SAM Neuro - Exam 2

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70 Terms

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Localization of the nero system

  • Intracranial

    • Forebrain, brainstem, cerebellum

  • Spinal cord

    • C1-5, C6-T2, T3-L3, L4-S1

  • PNS

    • Somatic nerve, muscle, NMJ, autonomic nerve,

  • Enteric nerve

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Mentation/behavior

  • Brainstem dx: Information processing

    • LOA, dull, coma

    • Use ascending reticular activating system (ARAS)

      • level of awareness

  • Foerbrain dx:

    • Confusion, disorientation, loss of learned behavior, compulsive behaviors

      • Ex: accidents in the house

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Gait

  • slowly, strait, turns, fatigue, free, joint flexion or extension

  • Plegia: absent gait generation

  • Paresis: weakness, min gait generation

    • LMN: maintains tone, short stride, toe scuffing

    • UMN: gait generation, slower protraction and longer stride, ataxia

      • Ataxia: without order, long stride and has unpredictable foot placement

  • Cerebellar: hypermetric, head tilt/listing/falling, Slow nystagmus (<60 per min), sm circles, rolling, side stepping, head down, rate/range motion change

  • Cerebrum: Lg circles, contralateral sign, perception issues

    • ipsilateral forebrain localization

      • forebrain dose not influence gait

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<p>Posture</p>

Posture

  • Postural Reactions: test 2x, support, do all limbs

    • Paw position, hopping, bracing

  • Muscle tone: symmetry

    • focal loss in 8d from nerve dx

    • Cranial tibial from L7-S1 disk/stenosis

  • Decerebrate: head up, legs strait down

  • Decerebellate: downward dog posture

  • Schiff Sherrington: extended front limbs

    • T3-L3

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Reflex testing

  • Done standing or lateral

  • Pelvic Limb: patellar, cranial tibial, calcaneal or gastrocnemius, and withdrawal

  • Thoracic Limb: biceps, extensor carpi, triceps and withdrawal

  • Cutaneous trunci

    • key for localization

  • Perineal

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Withdrawal in reflex testing

  • LMN stimuli to withdrawal limb

    • continued emotional rxn post stimuli = deep pain

  • Squeeze toes and watch

    • Which joints flex? Is it complete? does the animal kick?

    • Crossed extensor in lateral = UMN

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LMN signs

  • Weakness, decreased tone, decreased reflexes

    • withdrawal

  • Short stride, ±proprioceptive deficit, toe scuffing

  • Slow to rise/slow to sit, dribble urine or drop stool

    • L7-S1

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UMN Signs

  • Descending Tract Failure

    • Weakness, Increased reflex, long stride, Increased tone

  • Ascending Tract Failure

    • Proprioceptive ataxia, Postural deficit

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Peripheral neuropathy/myopathy

  • LMN signs

    • Short stride, weakness, good proprioception

    • Frequently normal cranial nerves??

  • Systemic signs

    • WBC, temperature, malaise

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Cranial Nerves

  • CN II: menace, tracking, obstacle course, PLR

  • CN III: PLR, head movement, Strabismus

  • CN IV: head movement, Strabismus

  • CN V: facial sensation/tone

  • CN VI: head movement, Strabismus

  • CN VII: facial sensation/tone

  • CN VIII: head movement, Strabismus

  • CN IX: gag reflex, resp sounds, tounge

  • CN X: gag reflex, resp sounds, tounge

  • CN XI: gag reflex, resp sounds, tounge

  • CN XII: gag reflex, resp sounds, tounge

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Mence response

  • CN II

  • dev @ 12-16w

  • Forebrain dx - when deficits

    • Contralateral to the lesion most common

    • Ipsilateral if its cerebellar (rare)

    • Abnormal PLR and menace = Rostral to the diencephalon

    • Normal PLR but abnormal menace: Caudal to the diencephalon

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Horner’s Syndrome

  • MOA: Long pathway within the CNS and periphery

    • Brain, cervical, thoracic, and middle ear disease

      • Consider both CNS and systemic diseases

      • can be partial or complete

  • CS: Miosis, Ptosis, Nictitans protrusion, Enophthalmos, Sweating (horse)

