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Internal Medicine
Neurology
137
Veterinary Medicine
Graduate
11/29/2011

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Cards

Term
Which anticonvulsant drug has a longer half-life: phenobarbitone or potassium bromide?
Definition
Potassium bromide
- this both means it will stay in effect longer (can be administered once a day) and that it takes longer to establish steady state blood levels
Term
What can be used for emergency treatment of status epilepticus?
Definition
DIAZEPAM
propofol
pentobaritone
Ketamine/iso (anesthetize them)
body cooling
*may need to give glucose
Term
Which anticonvulsant is more likely to cause toxicity phenobarbitone or potassium bromide?
Definition
phenobarbitone
can cause liver toxicity
Term
What are the two primary (and basic) functions of the nervous system?
Definition
To DETECT changes
and RESPOND to them
** this means that there must be a sensor - intact pathway - and responding organ
Term
Which of the following is not considered a sensory organ?
A) Skin receptors
B) Brain stem
C) muscle spindles
D) olfactory mucosa
E) Organ of corti
F) all of the above are sensory organs
Definition
Answer: Brain stem
the rest are all considered sensory organs
Term
What is the basic functional unit of the nervous system?
Definition
The reflex arc!!
Consists of:
recrptor->sensory fiber (afferent) -> dorsal root ganglion -> synapse -> motor fiber -> effector (ie. skeletal muscle)
Term
Where does the synapse between afferent and efferent (motor) fibers occur specifically?
Definition
the gray matter of the spinal cord
*afferents = dorsal root
*efferents - ventral root
Term
Where do afferent fibers enter the gray matter of the spinal cord?
Where do efferent fibers enter?
Definition
Dorsal root = afferent
Ventral root = efferent
Term
What coordinates reflex arcs?
Definition
The brain.
derp.
This is super important though because there is a reflex arc for each segment and they need to be coordinated to prevent chaos
Term
Where can ascending and descending motor tracts be found?
Definition
In the WHITE MATTER of the spinal cord
Term
Where are the two primary destinations of ascending tracts?
Definition
Cerebrum (conscious sensation)
Cerebellum (cor-ordination)
Term
Conscious sensation is controlled by: cerebellum or cerebrum ?
Definition
Cerebrum
Term
Coordination of motor activity is controlled by: Cerebellum or Cerebrum?
Definition
Cerebellum
Term
What are the ascending tracts that head to the cerebrum through the thalamus?
Definition
Dorsal columns (gracile and cuneate fasciculus
Spinothalamic tract
Term
What are the ascending tracts that head to the cerebellum?
Definition
Dorsal Spinocerebellar tract
Ventral spinocerebellar tract
Term
Dorsal columns:
What kind of tracts are they?
Where are they located?
Where do they go?
What type of information do they carry?
Definition
DORSAL COLUMNS
- ascending tracts
- located down the middle of the white matter of spinal cord
-goes to the cerebrum through thalamus
- carries low threshold skin sensation, "conscious" proprioception
Term
Spinothalamic tract:
What kind of tract is it?
Where is it located?
Where does it go?
What type of information does it carry?
Definition
SPINOTHALAMIC TRACT
- ascending tract
- located in the lateral aspects of the white matter in spinal cord
- goes to the cerebrum through thalamus
- carries high threshold sensation, pain
*multisynaptic pathway that crosses multiple times.
* only finely myelinated or unemyelinated!!
Term
Dorsal Spinocerebellar tract:
What kind of tract is it?
Where is it located?
Where does it go?
What type of information does it carry?
Definition
DORSAL SPINOCEREBELLAR TRACT
- ascending tract
- dorsolateral aspects of white matter in spinal cord
Dorsal Lateral Funiculus
- goes to cerebellum
- "direct" spinocerebellar tract
Term
Ventral Spinocerebellar tract:
What kind of tract is it?
Where is it located?
Where does it go?
What type of information does it carry?
Definition
VENTRAL SPINOCEREBELLAR TRACT
- ascending tract
- located on most lateral edge in the white matter of the spinal cord
- goes to the cerebellum
- "indirect" spinocerebellar tract
Term
What does the cerebellum do?
