauma and is paraplegic with no deep pain. DDs?

A

Fracture \ Luxation

Bleeding

Concussion

Acute disk herniation

103
Q

Optic Chiasma - Location in the brain

A

Rostral to the Hypophysis

104
Q

Tentorium Cerebelli - Definition

A

Dural reflection separating the Cerebellum and Cortex

105
Q

What is the name of the structure that separates both of the cortical hemispheres

A

Falx Cerebri

106
Q

An injury to CN 6 will cause what clinical sign? Why?

A

Medial Strabismus

Innervates rectus lateralis m. (and Retractors)

107
Q

An Injury to CN 3 will cause what kind of Strabismus?

A

Lateral Strabismus

108
Q

What test on physical examination can we perform to check if CN 6 is injured?

A

Corneal reflex

109
Q

What are the indications for conservative treatment in spinal cord injuries?

A

Non progressive deficits - at worse paresis

No compression on spinal cord

Accepted by the animal (i.e. Cast)

Fracture is stable

110
Q

What are the indications for surgical treatment in spinal cord injuries?

A

Fracture is unstable

Spinal cord compression

Plegic or worse

Progressive

111
Q

Swallow Reflex - Checks which cranial nerves?

A

CN 9 - Glossopharyngeal Nerve

CN 10 - Vagus

CN 11 - Accessory

*Note - Mainly checks CN9, but all 3 CN originate from “Nucleus Ambiguus” - in the ventrolateral portion of the caudal Medulla

112
Q

Hindleg reflexes - Cranial tibial muscle reflex - checks which nerve and which spinal nerves?

A

Sciatic N. - Specifically L6-S1

113
Q

Hindleg reflexes - Gastrocnemius muscle reflex - checks which nerve and which spinal nerves?

A

Sciatic N. (L6-S1)

114
Q

Increased cross extension reflex - Signifies what type of injury?

A

UMN Injury

Forelimbs - Cranially to C6 (C1-C5)

Hindlimbs - Cranially to L4 (T3-L3)

115
Q

Babinski sign - How to perform and what does positive result? What is the type of injury (UMN\LMN)?

A

Stroke on the palmar\tarsal plain - Carpus\Tarsus to toe or toe to Carpus\Tarsus

Positive result - Extension of toes

Injury - UMN

116
Q

Syringomyelia - Signalment

A

Young King Charles Caviler Spaniel (Can be as young as 3 months old)

117
Q

Syringomyelia - Common clinical signs

A

Main - Cervical pain! (C1-C5)

Unwillingness to move

Quadroparesis

118
Q

What are 2 DDs for increased patellar reflex? Explain the least common one

A

UMN Injury (T3-L-3)

Pseudo hyperreflexia - In cases of injury to the Sciatic nerve - The extensor (Antagonistic) muscles undergo atrophy - Causing less resistance to flexion and increased patellar reflex

119
Q

What is the connection between plantigrade walk in the hindlimb and Sciatic N. injury?

A

Loss of innervation to the Gastrocnemius m.

120
Q

Palpebral \ Lip \ Nasal Sensation - What 3 parts comprise the test?

A

CN 5

CN 7

Contralateral Cortical Hemisphere

121
Q

Head Trauma - What are the tenets of conservative treatment?

A

Ventilation (Keep CO2 down to decrease bloodflow to the brain)

Mannitol \ Hyperosmotic Saline

Keep head at 30 degrees

Anti-seizure (Prophylaxis)

122
Q

Chocolate Poisoning - 2 Most commonly affected systems and 2 most common clinical signs

A

Cardiovascular

CNS

Tachycardia \ Arrhythmias

Seizures

123
Q

Chocolate Poisoning - When trying to add up the amount of toxin the animal ingested - what 2 ingredients should be considered?

A

Theobromine

Caffeine

124
Q

Chocolate Poisoning - What is the most dangerous form of chocolate?

A

Cocoa Powder

125
Q

PLR - Where do you shine the light in order to check contralateral PLR as well as ipsilateral?

A

Nasal retina (Medial)

126
Q

PLR - Where do you shine the light to only check the ipsilateral PLR?

A

Temporal retina (Lateral)

127
Q

Lateral Strabismus is often associated with injury to which CN?