  • DDX: parasympathetic dx

    • 2 branches in cat and 5 in dog

      • weird pupils (D in cats)

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Retention/Storage of urine

  • Pontine storage to hypogastric nerve (T10-11) detrusor and trigone

  • Pudendal nerve to external urethral and anal sphincter

  • Voluntary control regulated by the forebrain

  • Cerebellar inhibition of urination

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Dysfunction in different parts of the brain

  • Forebrain

    • Seizures, near normal gait, compulsive behaviours, inappropriate urination

    • Lg circles to lesion, contralateral sensory deficits

  • Brainstem

    • Altered gait, altered LOA, proprioception

  • Cerebellum

    • Intention tremor, postural reaction issues,

      hypermetric gait, wide stance, normal strength

  • Vestibular

    • Central: gait and proprioceptive issues - horners

    • Peripheral: normal tone, proprioception, nystagmus opp lesion, head tilt, rolling to lesion

  • Paradoxical: the head tilt is opposite the postural deficit

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Disfunction in different parts of the spine

  • C1-5: Long stride and ataxia, proprioceptive deficits, weakness, increased tone and reflexes to all four limbs

  • C6-T2: Short stride(LMN), decreased reflexes, withdrawal changes and tone in front, long stride(UMN) with ataxia, increased tone and reflexes in hind, proprioceptive deficits, in all four

  • T3-L3: Normal front, long stride with ataxia in hind, proprioceptive deficits, altered tone, and reflexes, cutaneous trunci changes, bladder control(UMN).

  • L4-S1: Normal front, short stride in hind, flopping of the distal limb, altered withdrawal, decreased reflexes and tone, slow to rise/sit, tail drop, incountenance (LMN)

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Seizure-like Episodes

  • Cataplexy, narcolepsy, REM sleep disorder

  • Vestibular episodes

  • Panic attack

  • Episodes of neuromuscular disease or encephalitis

  • Myoclonus(twitching)

  • Syncope (fainting)

  • Cervical muscle spasm

  • Head bobbing & breed associated muscle disorders(bulldogs,danes)

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Seizure terms

  • Seizure: a sudden attack or convulsion

  • Status epilepticus: a persistent seizure >5 min, lowers lifespan

  • Cluster seizures: >1 in 24hrs, lowers lifespan

  • Non-convulsant seizure: sensorium only, lowers lifespan, common w/ clusters, ECG req

  • Refractory seizure: multi tx fail

    • Super-refractory: ER tx fail and meds

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Seizure causes

  • NT changes: High excitatory NT or Low inhibitory NT

  • Young (<1y): infectious, anomalous, metabolic, trauma, toxin

  • 1-5y: idiopathic

  • >5y: neoplasia, infarct, inflam, metabolic, infection

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Refractory seizure cases

  • MOA:

    • multi tx fail

    • Aussie, colie, Italian Spinoni

  • Tx:

    • Be aggressive >2 anticonvulsants

    • Rescue and emerg plan

    • Set expectations

    • 6m monitoring & CBC

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General treatment of seizure cases

  • Goal: <1seziure every 3m

  • Establish:

    • emerg, monitoring, tracking plan

    • maintenance, post episode tx

  • Consider:

    • Who, what, where, when, why?

    • Postictal phase behaviour (recovery)

    • takes 5 ½ lifes to reach steady state w/ meds

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Phenobarbital

  • Use: anticonvulsant

    • q12h

  • MOA: Ca/Na channel, Gaba

  • Monitor:

    • Liver, Bone Marrow, Skin, Endocrine toxic

    • BW 2w after changes then 6m

    • high metab of T4 and P450

  • Loading: 16-30 mg over 24hrs in 1-6 doses

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Keppra

  • Use: anticonvulsant

    • DEA not req

  • MOA: Ca channel, NT release

  • Loading: 60-100mg/kg IV - bolus

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Potassium Bromide

  • Use: anticonvulsant - salt

    • not in cats: pneumonia

  • MOA:

    • Membrane stabilization/hyperpolarization

    • 24hrs ½ life

  • Monitor: Pancreatitis, Esophagitis

    • 3m after changes then yearly

    • high Cl

  • Loading: 400-600mg/kg over 5d

    • 1/2 dose q12 to avoid nausea

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Zonisamide

  • Use: anticonvulsant

  • MOA: Na channel

  • Monitor: idiosyncratic/acidosis

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Emergency and rescue plan

  • Home

    • Repeat maintenance meds 1-3x

    • New med w/ short half life for 1-3d

    • Diazepam/midazolam: IN 80% or rectal 60%

  • ER/Clinic

    • Hospitalization after >3 till 24hrs clear

    • Supportive care

    • Load meds or new meds

    • Diagnostics, MRI, EEG

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Benzo

  • AKA: Diazepam/Midazolam

  • Use: active seizures

    • Nasal: 3-6 mins - most common, carful biting

    • Rectal: 10-14 mins - needs cath and safer for client

  • MOA: Gaba

    • Action of 15-30min

    • Tolerance 1-2w (regular use)

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Ketamine

  • Use: Refractory Status Epilepticus

    • no rxn w/ benzos

  • MOA: NMDA

  • Steps:

    • see EEG w/ active seizure

    • give w/ Propofol to stop movement

    • give ket IV then CRI

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super-refractory epilepsy treatment

  • Meds:

    • Ketamine-Dexdomitor

  • Other:

    • Induce hypothermia (36.7-37.7)

  • Indications:

    • no rxn to benzos

    • Propofol to stop movement

    • continues seizure

    • Ket/dex

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Stages of Feline seizures

  • Prodromal: behavior/personality change - very common

  • Aura: sensory type change/anticipation

  • Ictus: seizure phase

  • Post-ictal: persistent deficits min-days

    • High ALP/ALT, ataxia, aggression, disoriented, vison loss

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<p>Feline seizure causes </p>

Feline seizure causes

  • Neoplasia: meningioma #1

    • cats see changes in behaviour **

    • dogs have seizures

  • FIP: ventriculitis & diffuse inctercranial/spinal signs, high protien fluid

  • Ischemic encephalopathy FIE: Parasite migration through the brain, variable forebrain signs, sneezing

  • Stroke: renal, endocrinopathies, hypertension, systemic disease

  • Idiopathic: bimodal, normal neuro exam, 9-12y cats

<ul><li><p><strong>Neoplasia: <u>meningioma #1</u></strong></p><ul><li><p><strong><u>cats see changes in behaviour **</u></strong></p></li><li><p><strong><u>dogs</u></strong> have <strong><u>seizures</u></strong></p></li></ul></li><li><p><strong>FIP: </strong>ventriculitis &amp; diffuse inctercranial/spinal signs, <u>high protien fluid</u></p></li><li><p><strong>Ischemic encephalopathy FIE: </strong><u>Parasite migration</u> through the brain, <strong>variable forebrain signs, <u>sneezing</u></strong></p></li><li><p><strong>Stroke: </strong>renal, endocrinopathies, hypertension, systemic disease</p></li><li><p><strong>Idiopathic:</strong> <u>bimodal,</u> normal neuro exam, 9-12y cats</p></li></ul><p></p>
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Seizures maintenance in cats

  • Leviteracitam, Zonisamide, Phenobarbital, Topomax

  • NO KBr: pneumonia (fatal)

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Refractory epilepsy

  • Failing two medications used to maximal effect

  • Super-refractory SE (life threatening) not

    responsive to first line ER treatments

Cluster/SE/NCSE: Decreased lifespan

  • SE/NCSE common in cluster pt and refractory

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NCSE (Non-Convulsive Status Epilepticus), NCS (Non-Convulsive Seizure)

