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106 Cards in this Set
- Front
- Back
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Head tilt =
Head turn = |
Tilt = vestibular
Turn = forebrain |
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** If a forebrain disease is:
1. Acute but non progressive = 2. Relatively acute and progressive = 3. Insidious and progressive = |
1. Vascular
2. Meningoencephalitis 3. Neoplasia |
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Prosencephalon = _____ + ______
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Telencephalon + Diencephalon
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Give some signs of forebrain disease:
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Seizures, change in behavior, personality, head pressing, circling, head turn, menace and facial deficits.
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In forebrain disease, circling is towards/away from the lesion.
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Towards the lesion.
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You see a dog with seizures, changes in behavior, personality, head pressing, circling, head turn, menace and facial deficits. You think...
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Forebrain disease
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*Dementia =
*Delirium = |
Dementia = Inappropriate interactions with environment, impaired judgement but conscious.
Delirium = Inappropriate interactions with environment, reduced consciousness, may be acting completely crazy |
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Decerebrate rigidity
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Happens only in severe cases, a sawhorse-like posture, like a separation of head and limbs
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When the _______ (part of forebrain) is involved, you may see PU/PD, polyphagia, poor temperature regulation, odd sleep patterns.
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Hypothalamus
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T/F The things that cause forebrain disease are the same things that can cause seizures.
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True, and remember many things can cause seizures.
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This disease is characterized by dilation of the ventricular system in the brain, such that they are overfilled with fluid.
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Hyrocephalus
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Hydrocephalus is too much (pick one):
1. Water inside the brain 2. Water on/around the brain |
1. Water inside the brain
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What are some metabolic causes of forebrain disease (hint, a lot of them, and ions and small molecules pass the BBB easily)
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Hypoglycemia Hypernatremia
Hypocalcemia Hypothyroidism Hyponatremia Hypertriglyceridemia Hepatic encephalopathy Hypoxia |
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What breed of dog is associated with hypertriglyceridemia from a lipoprotein lipase deficiency?
How do you treat these dogs? |
Mini Schnauzers
Put them on a low fat diet. |
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Associate this with a cat on an all-fish diet, why?
What happens grossly to the brain? |
Forebrain disease from thiaminase in the raw fish breaking down the thiamine.
Microhemorrhages |
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What are the two primary brain tumors?
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1. Meningioma
2. Glioma |
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T/F Any infectious (and even sometimes noninfectious) agent type (bacterial, viral, fungal, etc) can cause a meningoencephalitis.
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True
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What do degenerative forebrain diseases tend to look like?
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Young animals with chronic, progressing signs.
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What are some tip offs that a puppy brought to you has hydrocephalus (ie, breed predilections and appearance)
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Brachycephalic or toy breed puppies, huge domed skull, may have seizures, walking into walls, *Ventrolateral strabismus, hippus (rhythmic dilation of the pupil)
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** What is the most important treatment for a head trauma case or vascular disease causing brain dysfunction?
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Keep oxygen and blood pressure levels normal.
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You see a puppy with neurologic signs, hippus, and ventrolateral strabismus. What disease goes to the top of your Ddx list?
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Hydrocephalus; ventrolateral strabismus and hippus are hallmark signs.
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* T/F There is no correlation between intaocular pressure and intracranial pressure.
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True, as much as we would like to be able to just measure the intraocular pressure to help us.
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** What 4 drugs (or classes) are given to a puppy to treat hydrocephalus?
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1. Prednisone
2. Anticonvulsants 3. Omeprazole (a Proton pump inhibitor but as a side effect it decreases CSF production) 4. Loop diuretics like Furosemide to decrease CSF volume |
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* What is the name of the surgical procedure to correct hydrocephalus?
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vetriculoperitoneal shunt = it takes CSF from the ventricles and lets it out in the abdominal cavity.
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T/F Ethylene glycol ingestion can cause forebrain disease.
T/F Nutritional secondary hypoparathyroidism can cause forebrain disease. |
Both are true as they both cause hypocalcemia.
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What often leads to hepatic encephalopathy, in one word?
What types are there? What can also lead to this disease? |
Shunt
Congenital = young runty toy breeds Acquired Liver disease/failure, can be acute |
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** What four things do you need to remember about hepatoencephalophathy?