Definition
Recieves both actual and planned movements - to compare and regulate movement
Term
What does the cerebellum do?
Definition
Recieves both actual and planned movements - to compare and regulate movement
Term
Pyramidal come from the cerebrum and their loss is more important in humans or animals?
Definition
HUMANS
if the pyramidal tract is lost with a human motor function ceases, but this is less important with domestic species
Term
What are the two major types of descending motor tracts in humans?
Definition
Pyramidal and extra-pyramidal
Term
What are the descending tracts in animals?
Definition
Corticospinal tract (pyramidal)
rubrospinal
vestibulospinal
tectospinal
reticulospinal
above are all extrapyramidal pathways
Term
Which descending tract is more important in humans that animals?
Definition
Corticospinal tract
Term
Ascending tracts collectively constitute the upper motor neuron centers.
True or False?
Definition
FALSE
DESCENDING tracts compose the upper motor neuron center
Term
Where do lower motor neurons originate?
Definition
in the gray matter of the brainstem or spinal cord
they they innervate the effector organ
Term
What would happen if a lower motor neuron stopped working?
Definition
- loss of muscle tone
- loss of decrease of reflex
(hypotonus and hyporeflexia)
Term
Muscle flaccidity is characterisitic of upper or lower motor neuron disease?
Definition
LOWER
Term
Rapid muscle atrophy is characteristic of upper or lower motor neuron disease?
Definition
LOWER
Term
Hyporeflexia is characteristic of upper or lower motor neuron disease?
Definition
LOWER
Term
In domestic species, UMN influence LMN directly or indirectly?
Definition
INdirectly
they change the sensitivity of a reflex
Term
What controls the sensitivity of a reflex: UMN or LMN?
Definition
Upper motor neuron
can increase or decrease sensitivity
Term
What are the effects of chronic upper motor neuron damage?
Definition
- increased muscle tone
- increased reflex sensitivity
(hypertonia and hyperreflexia)
Term
Muscle spasticity is characteristic of UMN or LMN disease?
Definition
UMN
Term
Hyperreflexia is characteristic of UMN or LMN disease?
Definition
UMN
Prevents inhibition
Term
Muscle wasting/atrophy will be seen with UMN or LMN disease?
Definition
LMN
Term
If there is damage to a peripheral nerve, UMN or LMN are damaged?
Definition
LMN
Term
What do reflex tests asses?
Definition
they assess function of the reflex arc ONLY
*evaluate if intact or exaggerated*
Term
What is the blink reflex and what nerves does it test?
Definition
touch canthus and side of face - animal should blink
- tests cranial nerves V and VII
Term
Pupillary light reflexes test what nerves?
Definition
optic nerve, Cranial nerve III (controls contriction), lateral geniculate body
Term
Pupillary light reflex i a subcortical reflex and requires no conscious input.
True or False?
Definition
TRUE
Term
What is mydraisis? What controls it?
Definition
myDraisis = Dilation of pupil
controlled by sympathetic nervous system
Term
What is miosis and what controls it?
Definition
Miosis - constriction of pupil
controlled by the parasympathetic NS by Cranial Nerve III
Term
Jaw tone assesses what nerve(s)?
Definition
Motor V
Term
Gag reflex assesses which nerve(s)?
Definition
Cranial nerve IX
** important in semicomatose animals*
Term
What nerve(s) do vestibular eye movements assess?
Definition
Eye muscles: III, IV, VI
Vestibular function: VIII
Term
Menace response assesses which nerve(s)?
Definition
Cranial nerve II (afferent)
Cranial nerve III (efferent - blinking)
Term
What are the two most consistent reflexes that can be used to evaluate spinal reflexes of the pelvic limb?
Definition
patellar and withdrawal
Term
What nerves does the patellar reflex assess? What segment of the spinal cord does it assess?
Definition
Femoral nerve
spinal cord segments L4-L6
Term
What nerve(s) and spinal segments are assessed by the withdrawal reflex of the pelvic limb?
Definition
SCIATIC nerve
Spinal cord segments L6- S1
Term
Loss of pelvic limb withdrawal reflex is most consistent with damage to what nerve?