  • More common with cluster seizures

  • Minimal to no evidence of seizure

  • EEG required for diagnosis

  • CS: Does not look like seizure, more dull, ataxic

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Treating disk disease

  • NSAIDS: better QOL score & recovery

  • Sx: best tx, timeline does not impact has recovery or success

  • Acupuncture: faster recovery

  • Physical therapy: better recovery

  • Glucocorticoids: contradicted

  • Methylprednisolone: no benefit, reduces bld flow & PMN’s

  • Cage rest: no benefit

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Evaluating disk disease prognosis

  • Moderate reoccurrence for rx and low for sx

  • Higher grade worse rx prognosis, sx indicated

  • Thoracolumbar

    • Paraplegia/deep pain negative: poor rx, moderate sx

    • Paraplegia/deep pain positive: moderate rx, good sx

    • Non-ambulatory paraparesis: moderate rx, good sx

    • Ambulatory paraparesis: moderate rx, good sx

    • Paraspinal hyperasthesia: good rx, good sx

  • Cervical

    • Grade I-III: moderate rx, good sx

    • Grade IV-V: low sx, moderate sx

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Testing for disk disease

  • Deep pain negative: eval w/ MRI

  • Evalute breed, focality, progressiveness

    • Myomalasia: diaphragm innervation issues, risk w/ acute

      • C6-7 keep u from heaven, C5-4 keeps you from the door (diaphragm)

  • DDX: Fibrocartilagenous emboli, Acute non-compressive nucleus pulposus extrusion, cancer, metabolic dx, malformations

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Hydrocephalus

  • MOA: Active distention of ventricular system obstruction flow

    • breed mesencephalic stenosis, acquired

      • Stenosis of the mesencephalic aqueduct most common

  • CS: High ICP, white matter pressure, cortical atrophy, dome head, altered behavior, seizures, stupid, ataxia, circling(big), blindness, soft spots

  • ID:

    • Congenital: MRI, CT, US

    • Acquired: MRI, CSF

  • Tx: Life long pred & Omeprazole, ventriculoperitoneal shunt sx, ventriculostomy sx

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<p>Atlanto-occipital AO or Atlanto-axial junction AA malformations</p>

Atlanto-occipital AO or Atlanto-axial junction AA malformations

  • MOA:

    • AO: overlap, concussive, medulla compression

      • C1 tips foward

    • AA luxation: cranial/cervical spine concussion

      • C2 tips backwards

  • CS: paresis(more aute), plegia(unilateral to bilateral), vestibular signs(mild)

  • ID: CT, MRI, C2 rads (AA)

  • Tx: sx stabalization, braces (1” rolled gauze “dough nuts” in emerg)

    • Avoid ventroflexion

<ul><li><p><strong>MOA:</strong></p><ul><li><p>AO: overlap, concussive, medulla compression</p><ul><li><p>C1 tips foward</p></li></ul></li><li><p>AA luxation: cranial/cervical spine concussion</p><ul><li><p>C2 tips backwards</p></li></ul></li></ul></li><li><p><strong>CS: </strong>paresis(more aute), plegia(unilateral to bilateral), vestibular signs(mild)</p></li><li><p><strong>ID:</strong> CT, MRI, C2 rads (AA)</p></li><li><p><strong>Tx: </strong>sx stabalization, <u>braces</u> (1” rolled gauze “dough nuts” in emerg)</p><ul><li><p><u>Avoid</u> ventro<u>flexion</u></p></li></ul></li></ul><p></p>
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<p>Caudal occipital junction malformations COMS</p>

Caudal occipital junction malformations COMS

  • MOA: overcrowding of fossa, poor fluid dynamics, herniation, cerebellum/medulla compression

  • CS: hyperesthesia, phantom scratching, ataxia, vestibular signs, paresis, vocalization, face rubbing, seizures

  • ID: CT, MRI

  • Tx: Long term, NSAID, Steroid, gabapentin/lyrica, omeprazole, sx w/ short term success but reoccurs

  • Recurrences due to scar tissue 40-60%

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<p>Vertebral malformation</p>

