Neuro exam 2 - the good stuff

Uvea vasculature

it has it’s own but it ismore separated

bullet goes from front of eye to the back, list in order all of the structures it goes through

Eyelids -> conjunctiva -> cornea -> anterior chamber -> iris pupil -> posterior chamber -> lens -> ciliary body -> vitreous -> posterior eye wall (retina -> choroid -> posterior sclera) -> optic nerve

eye has a negative fluorescence stain test but has corneal vascularization what should you do for treatment and what are the causes

tx - steroids
causes - uveitis or immune mediated, allergic conjunctivitis
canine - pannus
feline - eosinophilic dermatitis

You have a corneal ulcer
what are the 3 questions to ask yourself

is it superficial or deep?
is it infected or not? (if it is deep assume it is already infected)
is there underlying disease that is contributing to the ulcer?

Superficial/ uncomplicated ulcers - what does it look like and tx

no bumps or depressions
tx - topical abx to prevent infections

Complicated corneal ulcers - what does it look like, and tx

depression, can have infiltration, melting, edematous, vascularized
assume it’s infected
tx - broad spectrum abx or based on cytology and increase the frequency

Steroids can’t be used in what 3 eye diseases

corneal ulcer, dry eye, or glaucoma

How to dx a corneal infection and what are the s/s

dx - cytology because we need fast results when we don’t want malacia (can still do culture to get a better description)
s/s - WBC, deep blood vessels, inflammation in response

Conjunctivits causes in dogs and tx

allergies
give topical anti-inflammatories (steroids) 3 times a day

Conjunctivitis causes in cats and tx

infectious (herpes, chlamydia, myoclonus)
tx - topical antivirals or antibiotics 3 times a day, no steroids because the animal needs to fight the infection

P has red eye
what 3 test do you need to perform and what is their normal
if any of these test are normal what can you not perscribe

STT - abnormal is under 10
IOP - abnormal is over 10-25 mmHg or difference over 5-7 between eyes
fluorescence stain test - there shouldn’t be any stain uptake
any abnormal = NO STEROIDS

Inflammation of the eyelids is local or systemic

systemic

Glaucoma is caused by

Never over production of AH so it is always a block drainage
pupil can be blocked by lens lux, iris bombe, mass, iridocorneal drain can be clogged by WBC (uveitis) or born with a bad drain

Normal pathway of AH

ciliary body to pupil to iridocorneal angle to sclera vasculature
closed system unlike tears that drain

S/S of chronic glaucoma

cupped nerve, lens is subluxated, bupthalomos that can also cuase Haab’s stria stretch marks on cornea

What is this

subluxated lens

What is this

cupped ONH

what is this

Haab’s striae

What means you are irreversibly blind in a glaucoma case

cupped nerve, buphthalmic eye or no consensual PLR

Glaucoma - tx primary

unilateral
latanoprost or osmotic diuretic (faster and strongest) carbonic anhydrase - safe for all time across all species, reduces AH production
timolol used to delay glaucoma in good eye

Glaucoma tx - secondary

bilateral
Carbonic anhydrase inhibitors reduce aqueous humor production
Do not use prostaglandin analog or mannitol

Glaucoma - chracterisitcs that indication vision or potential for vision and how to tx

acute (under 48hrs), positive menace, dazzle reflex or consensual PLR to fellow eye, normal ONH
Treat aggressively with consideration of referral

Glaucoma - chracterisitcs that indication irreversibly blind

chronic (over 72 hrs), bupthalmic (except puppies) absent dazzle, no con sensual PLR to fellow eye, grey/dark, round and cupped optic nerve head

What is this

Uveitis (hazy and color change)

What is this

Uveitis

What is this

uveitis

Uveitis is caused by

reflex of corneal ulcer, trauma, leaking of lens antigen, intraocular tumors
if not one of those 4 disease then it is somewhere else in the body

If the cause of uveitis is systemic what should be your next step

CBC, Chem, UA (systemic work up)

Uveitis - s/s

small pupil, hazy red eye, low IOP (in beginning)
inflammation makes iris anchor down and endothelial damage both lead to corneal edema

