Neuro Exam 2 (copy)

Main things to gather in a history?

• Signalment (breed and age)

• functional use

• Familial history

• Previous/current illness/surgery

• progression

Importance of vaccine history?

• Rabies and distemper

• Seizures are the most common neurological signs with distemper

Repetitive myoclonus is pathognomic for?

• Distemper

• other CS may be: thickened paw pads, and enamel hypoplasia

What is a sequelae of distemper?

• Viral inclusion bodies in the brain affecting the pacemakers of LMN which will cause repetitive myoclonus

What are some pre-ictal signs of seizures?

• Anxiety, confusion, disorientation, spacey

Order to conduct neuro exam?

• Mentation

• gait/posture

• postural reactions

• reflex/tone

• cranial nerve and the retina

• hyperpathia

LOA, dull-semi coma, coma, are all signs of?

• Brainstem disease

Name signs of forebrain disease

• confusion

• disorientation

• loss of learned behavior

• compulsive behaviors

Why may a patient have an abnormal level of consciousness?

• Ascending reticular activating system (ARAS)

• Brain stem location

What nervous system does hypothyroidism predominantly affect?

• common manifestations may be vestibular dysfunction, laryngeal paralysis, facial nerve involvement and generalized lower motor neuron weakness

What type of gait may you see with Cushings?

• Stiff toy solider gait

• Rigid and stiff muscle tone - these neurologic signs don’t go away

Side stepping is a CS of what

• classic brain stem location

What is torticollis?

• Turning of the body one side or another

Low neck carriage indicates?

• Disk problem

LMN injuries think more / less reflex, tone, strength

• less

• everything is diminished

What is considered a slow nystagmus

• less than 60 per minute

• 20-30 bpm is normal - cerebellar issue

Small circle and rolling you should think what location ?

• Back portion of the brain - brain stem / cerebellum

Does the cerebrum significantly influence the gait?

• No

Big circles, what location should you think the issue is in

• Forebrain (top of the brain)

Explain a decerebrate position

• Front legs extended, back legs flexed at hip

• Back legs extended at stifle

• head arched back between cerebellum and brainstem

Describe Schiff Sherrignton postion

• Lateral recumbency (T3-L3 location)

• may have increased tone in front legs

• head may not arch back

• little bit of paralysis in pelvic limbs

Long stride and ataxia

• UMN lesion

Short stride

• lower motor neuron or orthopedic disease

Side stepping

• Brainstem

If gait is different between front/back legs where is the problem likely?

• C6-T2

If it is just back legs affected and they short strided where is the location?

• L4-S1

If it is just back legs affected and they are long strided where is the location?

• T3-L3

In how many days will you lose muscle if you cut a nerve?

• 8 days and you will see significant muscle loss

Brachie plexus arises from ?

• C6-T2

Radial nerve arises from?

• C7-T2

Musculocutaneous nerve arises from?

• C6-C8

Patient comes to you for exercise intolerance, gradually back legs become more and more short strided until they sit down? main DDx?

• Myasthenia Gravis

Treatment for Myasthenia gravis

• Pyridostigamine

Will changes in the cortex impact vision and PLR?

• No just vision - PLR will remain intact

What stimulates contraction of bladder?

• Pons

Are seizures a forebrain or brainstem dysfunction

• Forebrain

• you may also see near normal gait, compulsive behaviors, large circles and sensory deficits contralateral

What are some other signs of forebrain dysfunction?

• Loss of learned behavior like in-appropriate urination

CN 3&4 are in the ?

• mid brain

CN 5 is where?

• Pons

CN 6-12 is where?

• Medulla

What does dysfunction of the C1-C5 look like?

• long stride and ataxia, proprioceptive deficits, weakness, increased tone and reflexes to all four limbs

What does dysfunction of the C6-T2 look like?

• short stride, decreased reflexes, withdrawal changes and tone in TL, long stride with ataxia increased tone and reflexes in PL, proprioceptive deficits in all four

Give an example of diffuse peripheral disease

• Coonhound paralysis

• all limbs and muscle groups are affected

Give an example of focal peripheral disease

• Masticatory Myositis

T3-L3 only the back legs are affected often with ____ stride

• Long

L4-S1 only the ___ legs are affected but with a ___ weak stride

• Back , short

What is status epilepticus?

• A persistent seizure longer than 5 minutes or not returning to normal between seizure

Cluster seizure?

• more than one in 24 hours

Refractory seizure

• no responding to normal meds needing 3-6 drugs to stop the seizure

super refractory

• failure to respond to ER treatments

Fly biting history is important can likely be divided into what three possible causes

• GI

• Behavioral

• seizures

What breeds tend to show up with glial cell tumors early?