Vertebral malformation

  • L7-S1 mosy common

  • MOA: segment failure or trama

    • transition, butterfly, block, wedge, hypoplasia (pugs/frenchies), hemivertebra

    • Scoliosis, lordosis, kyphosis: brachiocephalic breeds

    • young T3-L3 myelopathy or old w/ multi disk injuries

  • CS: paraspinal discomfort, paresis, plegia, incontinence, ataxia

    • UMN signs

  • ID: MRI, rads

  • Tx: NSAID, gabapentin, sx stabilization

    • gliosis/atrophy of spinal cord = guarded the prognosis,

  • Facet hypoplasia: Recurrent concussive injury leading to scar tissue w/in spinal cord (pugs, frenchies)

<ul><li><p>L7-S1 mosy common</p></li><li><p><strong>MOA:</strong> segment failure or trama</p><ul><li><p><strong>transition, butterfly, block, wedge, hypoplasia (pugs/frenchies), hemivertebra</strong></p></li><li><p>Scoliosis, lordosis, kyphosis: brachiocephalic breeds</p></li><li><p><u>young T3-L3 myelopathy</u> or old w/ multi disk injuries</p></li></ul></li><li><p><strong>CS:</strong> paraspinal discomfort, <strong>paresis, plegia, incontinence</strong>, <strong>ataxia</strong></p><ul><li><p><u>UMN signs</u></p></li></ul></li><li><p><strong>ID:</strong> <u>MRI</u>, rads</p></li><li><p><strong>Tx: </strong>NSAID, gabapentin, sx stabilization</p><ul><li><p>gliosis/atrophy of spinal cord = guarded the prognosis,</p></li></ul></li><li><p><strong>Facet hypoplasia</strong>: <u>Recurrent concussive injury leading to scar tissue w/in spinal cord (pugs, frenchies)</u></p></li></ul><p></p>
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Arachnoid diverticula

  • MOA: unknown

    • Dilation of the arachnid space in caudal cervical/thoracolumbar spine

    • Brachycephalic, Rottie

  • Tx: decompressive/stabilizing sx

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Localizing spinal cord/myelopathies based on CS

  • C1-2

    • UMN: all limbs and bladder

  • C6-T2:

    • UMN: hind limb and bladder

    • LMN: front limb

  • T3-L3

    • UMN: hind limb and bladder

  • L4-S1:

    • LMN: hind limb and bladder

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<p>Steroid responsive meningitis arteritis SRMA</p>

Steroid responsive meningitis arteritis SRMA

  • MOA: 6m-2y Beagle, Berner, Boxer

  • CS: low head, stiff, random vocalizing , choppy steps, walking on egg shells

    • Neutrophilia/IgA elevation

  • ID: Febrile 103-105, neutrophilia, high IGA, CSF ±MRI

  • Tx: Steroids, cyclosporine - 6-8m back to normal

<ul><li><p><strong>MOA:</strong> <u>6m-2y Beagle, Berner, Boxer</u></p></li><li><p><strong>CS:</strong> <u>low head</u>, stiff, <u>random vocalizing , choppy steps, walking on egg shells</u></p><ul><li><p>Neutrophilia/IgA elevation</p></li></ul></li><li><p><strong>ID: </strong>Febrile 103-105, neutrophilia, high IGA, <u>CSF ±MRI</u></p></li><li><p><strong>Tx: </strong>Steroids, cyclosporine - 6-8m back to normal</p></li></ul><p></p>
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<p>Discospondylitis</p>

Discospondylitis

  • MOA: Infection of the disk/endplate

    • lg dogs

  • CS: ±Pain w/ empyema/disk extrusion

  • ID: difficult: rad(30%), MRI, CRP, culture(rule out), urine analysis(rule out), brucella(intact males)

  • Tx: C&S antibiotics (6-12m), analgesic,

    • euth w/ brucella

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<p>Infection/empyema of the spine</p>

Infection/empyema of the spine

  • MOA: Grass awn from resp into L4 @ diaphragm

  • CS: Cough (weeks to months prior), pain ± lumbar myelopathy

  • Tx: Sx, long term antibiotics

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<p>Tetanus</p>

Tetanus

  • MOA: 1-3w post wound or sx (AI or spay)