Uveitis - tx

as long as the fluorescent stain is negative give a steroid and possible dilate the eye

Chornic uveitis can cuase

glaucoma but WBC clogging the drain

Best way to examine the lens

retro illumination (glowing photo of lens)

Best way to asses cornea or if light passes through a cysts in the anterior chamber

trans illumination

what is the response to the lens to anything triggering

become opacic (cataracts)C

Cataracts - tx

sx and mitigate lens induce uveitis (steroids if no corneal ulcer)

Most common cause of luxation

zonula dysgenesis
traumatic lens luxation requires severe luxation

Why do we struggle to get drugs into the eye

because there are 3 layers to the tear film
hydrophobic - lipid
hydrophilic - aqueous
hydrophobic - mucin

How to differentiate retobullbar abcesses/cellulitis vs neoplasia

abcesses/cellulitis are painful on retropulsion and opening of mouth

What makes a patient a better prognosis for proptosis

easy out easy in
brachycephalic, acute, less number of muscles torn

Distichia

additional row of lashes orginating from metaplasitc meibomian gland

Ectopic eyelashes

grow straight down through the conjunctiva
more likely to cause ulcer

Trichiasis

normally placed cilia directed toward cornea

Neural Larval Migrans (NLM)

aseptic suppurative or eosinophilic meningoencephalitis form aberrant migration of larvae throughout the CNS

Taenia Multiceps - DH and IH and how is it spread

DH - canine
IH - ovine in brain and spinal cord
causes ataxia that allows dogs to eat them and then ingest the parasite

Baylisascaris Pryocyonis - DH, what species have larva migrans

DH - raccoon (in small intestines and do not cause s/s)
Ocular larva migrans in wild nad domestic animals

Baylisascaris pryocyonis - time of life cycle and dx

direct lifecycle
dx - patent infections done through fecal float

Parelaphostrongylus Tenius - type of life cycle, DH, IH

indirect life cycle
DH - white tailed deer (little to no disease)
IH - gastropods

Parelaphostrongylus Tenuis - accidental hosts and where does it infect

Accidental hosts - moose, elk, caribou, llamas, alpaca, sheep, goats
migrates through nervous tissue in either the brain, spinal cord or both

Parelaphostrongylus Tenuis - s/s and dx

s/s - depend on location in CNS - asymmetrical spinal cord disease - ataxia
dx - asymmetric neurologic s/s, CSF eosinophilic pleocytosis, absence of evidence for DDX, hx of white tailed deer exposure

Parelaphostrongylus Tennuis - tx and prevention

tx - anthelminitcs + anti inflammatories
prevention - minimize contact with white tailed deer and snail/slug

Angiostrongylus Cantonesis - Rat lung worm - DH, IH

DH - rats and other rodents (only rat will have larvae in feces)
IH - gastropods

Angiostrongylus cantonesis - incidental hosts and s/s

incidental hosts - humans
s/s - eosinophilic meningitis

ICP normal

5-14 mmHg

what incicates increased ICP

disease - known space occupying lesion, hydrocephalous, traumatic brain injury
s/s - decreased mentation, recurrent or cluster seizures, anisocoria (pupils are unequal sizes), reduced/absent PLR
severe - Cushing reflex - bradycardia, irregular breathing, hypertension

Anesthetized beagles normal cerebral perfusion pressure (CPP)

82 mmHg

what to monitor for a P with potential for increased ICP

ETCO2 (consider arterial blood gas in not accurately reflexing PaCO2), invasive arterial blood pressure, SPO2, ECG (detect bradycardia and arrythmias) temp

Normal ETCO2

between 30-45 mmHg

Normal PaCO2

35-40mmHg

Normal SPO2

over 95%

Normal PaO2

over 80-90mmHg

Bromethalin - s/s

hours to days after ingestion
dull mentation
mild - hindlimb ataxia and paresis
severe - generalized seizures, hyperexcitability, hyperthermia and coma → respiratory failure and death