• Brachycephalic breeds

what is your target for rate of seizures?

• single seizure every 1-3 months

what breeds are your nightmares

• Border collie, Australian shepherd and Italian spinoni

you can have deficits from a seizure that last between ____ days

• 3-7

Is it weird to see elevations in liver values after seizure

• no dont really let if affect your drug choices

What are the big four drugs we will be using for seizure control?

• Phenobarb, Levetiracetanm (keppra), pottassium bromide, zonisamide

you want to check liver values every ____ months with pheno

• 6

which drug has more side effects?

• Pheno

• keppra has less side effects and is cheaper

Why does pheno likely work better than keppra?

• Pheno works in a lot more places Ca channels, gaba receptors, Na channels

Main downside to pheno?

• Controlled drug

  • this means you have to examine the patient every 6 months

for keppra and zonisamide you need to only monitor it once and youre looking for the blood level to be above?

• 20

• this shows it is likely working

Monitor bromide the toxicity looks a lot like?

• the loading phase

When using pheno check the dog in ___ weeks and then every 6 months

• 2

How many half lives does it take to reach a steady state?

• 4-5 half lives

With bromide, ___will also be elevated

• chloride

What are good meds to add on to disrupt clusters?

• Gabapentin or lyrika

• used to transient bump up blood levels and get control for 2-3 days

Midazolam is very short acting drug only has a window of about ?

• 30 minutes

• only use it on a patient who is actively seizuring or when you can predict one

you should stay in hospital until you are?

• 24 hours seizure free

Why might bromide loading doses by given twice daily?

• Because its a salt and too much at once can make patient nauseous and vomit

In emergency situations you will need to also consider what?

• Brain swelling and edema

Possible consequences of seizing for 2 hours?

• forget owner or learned behaviors even after the 14 days, loss of vision, may never recover to what they were before

Not knowing the duration and the patient is in status he always uses what first

• Midazolam because it should work within 3-5 minutes

What half life in midazolam

• 3hr in dog

• 15hr in cat

what works quicker IN or IR

• IN but risk getting bitten

• IN works in 3-6 min with 80%

• IR works in 10-14 min with 60%

MOA of midazolam is short. How short?

• 15-30 minutes I

Is midazolam a good drug for a dog who seizes hourly?

• No duration of drug is way too short

If you use midazolam regularly you will develop a tolerance within ___ weeks

• 1-2

What is the second leading cause for seizures?

• Head trauma

Behavior problem and seizuring or disorientation, spacey, large circle, and head pressing is there an underlying cause?

• Yes

What are some choices for managing a status patient?

• Barbituate coma - high dose of pheno

• Midazolam CRI

something interesting with propofol?

• can cause or decrease seizures

What is the prognosis with status epilepticus?

• Guarded

• doing everything you can

You can try hypothermia in super-refractory patient, but what is the very small temperature window

• 98 - 99.8 (36,7-37.7)

Describe idiopathic genetic based status epilepticus in cats

• Happens every 1-3 months, before normal before and after, seizure lasts 1-2 minutes

When consideration age and seizures is it more important in dogs or cats?

• Dogs

common infections that can cause seizures in cats?

• Toxo

• FIP (hydrocephalus)

• Cuterebra (crawl up in brain)

• fungal (granulomas act like masses)

Cats with meninglomas present most commonly with what?

• behavior changes!!

• Radical and significant change

Dogs with meninglomas present more commonly with

• Seizures

Cuterebra can cause what disease in cats that affect the brain?

• Feline ischemic encephalopathy

Treatment for FIE?

• Deworming, steroid and anticonvulsants

50% of strokes are due to systemic disease consider?

• Diabetes, renal, endocrinopathies, hypertension, systemic disease

What prognosis for cats with meningioma?

• Excellent apparent

Can you use bromide in cats?

• NO -can be fatal

• avoid at all costs

Non convulsant seizures are more or less common with cluster seizures

• More common

Pheno and keppra good for cats because they come as?

• An elixir

• other drugs are possible but they will have to be compounded

Topical pheno is optional what are the downsides?

• very difficult to maintain a blood level with a topical

Decreased level of awareness are signs of

• Brain stem disease (will appear obtunded, dull, and stages of coma)

Confusion, disorientation, loss of learned behavior, compulsive behaviors, are signs of

• Forebrain disease

Common neural problems with hypothyroid

• Laryngeal paralysis and vestibular disfunction