A

Ipsilateral Oculomotor lesion

128
Q

Cross Extension Reflex - UMN / LMN Lesion?

A

UMN

129
Q

MRI of the brain - Ring Enhancement - DDs

A

Metastasis

Abscess

Glioma

Infarct

Contusion

Demyelinating disease

Radiation necrosis

130
Q

Idiopathic Trigeminal Neuritis - 3 Clinical signs

A

Dropped jaw

Facial paralysis

Trigeminal sensory deficits

131
Q

Describe the nerves, their location and function involved in Micturition

A

Hypogastric N.
L2-L5
Sympathetic innervation of the bladder detrusor muscle that allows relaxation and filling

Pelvic N.
S1-S3
Parasympathetic innervation of the bladder - Contraction of the Detrusor and relaxation of the Internal Urethral Sphincter - allowing urination

Pudendal N.
S1-S3
Somatic innervation - Contraction of the External Urethral Sphincter - allowing urination.

132
Q

Myasthenia Gravis - 3 Breeds at risk for acquired MG? (Which is the most common)

A

Akita (Most common)

Chihuahua

German Shorthaired Pointer

133
Q

Trismus (Hard to open Mandibles) - Common Causes

A

Tetanus

Rabies

TMJ Osteoarthritis

Masticatory muscles Myositis

Otitis + Cellulitis

Retrobulbar Abscess

134
Q

Cerebellar Hypoplasia - Usually caused by…in what animal?

A

Panleukopenia Virus

Kittens

135
Q

Pendular Nystagmus - Common breed & Concurrent neurological deficit?

A

Siamese cats (Also albino cats)

Bilateral blindness in the nasal visual field

136
Q

A Great Dane presents with limb tremors. They appear only when standing. What is the name of the syndrome and what is the signalment?

A

Orthostatic Tremor

Large Breeds (e.g. Great Dane \ Irish Wolfhound \ Deerhound)

137
Q

Steroid Responsive Tremor Syndrome - Signalment and Tremor Characteristics

A

Dogs Under 15 Kg

Whole Body, Constant, Mostly no other deficits (Rarely Vestibular also)

138
Q

Describe the way to define a Tremor

A

1) First - Tremor or Muscle fasciculation

2) Which part of the body is tremoring

3) Is it Intermittent \ Constant \ Intentional

4) Is the tremor positional

5) Are there other neurological deficits

139
Q

Whole body, constant tremors in a young puppy. Probable cause?

A

Hypomyelinogenesis

140
Q

Head-only tremor that can be intermittent. Possible DD

A

Idiopathic Head Tremor

141
Q

Most common toxins that can cause Tremors

A

Organic Phosphates

Pyrethroid

Mycotoxins (Aspergillosis)

142
Q

What are the 5 possible changes in Wobblers Syndrome (Caudal Cervical Spondylomyelopathy)?

A

IVDD Type 2

Articular facet hypertrophy

Ligament hypertrophy

Central canal stenosis

Cervical vertebral instability

143
Q

Plantigrade Posture - causes

A

Tarsal extensors dysfunction - Gastrocnemius and SDF

Calcaneal tendon rupture

Calcaneal bone fracture

L4-S3 Spinal Lesion

DM \ Hypothyroidism

Hypokalemia Polymyopathy

144
Q

Neck Flexion - DDs

A

Spinal lesions: Fracture \ IVDD \ Atlanto-Axial sub-luxation

Metabolic: Hypokalemia \ Hypocalcemia \ Thiamine Deficiency

Endocrine: DM \ Hyperthyroidism \ Hypothyroidism

Myositis

Polyneuropathy

Myasthenia Gravis

145
Q

Meningoencephalitis of unknown etiology (MUE) - Signalment

A

Small breeds Females 3-7 Years

146
Q

Meningoencephalitis of unknown etiology (MUE) - Diagnosis

A

MRI

CSF - Mononuclear Pleocytosis

Screening for infectious diseases (e.g. Distemper \ Neospora \ Toxoplasma \ Cryptococcus \ Aspergillosis \ Bacterial)

If neoplasia is suspected - US \ X-ray

Histopathology (Gold standard)

147
Q

SRMA - Useful tool for monitoring treatment?

A

CRP

148
Q

SRMA - What concurrent disease can be found in ~50% of patients?