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1) Severe liver disease is needed
2) Congenital shunts happen in young toy breeds 3) Blood from the GI tract is not being filtered. 4) Signs may show after the animal eats a fatty meal. |
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What drugs/techniques are used to bring down intracranial pressure?
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1. Oxygen (?)
2. Mannitol (suck water out of the brain and into vessels) 3. Hypertonic saline (suck water out of the brain and into vessels) 4. Elevate the head 30 degrees |
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T/F Ammonia is thought to be the main cause of the signs with hepatic encephalopathy, but there are likely other compounds at work.
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True; the amount of ammonia in the blood does not always correlate with the amount of disease seen.
Fatty acids, mercaptans, phenols, and bile salts are thought to act synergistically with ammonia. |
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What is something you can measure in the blood to rule in hepatic encephalopathy?
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Serum bile acids.
Also a chem may show: Hypoalbuminemia Low BUN Hypoglycemia Hypocholesterolemia |
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** What drugs/techniques are used to treat hepatic encephalopathy?
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1. Antibiotics to reduce gut flora so they stop breaking down as much protein.
2. Put the animal on a low protein diet 3. Lactulose (acidifies colon contents to trap ammonia in the gut) |
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Lactulose is used to treat _______ by ______.
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Hepatic encephalopathy
Acidifying the colon contents to trap ammonia in the gut. |
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** What are two causes of hyponatremia that can cause forebrain disease?
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1. Whipworms
2. Addisons |
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** What is the most common cause of hypoglycemia-related forebrain disease in cats?
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Insulin overdose in a diabetic cat, can be iatrogenic or from an insulinoma.
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When you think of a vascular forebrain disease, think the following three things:
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Acute
Asymmetric Non-progressive |
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What should you see in the blood of a mini schnauzer with hypertrigliceridemia?
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Grossly fatty blood
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** Why is thiamine important to brain function? (board question)
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Thiamine is needed for brain and vessel integrity, so loss results in microhemorrhages.
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What is a manifestation of abnormal, excessive, hypersynchronous neuronal discharges within the brain?
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A seizure
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T/F Synonyms for a seizure include ictus, fit, and convulsion.
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True
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What does epilepsy mean?
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Recurrent seizures due to an intracranial cause.
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The two main types of seizures (based on the brain matter they affect) are:
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Generalized
Focal |
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Cluster seizures =
Staus epilepticus = |
More than 2 seizures in a 24 hour period
2 or more seizures without a return to consciousness inbetween, or constant seizures for over 5 minutes. |
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What are the 4 parts of a seizure?
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1. Prodrome = odd feelings or behaviors hours or minutes before a seizure
2. Aura = Feeling at the start of a seizure 3. Ictus = The seizure itself 4. Post-ictal period = Recovery, animal may feel and act oddly |
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What to remember about the autonomic system during a seizure?
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SLUD
Salivation Lacrimation Urination Defecation These can all happen |
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Tonic =
Clonic = |
Tonic = rigid extension
Clonic = rhythmic contractions |
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List two things that can look like seizures.
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Syncopy (fainting spells)
Cataplexy (animal falling over asleep when excited) |
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Syncopy =
Cataplexy = |
Syncopy = fainting spells
Cataplexy = like narcolepsy but it occurs when the animal is excited. |
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What is idiopathic epilepsy?
What dogs tend to get it? Is it progressive? |
Epilespsy without an identifiable brain lesion or other neurologic cause, thought to be familial.
Pure-breed dogs 1-5 years old Yes. |
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T/F Cats get idiopathic seizures
T/F Cats rarely get seizures |
False, they do not seem to get it
False, they commonly get seizures |
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What is a diagnostic step you do for all animals with seizures, and why?
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Get a minimum database, since so many things can cause seizures, and to get baseline levels before you start giving drugs like Phenobarb
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* What are guidelines for when to refer seizure cases?
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1. Dogs under 6 months or over 5 years since outside the range of idiopathic
2. All cats 3. Focal seizures 4. When they need MRI, CT, CSF taps 5. Owner's wish |
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How are cryptogenic and idiopathic seizures similar and different?
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Both have recurrent seizures, you can't find the cause, but it does not appear to be inherited with cryptogenic.
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** What are the three main drugs used to treat idiopathic epilepsy (anticonvulsants)
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1. Phenobarbital
2. Bromide (K or NaBr) 3. Diazepam |
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** How does Phenobarbital work?