Definition
SCIATIC
Term
Why is spinal palpation important when evaluating neurologic disease?
Definition
Spinal injuries are often painful, so the site of a spinal lesion may be localized by palpating a region of intense pain.
Term
Which segments of the spinal cord are associated with the thoracic limb?
Definition
C6 - T2
Term
What segments of the spinal cord are associated with the pelvic limb?
Definition
L4 - S3
Term
If there is damage to the spinal cord in the C1-C5 region, what would you expect postural reaction and reflexes to look like in both thoracic and pelvic limbs?
Definition
- abnormal postural reaction in all limbs
- intact reflexes in all limbs
*may drag feet and need support to stand
Term
If there is damage to the spinal cord in the C6-T2 region, what would you expect postural reaction and reflexes to look like in both thoracic and pelvic limbs?
Definition
- abnormal posture reactions in all limbs
- depressed forelimb reflexes
- intact hindlimb reflexes
Term
If there is damage to the spinal cord in the T3-L3 region, what would you expect postural reaction and reflexes to look like in both thoracic and pelvic limbs?
Definition
- abnormal postural reactions in HINDlimbs only
- intact reflexes of all limbs
Term
If there is damage to the spinal cord in the L4-S3 region, what would you expect postural reaction and reflexes to look like in both thoracic and pelvic limbs?
Definition
- abnormal reflexes of hindlimbs only
- abnormal postural reactions of hindlimbs only
- forelimbs have normal reflexes and postural reactions
Term
If there is damage to a local peripheral nerve, what would you expect reflexes and postural reactions to show?
Definition
Depressed reflexes
abnormal postural reactions
Term
If there is an injury to the brainstem, what would you expect of the limbs postural reactions and reflexes?
Definition
Abnormal POSTURAL reactions of limbs
Normal limb reflexes
**cranial nerve deficits present**
Term
What would you expect of limb reflexes, postural reactions and cranial nerve function with an injury to the cerebellum?
Definition
- abnormal postural reactions of limbs
- normal limb reflexes
- normal cranial nerve reflexes
* may have tremors, head tilt *
Term
What would you expect to see with an injury to the 'forebrain'?
postural reactions, limb reflexes, cranial nerves, etc...
Definition
- ABnormal postural reactions of limbs
- normal limbs reflexes
- may have cranial nerve deficits
***circling and altered mentation present**
Term
What ancillary diagnostic tests may be preformed when suspecting neurological disease?
Definition
-Imaging: myelography and MRI
-electrdiagnostics
-CSF sampling
Term
CSF sampling can be used to help diagnose the type of neurological disease present.
True or False?
Definition
TRUE
will not determine location though
Term
What is DAMNITV?
Definition
Diagnostics...
D= degenerative
A= anomalous
M= metabolic
N= nutritional, neoplasia
I= Inflammatory, infectious
T= Traumatic, toxic
V= Vascular
Term
Non compressive spinal cord injuries may require surgery to alleviate neurologic symptoms.
True or False?
Definition
FALSE
there is no surgical option for non compressive spinal cord lesions
Term
What are some causes of compressive spinal cord injuries?
Definition
Intervertebral disc disease
fracture
luxation
tumors (neoplasia)
bone or ventricular malformation
Term
What are some causes of non-compressive spinal cord injuries?
Definition
CONTUSION
infectious/inflammatory
Vascular
malformations
Degeneration
Toxic
Term
Single, localized, painful lesions of the spinal cord are characteristics of compressive or non-compressive injuries?
Definition
COMPRESSIVE
non-compressive injuries tend to be poorly localized and more diffuse
Term
What are some causes of secondary non-compressive spinal cord injury?
Definition
Elevated Intracellular calcium
inflammation
Term
How does elevated intracellular calcium cause secondary non compressive spinal cord injury?
Definition
Enter neurons (via ion or gated channels)or axons (via reverse operation of Na/Ca exchanger).
-this activates apoptotic cascade
-activates enzymes, generation of free radicals
-free radical damage to cell and mitochondria = cell death
- activation of phospholipase A which starts inflammatory cascade
Term
How does inflammation cause secondary non compressive lesions of the spinal cord?