A

Immune-mediated polyarthritis

149
Q

Eosinophilic meningoencephalitis (EME) - Common breeds

A

Golden retriever

Rottweiler

150
Q

Eosinophilic meningoencephalitis (EME) - Diagnosis (And necessary rule outs)

A

MRI

CSF - Eosinophils

Rule out Cryptococcus \ Aspergillosis \ Toxoplasma \ Neospora \ S.Lupi \ Worms

151
Q

Infectious Meningoencephalitis - Bacterial meningitis - What is the most common cause?

A

Otitis interna

152
Q

Discospondylitis - Possible causes

A

Hematogenous Spread - UTI \ Skin infection \ Dental infection \ Endocarditis

Trauma \ Surgery \ Foreign body

153
Q

Discospondylitis - 2 Main categories of infective agents and name one zoonotic agent

A

Bacterial \ Fungal

Brucella Canis

154
Q

Chiari-Like Malformation & Syringomyelia - Signalment

A

Cavalier King Charles Spaniels, Brussels Gryphon, Small breed dogs

155
Q

Chiari-Like Malformation & Syringomyelia - Clinical signs

A

Phantom pruritus of neck area

Neck pain

+-Ataxia

+- Paresis

Vocalization

156
Q

Chiari-Like Malformation & Syringomyelia - Classic MRI findings

A

Occipital bone hypoplasia

Protrusion of the cerebellar vermis

Obliteration of dorsal sub-arachnoid space below cerebellum

Medullary kinking

Secondary Syringomyelia

Dilation above mesencephalic aquaduct

Ventriculomegaly

157
Q

Chiari-Like Malformation & Syringomyelia - Treatment

A

Surgery - Fat implantation. Best prognosis and can give normal life expectancy along with adjunctive medical treatment

Medical treatment (Alone or with surgery):
Analgesia

NSAID or Steroids to reduce inflammation + Proton pump inhibitors (Decreases CSF production)

158
Q

Vestibular Disease + Temporal M. Atrophy - Central \ Peripheral? Why?

A

Central

Mastication muscle atrophy = Trigeminal N. (CN 5) Lesion. CN 5 + CN 8 involvement = Medullary lesion

159
Q

Peripheral vestibular disease - DDs

A

Foreign body

Old dog vestibular syndrome

Otitis Media \ Interna

Hypothyroidism

Excessive ear flushing

Metronidazole toxicity

Neoplasia, Polyps

160
Q

Subarachnoid Diverticulum - Most common breed and name two others

A

Pugs.

French Bulldog, Rottweiler

161
Q

Cranial Nerve Evaluation - How to perform?

A

Observation: Facial Symmetry \ Head Tilt \ Nystagmus \ Muscle Atrophy.

Vision (Cotton Balls) \ Menace \ Palpebral \ Pathological Nystagmus \ Physiological Nystagmus \ Strabismus \ Swallow Reflex \ PLR

162
Q

Proprioception Evaluation - How to perform?

A

CP Evaluation

Wheelbarrow

Hopping

163
Q

Spinal Reflexes Evaluation - How to perform?

A

Withdrawal

Patellar

Sciatic

Perianal

Cutaneous Trunci

164
Q

Pain Evaluation - How to Perform?

A

Deep Pain

Back Palpation

165
Q

Elevated ICP - 3 Main clinical signs to look for at examination

A

Mentation Changes

Hypertension

Bradycardia

166
Q

Tenets of managing/treating head trauma

A

Elevate head to 30 degrees

Mannitol / Hypertonic Saline

O2 Supplementation

Preventative anti-seizure medication

167
Q

What is the drug that is contraindicated in all head trauma patients?

A

Steroids

168
Q

What are the best routes of administration of Benzodiazepines during a seizure?

A

Midazolam - Intranasal

Diazepam - Intrarectal

168
Q

What are the 3 Types of Ataxia?

A

1) Cerebellar

2) Vestibular (Non-cerebellar)

3) UMN \ Spinal Cord \ Proprioceptive

169
Q

All four limbs affected + Horner sign. Possible Neurolocation?

A

T1-T3

170
Q

Cutaneous Trunci reflex absent on one side in its entirety. Neurolocation? What’s the name of the nerve that is damaged?

A

C8-T1 of that side

Lateral Thoracic N.