    • Travels retrograde to block interneuron

  • CS: rhesus sardonus, extensor rigidity, light/sound hypersensitivity, saw horse stance, lock jaw

  • Tx: antibiotics, clean, antitoxin, high mortality

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Degenerative Myelopathy DM

  • >8yr start to show signs

  • MOA: Progressive degeneration SOD 1 mutation

    • GSD, Boxer, Corgi (still RARE

  • CS: Non painful, Ataxia

    • similar to T3-L3 myelopathy

  • ID: genetic screening (purple top MSU/OFA)

    • neg, carrier, affected

  • Tx: fucked, PT, 6-18m till euth

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<p>Trigeminal neuritis</p>

Trigeminal neuritis

  • CS: Drop jaw/bilateral

  • idiopathic 3-6 weeks

  • Tx: assist feed, 6w to fix

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Infectious neuropathy

  • Neospora positive

  • Protozoal infection, young dogs

  • Focal granuloma

  • Cerebellum, spinal cord, nerve or

    muscle

  • Do not always see eosinophils

  • TX: clinda, TMS

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Polyradiculoneuritis

  • AKA: Coonhound paralysis

    • pelvic limbs

  • MOA: Rapid porgression

  • CS: LMN signs w/ intact sensation, Rapid atrophy 8d #1, normal cranial nerves

  • Tx: 4-6w recovery, can relapse, spontaneous

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<p>Laryngeal paralysis</p>

Laryngeal paralysis

  • degenerative dz, trauma, thyroid, cancer

  • MOA: Vibration of larynx causes voice and breathing changes

    • think horses

  • CS: Roaring, heat/exercise intolerance

  • Tx: Tie-back

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<p>Horner’s</p>

Horner’s

  • Miosis (constriction)

  • Ptosis (eye lid drooping)

  • Nictitans protrusion (3rd eye lid)

  • Enophthalmos (eye dispplacment)

  • Sweating (horse)

  • Rule out causes

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<p>Nerve sheath tumor</p>

Nerve sheath tumor

  • MOA: Trigeminal, brachial plexus, pelvic plexus

  • CS: focal rapid atrophy, progressive lameness

  • ID: may be able to palpate, US

  • DDX: mononeuropathy

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Mononeuropathy

  • Spinal cord invasion

  • Tonic UMN reflexes (brisk)

  • Other limbs

  • Cutaneous trunci

  • Horner’s (same side)

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<p>Endocrinopathies</p>

Endocrinopathies

  • CS: Classic Cushing’s signs, stiff stilted gait

  • Tx: Do not recover motor function

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<p>Immune myopathies (MMM)</p>

Immune myopathies (MMM)

  • MOA: location dependent, Immune attack on musle/NMJ

    • Masticatory muscle myositis embryo distinct

  • CS: swelling, pain, progresses atrophy, fibrosis - Bilateral

    • ocular myositis: eye bulge

    • Junctionopathy: aspiration

  • ID: AB titer(make dx), biopsy, eosinophils, high CK/CPK/AST

    • Poly myositis is tricky, takes weeks to dx

      • diffuse immune attack on muscles

  • Tx: Immune suppress (steroids)

<ul><li><p><strong>MOA:</strong> location dependent, Immune attack on musle/NMJ</p><ul><li><p><u>Masticatory muscle myositis</u> embryo distinct</p></li></ul></li><li><p><strong>CS:</strong> <strong>swelling, pain, progresses atrophy</strong>, fibrosis - Bilateral</p><ul><li><p>ocular myositis: eye bulge</p></li><li><p>Junctionopathy: aspiration</p></li></ul></li><li><p><strong>ID:</strong> AB titer(make dx), biopsy, eosinophils, <u>high CK</u>/CPK/AST</p><ul><li><p><strong>Poly myositis is tricky, takes weeks to dx</strong></p><ul><li><p><strong>diffuse immune attack on muscles</strong></p></li></ul></li></ul></li><li><p><strong>Tx:</strong> Immune suppress (steroids)</p></li></ul><p></p>
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Myasthenia Gravis