What is it used to treat? Dogs on this drug can have blood levels that make them look ____ and _____. |
It is a GABA agonist, which leads to less excitation.
Seizures Hypothyroid (Lower TT4, FT4, inc. TSH) Liver failure (Increased ALP, ALT) |
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This drug is a GABA agonist, which causes less excitation, given twice a day, metabolized in the liver to a less active compound.
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Phenobarbital
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Phenobarbital is eliminated through the _____.
What are some side effects of phenobarbital? |
Urine
Sedation, polyphagia, PU/PD, pelvic limb ataxia, and weakness. |
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* What is Bromide used to treat?
How does it work? |
Seizures
It ionizes and is thought to work at GABA-mediated Cl- channels (similar molecular weight to Br) and the Br competitively binds and prevents the binding of Cl- |
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What are the advantages of treating seizures with Bromide?
What are the disadvantages/precautions of treating seizures with Bromide? |
Easy to sprinkle on food once a day, long half life (days) in both D and C.
It needs to be compounded, you need to keep the salt intake in the diet constant or else the Cl- will take it's place back on the GABA receptors, can irritate the stomach, cause vomiting, pancreatitis. |
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Bromide is eliminated through the ______.
Which has more Br-, NaBr or KBr? *What is the odd side effect Bromide can cause in cats? |
Urine
NaBr has more Br- Inflammatory lung disease in cats. |
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*How does Diazepam work?
What is it good for in terms of seizure control? Why can't it be used for long-term seizure control? |
It is a GABA agonist like Phenobarbital and it brings Cl- into cells.
It is a great drug in emergencies but is not long-acting. Animals will develop a tolerance to it in a couple of weeks and it does not last long. |
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What side effect of Diazepam is sometimes used on purpose?
* What is a very negative side effect of Diazepam in cats? |
It increases appetite.
Acute idiosyncratic hepatic necrosis |
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** What is your drug of choice for treating seizures in cats?
What is your drug of choice for treating seizures when the owner isn't prepared to give Phenobarb twice a day? |
Phenobarbital
Bromide |
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Why should female animals be spayed before putting on seizure medication?
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Hormones can alter the effectiveness of the drugs, and this way you won't pass on genetic epilepsy.
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** What must you always monitor when an animal is on Phenobarbital?
(What kind of blood tube do you collect the samples in?) |
Serum bile acids
Red top tube |
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T/F You try to just have an animal on one anticonvulsant drug, and you never go cold turkey off of one of these drugs.
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True
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* The brainstem =
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Brainstem = Mesencephalon + Metancephalon (Pons) + Myelencephalon (Medulla) + Thalamus and Hypothalamus
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Vertical nystagus points to more central/peripheral disease
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Central
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* What are your two main indicators for central disease (at least for the brainstem, vestibular system)?
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1. Paresis
2. Postural deficits |
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T/F Most cranial nerves come out in the Myelencephalon (medulla)
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True, C6-12
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* Define positional strabismus
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It is the eye drop or "doll's eye" test, where the head is tilted to see if an eye fails to track upwards.
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* The 3 most common causes of brainstem disease are:
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1. Meningoencephalitis
2. Neoplasia 3. Vascular (Stroke) |
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* The brainstem =
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Brainstem = Mesencephalon + Metancephalon (Pons) + Myelencephalon (Medulla) + Thalamus and Hypothalamus
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Vertical nystagus points to more central/peripheral disease
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Central
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* What are your two main indicators for central disease (at least for the brainstem, vestibular system)?
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1. Paresis
2. Postural deficits |
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T/F Most cranial nerves come out in the Myelencephalon (medulla)
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True, C6-12
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* Define positional strabismus
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It is the eye drop or "doll's eye" test, where the head is tilted to see if an eye fails to track upwards.
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* What is a physiologic nystagmus?
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It is the normal nystagmus, or tracking, as eyes follow objects or adjust naturally to changes in direction.
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Fill in the table:
Central Peripheral Paresis Proprioception Conciousness CN deficits? |
Central Peripheral
Paresis Yes No Proprioception Yes No Conciousness Altered CN deficits? Yes VII only |
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*Horner's syndrome is seen with peripheral or central vestibular disease?