Definition
Increased inflammatory mediators
- vasospasm
- increased vascular permeability
Increase inflammatory cells
- cytokins affect neural function
- toxic products produced
Term
How can spinal cord contusion be treated?
Definition
NOT SURGICALLY
- maintain perfusion (normotension)
- methyprednisolone (controversial)
Term
When intracranial pressure is increased the brain can only move in one direction. What direction is that, and what portions of the brain may then be compressed?
Definition
moves CAUDALLY
- tentorium
- foramen magnum
Term
What is the clinical presentation of infratentorial compression?
Definition
- depression, stupor, coma
- bilateral dilatation of pupils
- ventrolateral strabismus of eyes
Term
What are the clinical signs associated with herniation through foramen magnum?
Definition
- tetraparesis, tetraplegia (rigid or flaccid)
- stupor, coma, death
- loss of vestibular reflexes
- loss of gag reflex (CN IX)
- abnormal breathing patterns
Term
What are some infectious causes of brain injury?
Definition
Canine distemper virus
FIP
protozoa (inflammatory)
reticulosis
Term
How would you diagnose a brain injury of infectious origin?
Definition
Blood sample, CSF analysis
Term
What is discospondylitis?
How would you diagnose and treat it?
Definition
infection of the disc/vertebral endplate
that is blood borne with local extension.
DX: xrays, CBC/Chem?UA
TX: Abx, possible surgery
Term
What is the typical appearance of discospondylitis?
Definition
"eaten out" (tehehe) areas of bone adjacent to the disc space
Term
What are some causes of CNS degeneration?
Definition
- degenerative myelopathy of german shepards
-breed-related spinal conditions
- storage disease
-cerebellar degeneration
Term
What is the treatment options for CNS degeneration?
Definition
NONE
try physiotherapy
Term
What vascular causes of non-compressive spinal cord injuries?
Definition
Fibrocartilaginous embolism
idiopathic hemorrhage
bleeding disorders
stroke
Term
What is dysraphism?
Definition
incomplete closure of the neural tube - ie. spina bifida
Term
What can cause toxic injury to the spinal cord?
Definition
Cannabus (the wacky tabacky)
ingredients of slug/snail bait (ferric sodium hydroxy EDTA)
toxic injury uncommon
Term
What are the long term effects of compression to the spinal cord?
Definition
prolonged pressure -> impaired perfusion -> demyelination, axon and neuron loss
Term
How can you diagnose a compressive spinal cord lesion?
Definition
Localize with neuro exam (often painful)
**Imaging**
-myelogram
- MRI
Term
What is the difference between type 1 and type II disc degeneration?
Definition
Type I: annulus RUPTURED and nucleus expelled.
-chondrodystrophic, middle aged dogs
-sudden onset
Type II: annulus intact
-non chondrodystrophic breeds, older
-chronic onset
Term
What is Wobbler syndrome?
Definition
disc disease of caudal cervical spine
**Type II disc at C5/6 or C6/7**
-more common in lrg breeds (doberman)
- causes ataxia and paresis or hindlimbs
Term
What is the most common disc injury associated with Wobbler syndrome?
Definition
Type II disc degeneration at C5/6 or C6/7
Term
What is degenerative lumbosacral stenosis?
Definition
Type II disc degeneration of large breed dogs (esp german shepards)
occurs in the lumbosacral area
Term
What is the treatment for a dog with short term pain only that is associated with a disc lesion?
Definition
cage rest
Term
What is the treatment for a dog with chronic pain in the neck associated with a disc lesion?
Definition
Surgery
Term
What type of decompressive spinal surgery should be preformed in the thoracolumbar region?
Definition
Laminectomy or hemilaminectomy
(remove part of lamina)
Term
What type of decompressive spinal surgery should be preformed in the cervical region?
Definition
Ventral slot
Term
When surgically treating for disc injuries, what is the prognosis if the animal has intact deep pain at the time of surgery?
Definition
Very good - almost all return to walk again with no pain
Term
What are the surgical treatment options available for Wobbler's syndrome?