  • MOA: acquired or congenital, thymoma

  • CS: Exercise intolerance, fatiguable palpebral, megaesophagus: aspiration pneumonia, regurge, sits

  • Tx: Tensilon, pyridostigmine, mass remvoal sx

    • test for monoclonal antibody

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Forebrain signs

  • Behavior/personality changes

  • Loss of learned behavior

  • Seizures

  • Menace deficits

  • Altered sensation/proprioception

  • Large circles to the lesion

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Cerebellum signs

  • Altered balance

  • Hypermetria

  • Titubation/truncal sway

  • Menace/PLR changes

  • Anxious/normal mentation

  • Small circles/falling/rolling

  • Nystagmus (slow) less then 60 bpm

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Brainstem signs

  • LOA changes/obtunded to coma

  • Cranial nerve deficits; 3-12

  • Paresis to plegia

  • Small circles

  • Side stepping

  • When evaluation: Repeat frequently, patient requires

    hydration

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Spinal cord

  • Normal mentation/awareness

  • Paresis to plegia - tetra vs hemi

    • ??vestibular signs??

    • ??Horner’s??

    • ??Breathing??

    • ??Urination??

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Dealing with Head trauma

  • ID:

    • Breathing patterns, Postures, Diaphragm, forebrain CS

    • Brainstem evaluation: LOA, UMN function, reflexes

      • Score of 1-6 for each, total >8 = 50% survival @ 48hrs

      • Cushing’s reflex: high ICP, low CBF, high CO2

        • life threatening

  • Tx: replace fluids, NSAIDS, fentanyl, benzodiazepines, ketamine, dexmetatomidine, propofol, anticonvulsant medications

    • Short acting reversible drugs

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High ICP

  • MOA: Cushing’s reflex

    • high ICP, low CBF, slow HR, high CO2

    • life threatening brainstem issue

  • CS: Slow HR (<60), high BP (>150), brain stem CS

  • Tx: incline to 30o, lower metab (barbiturate/sedation), anticonvulsants (Keppra/phenobarbital), electrolytes (Mannitol/hypertonic saline)

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Hyperosmolars

  • Mannitol: sugar, osmotic diuretic, decrease CSF production, draws extracellular fluid into vessels, rheologic/improve cerebral blood flow

  • Hypertonic saline: Salt, osmotic diuretic, draws extracellular fluid into vessels, improved cerebral blood flow, less diuretic effect

    • Monitoring: dehydration, electrolyte concentration

  • Contradictions: not for intracranial hemorrhage

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Meningoencephalitis

  • MOA: inflam of brain/meninges

    • Sm dogs: pug, korkie, Maltese

  • CS: rapid progression (3-7d), status epileptics, blindness

    • Diffuse or multi-focal most common -

      mentation, balance, gait changes +/-

      seizure

  • DDX: peripheral vestibular disease

    • loss of balance, side stepping

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Caudal Fossa

  • Wet dog shake

  • MOA: immune CNS dx

    • bacterial - otitis #2 (cats), fungi, viral, Tick borne (vasculitis, thrombocytopenia), cuterebra

    • forebrain/brain stem issue

  • CS: balance loss, side stepping, peripheral vestibular dx, forebrain, occular only

  • ID: MRI, CSF, Myringotomy

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Peripheral vestibular dx

  • Nystagmus greater than 60bpm (fast)

  • Head tilt

  • Falling/rolling

  • Normal proprioception, mentation

  • Cranial nerve 7 dysfunction, maybe horners

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Myringotomy

  • Via Otoscope/endoscope w/ tom cat catheter

  • Puncture TM

  • Culture material beyond TM

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Otitis

  • ID: Culture canal or myringotomy

  • Tx:

    • Antibiotic/fungal, topical if tympanum is intact

    • Media/interna will require long tx (7m)

    • Sx VBO or TECA

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Meningitis

  • ID: MRI, CSF(rule out)

  • Tx: Immune suppress (steroids, cyclosporine), initial tx chemotherapeutics

    • long tx 12m-18m

      • recheck xray/MRI b4 stopping meds