Bromethalin - tx

Acute - aggressive decontamintaiton
tremors and seizures - benzodiazepines ± phenobarbital
cerebral edema - mannitol, hypertonic saline, elevated head 30 degrees
Iv fluids and nutritional support
recumbnecy care

Xylitol - s/s and tx

seizures, hypoglycemia
s/s - p is systemically stable and then supportive care

Temorgenic mycotoxin - where do you get it from and s/s

moldy cheese ingestion (or other moldy organic material)
acute, causes tremors that can progress to seizures

Temorgenic mycotoxin -tx

stop tremors, supportive care, IV lipid therapy

Permethrin - common cause and s/s

cats with topical dog flea meds
tremors

Permethrin - tx

bath (avoid hypothermia), stop tremors, IV fluids and supportive care, IV lipid therapy

Ivermectin and macrocylic lactones - s/s

starts neuroexcitation but at higher doses can result in flaccid paralysis and coma, seizures, blindness, weakness, stupor

Ivermectin and macrocyclic lactones - tx

seizure control - no benzodiazepines as they can bind to gaba and prolong recovery
aggressive supportive care
IV lipid therapy

Redirected aggresion in cats has the underlying emotional motivator of

fear

What medications can you use in assertive aggressive cats and what should you not sue

paroxetine, sertaline, fluoxetine, clomipramine
not buspirone

what drugs helps in the tx of owner direct aggression in dogs

Fluoxetine

How to desinsitze a leash reactive dog toward unfamiliar dogs

exposure to stuffed decoy dog off leash
walking on leash with approach from familiar dog
walking on leash with approach from unfamiliar dog

What do has seperation anxiety
1) dog that destroys something in house while O is gone
2) velcro dog

1

Safety signals (dog training) are considered

inhibitory conditioned stimulus

Doing the stimulus multiple times without the associated effect to get the dog to no longer react to the stimulus would be an example of

extinction of classical conditioning

What can help reduce the need for pharmacological itnervetion in noise phobia

noise desensitization

What medication is best for ACUTE control of noise phobia in dogs

dexmedetomidine (sileo)

In vet offices increased stress can lead to increased or decreased risk of anesthetic complications

increased risk

What can you do to decreases stress at the vet

examine the pet in front of O

If O is unable to place a muzzle on P what should be the next step

event mediaction

What is a pharmacological effect of tricyclic antidepressant amitriptyline

Antihistamine, H-1 blockade

Meds for at home use in aggressive canine patient and what should you not use

sertaline, paroxetine, fluoxetine, clomipramine
Not alprazolam

Most common side effect of fluoxetine

inappetance

what event medicne should you use for a dog with predictable noise phobia

Alprazolam, clonidine, trazodone, gabapentin

Compuslive disorder

behavior persists even after stressors have been corrected

Management factors that influence the incident of sterotypes

social isolation, feeding concentrates, limited access to forage, extensive stall confinement

Sensory replacement

offer a confined horse an item that promotes an appropriate behavior that address the nervous system need for specific sensory input

Devices that physically prevent sterotpy increase

the performance of sterotpies

What can decrease sterotipies

increase grazing time, stalling near companions, providing foraging enrichment, reducing high energy concentrates

MUE localizes where but you should also keep what in mind

asymmetrical and multifocal in young to middle aged dog, small breed
also think about infection

Cat has a swollen nose what disease do you think it is and what can you do to dx

cryptococcous
antigen test (the only one that is not antibody)

FIP - localzation

multifocal asymmetrical brain typically
can’t easily dx

when do you put neoplasia on DDX list

older chronic (occ acute) progressive, asymmetrical (except pituitary that grow on midline)

Meningioma are commonly found in

cats and dolichocephalic dogs

Glioma are found in

brachycephalics

Pituitary tumors - distinguishing s/s

dull mentation that stops eating

Metasitc brain neoplasia

hemangiosarcoma

Stroke - characterisitcs

acute/peracute that gets better on its own

SRMA - signalment

young medium to large breeds
6months - 2 years
classic breeds - beagle, boxer dog, Bernese mountain dog (3 Bs)