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Peripheral
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For most of the brainstem, signs will be ipsilateral/contralateral
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Ipsilateral, since crossover happens at the midbrain before it reaches the brainstem
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Why might you see Horner's syndrome with facial nerve paralysis?
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Because the nerve runs near the ear.
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Otitis media/interna, inflammatory polyps in cats, hypothyroidism, neoplasia, signs after an ear flush, and trauma/toxins are characteristic causes of ______ vestibular disease.
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Peripheral
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Meningoencephalitis, neoplasia, stroke, high dose Metronidazole, and degenerative conditions are characteristic causes of ______ vestibular disease.
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Central
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Why does otitis media (a cause of peripheral vestibular disease) require long-term antibiotic therapy?
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Because the drugs need to get deep down and penetrate bone.
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Meningiomas tend to grow along the ________ (floor and edges/inside) of the brain.
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Floor and edges.
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* High-dose ____ can cause _____ vestibular effects.
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Metronidazole
Central |
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T/F Most ear cleaning flushes contain compounds that are actually ototoxic.
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True; be careful with them or avoid them.
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"Stevie Wonder head excursions" (big swinging head motions to both sides), think...
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Bilateral vestibular disease; swinging head both ways because both sides are messed up and want to tilt. Connect this with Feline idopathic vestibular disease.
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** What acute, non-progressive vestibular disease has an unknown cause and tends to happen in older dogs?
What is the point about treating these dogs? |
Canine geriatric vestibular disease (describes itself)
Avoid the temptation to euthanize them; give them 2-4 weeks and many will spontaneously resolve. |
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** What vestibular disease of cats and old dogs has an unknown cause (possible respiratory infection or Cuterebra migration) is characterized by wide head excursions?
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Feline idiopathic vestibular disease.
There is no real treatment. |
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* Young cats get these red bumps in their auditory tubes and vestibular signs. You think...
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Feline middle ear polyps. The prognosis is great if you can remove them surgically.
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T/F The cerebellum is responsible for initiating movements
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False, it coordinates movements, it does not start them
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What is responsible for unconscious proprioception
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The cerebellum; how you know where you are without thinking about it
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You are presented with an ataxic dog that makes huge exaggerated movements when trying to walk, sways while standing, but is strong and happy. What part of the brain is affected?
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Cerebellum
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T/F Pure cerebellar disease will not cause paresis or proprioceptive problems.
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True. Dogs with cerebellar disease have strong movements and sensation as long as the brainstem is not involved.
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T/F If a cat has cerebellar hypoplasia, it has always had the disease.
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True; remember hypoplasia means it did not develop fully, so never was normal.
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* What is the common causative agent of feline cerebellar hypoplasia?
What is the good news and bad news about this disease? |
Feline Panleukopenia Virus; infection of the pregnant mother
The cat is happy, they think it is normal, it will not get better but it will not get worse. |
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** What is the #1 cause of multifocal neurologic disease? #2 and #3 cause?
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1. Inflammation
2. Degenerative 3. Metastatic neoplasia |
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T/F While there are many inflammatory causes of multiforcal neurologic disease, bacterial infections are rare in this case for small animals.
Though rare, what bacteria is the most common for this in dogs? |
True. Fever is also uncommon. Dogs often get a "sterile" inflammation.
Staph intermedius |
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Name 3 viral diseases that can cause multifocal neurologc disease
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CDV, rabies, FIP, FIV, Pseudorabies
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** What is the #1 cause of meningoencephalomyelitis in cats?
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FIP, usually the dry form
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What are 3 antibiotics that can reach the CNS?
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Doxycycline
TMS Clindamycin |
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Inflammation of the meninges =
Inflammation of the brain = Inflammation of the spinal cord = |
Inflammation of the meninges = Meningitis
Inflammation of the brain = Encephalitis Inflammation of the spinal cord = Myelitis |
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** What are the reference ranges for CSF fluid?
RBC WBC Protein |
RBC 0-few per microliter
WBC 0-5 per microliter Protein 0-25 mg/dl |
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Name 2 protozoal causes of Meningoencephalitis
Name 2 tickborne causes of Meningoencephalitis |
Toxoplasmia gondii and Neospora caninum
Ehrlichia canis, Rickettsia rickettsia (RMSF) |
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T/F The brain when touched cannot feel pain
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True; no sensory fibers there
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