171
Q

You suspect IVDD type 1. What is the tole of spinal X-rays in the diagnosis?

A

Rule in/out OTHER pathologies (e.g. Trauma \ Discospondylitis \ Neoplasia)

*Spinal X-rays SHOULD NOT be used as a definitive diagnostic for IVDD - for that use Myelography \ Myelo-CT \ MRI

172
Q

Cauda Equina Syndrome - Signalment

A

Medium to large breed dogs.

*German shepherd predisposed to Lumbosacral stenosis

173
Q

Cauda Equina Syndrome - Neurolocation

A

L7-S3

174
Q

Cauda Equina Syndrome - Clinical Signs

A

L7-S1 Involvement - Pelvic limb lameness \ Muscle atrophy \ Postural and Proprioceptive deficits

S1-S3 Involvement - Fecal and urinary incontinence

Negative perianal reflex

Caudal Nerve involvement - Limp tail

175
Q

Cauda Equina Syndrome - Diagnosis - Gold standard

A

MRI - Can visualize soft tissues (The Cauda Equina)

*CT for identifying protruding disks( disk can protrude but can also be an incidental finding and doesn’t necessarily cause clinical signs)

176
Q

Cauda Equina Syndrome - Indications for surgery

A

Severe pain

Neurological deficits

No response to medical therapy

Prevention of incontinence if still hasn’t occurred

177
Q

Cauda Equina Syndrome - Treatment

A

Conservative treatment:
Cage rest for 4-6 weeks
Analgesia
Physical therapy

Surgery

178
Q

Brain Stroke - What are the 2 types of stroke?

A

Ischemic

Hemorrhagic

179
Q

Brain Stroke - What are the 2 blood supply routes in which strokes most commonly occur?

A

Territorial (Cerebellar vessels)

Lacunar

180
Q

Brain Stroke - 3 Breeds that are over-represented

A

Cavalier King Charles Spaniel, Greyhound, Miniature Schnauzer (Familial Hyperlipidemia)

181
Q

Brain Stroke - Characteristics (i.e. The definition of a stroke)

A

Acute

Non Progressive

Focal

182
Q

Brain Stroke - Causes for Ischemic Stroke

A

Thrombus

Hyperviscosity Syndrome

Emboli (Parasites \ Septic \ Neoplastic)

183
Q

Brain Stroke - Causes for Hemorrhagic Stroke

A

Hypertension

Neoplasia

Vasculitis

Coagulopathies

184
Q

Brain Stroke - You diagnosed an Ischemic Infarct (on MRI) - What are appropriate further diagnostics?

A

CBC \ Panel \ T4 \ Cushing Screening \ UA X-Rays \ US

PT\PTT

TEG\TEM

D-Dimer \ FDP

Echocardiography

CSF

185
Q

Brain Stroke - You diagnosed a hemorrhagic Infarct (on MRI) - What are appropriate further diagnostics?

A

CBC \ Panel \ UA

BP

PT\PTT

BMBT

X-Rays \ US

186
Q

Brain Stroke - What is the “Penumbra”?

A

The area circling the permanently damaged area. This area can heal

187
Q

Brain Stroke - Treatment (Plus 1 Special Treatment only for Hemorrhagic Infarcts)

A

Treat underlying cause

Fluids

Anti-seizures: Keppra \ Phenobarbital \ Benzodiazepines

O2

Anti-Emetics (Vestibular disease)

Sedatives

Anticoagulants (e.g. Clopidogrel \ LMWH \ Rivaroxaban)

188
Q

Brain Stroke - Common Causes (AKA Risk Factors) in Dogs

A

Ischemic:
Hyperlipidemia (Atherosclerosis)
Hypothyroidism (Atherosclerosis)
Cushing’s disease
PLE \ PLN
Parasitic (Curtebra in cats)
Metastasis \ Neoplasia
Cardiac disease

Hemorrhagic:
CKD \ Hyperthyroidism (Hypertension)
Neoplasia
Thrombocytopathy / Thrombocytopenia
Decrease in clotting factors

189
Q

Status Epilepticus - Treatment options

A

Benzodiazepine

Keppra

Phenobarbital

Propofol

General Anesthesia

Doctor of Veterinary Medicine (Work in progress) (17 decks)

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