Definition
-remove disc via ventral slot
- stretch affected space
Term
What are the three classifications of spinal tumors?
Definition
1) extradural (most common) - located outside CSF but compressive on cord
2) intradural/extramedullary - not in the spinal cord but in the CSF
3) Intramedullary - within the spinal cord
Term
What breeds are predisposed to brain tumors?
Definition
BOXERS
boston terriers
Term
What are the chronic effects of a brain tumor?
Definition
Compresses the brain
destruction of brain tissue
herniation(through foramen magnum)
Term
How do neurons and axons recover from injury?
Definition
They will not be regernated or replaced
they recover through 'plasticity'
Term
If there is a lesions along the reflex arc the clinical signs will be of LMN.
True or False?
Definition
TRUE
Term
What is the clinical presentation of an animal with myopathy?
Definition
nonspecific
-reduced muscle strength (hypotonia)
and atrophy or hypertrophy
- weakness
- generalized
- difficulty with exercise and obstacles
- stiff gait, decreased joint amplitude
- reflexes and sensation normal
- direct percussion of muscle may be abnormal
Term
What are the clinical signs of neuropathy?
Definition
- distal paresis/paralysis
- muscle atrophy
- fasciculations
- loss of reflexes
- abnormal sensation (placement)
- loss of pain/temp sensation
- direct percussion of muscle normal
- tendon reflex, flexion reflexes depressed
Term
What are some signs associated with neuromuscular disease ?
Definition
-Megaesophagus
-opthalmoplegia, ptosis
-dyspnea
- dysphagia
-cardiac arythmia
- brown urine (myoglobinuria)
Term
What are some blood tests that can be preformed to help diagnose a neuromuscular disease?
Definition
CK - if very increased its highly specific
biochem - r/o metabolic abnormalities (endocrinopathis, electrolyte imbalance like hyper/hypokalemia)
Specific tests like antibody titers, serology or PCR for agents
Term
Neck ventro-flexion is a common clinical presentation of myopathy in what species?
Definition
CATS
meeeeeow
Term
What are the two types of electrodiagnostic tests that can be performed? What is the difference between them?
Definition
EMG - measures electrical activity within a region of muscle. Very sensitive, NOT specific (will not differentiate between muscle and nerve dz)
NCV - measures nerve conduction velocity. (records action potential of the muscle)
Term
How is a muscle biopsy diagnostic of neuromuscular disease?
Definition
it will differentiate between myositis, muscular dystrophy.
It confirms the ETIOLOGY, specific disease association
Term
Which type of acquired myopathy is most common?
a) Endocrine
b) metabolic
c) traumatic
d) inflammatory
Definition
Answer: D) inflammatory
Term
What is masticatory myositis? How can you diagnose it? How is it treated?
Definition
- swelling in acute phase (often unnoticed) then atrophy when chronic
- DX by finding anti-type 2 antibodies
- TX immunosuppression (steroids, azothioprine)
Term
What are some metabolic myopathies associated with dogs and cats?
Definition
DOGS: cushings (steroid) myopathy - weakness and myotonia that is poorly reversible
CATS: Hypokalemix myopathy - reversible
Term
What are degenerative myopathies? What are the clinical signs?
Definition
deficiency in muscle membrane proteins (ie dystrophine)
- causes stiff gait, dysphagia, tongue hypertrophy, megaesophagus
- CK will be VERY high (10K-50K)
Term
What is acute idiopathic polyradiculoneuritis ?
Definition
Ascending flaccid paralysis with acute onset.
immune mediated attack of neural tissue, self resolving with spontaneous remission and Great prognosis.
- sensation preserved
- occurs in dogs>cats
Term
A plantagrade stance in cats is almost pathognomonic for what?
Definition
DIABEETUS
Diabetes Mellitus
- referred to as diabetic nephropathy
- can be reversed with treatment of diabetes
Term
What are some things that cause intereference with transmission across the neuromuscular juction?
Definition
- botulism
- myasthenia gravis
- tick paralysis
- organophosphate toxicity
Term
With myasthenia gravis, reflexes are often preserved but muscle atrophy is occurs.
True or False?
Definition
FALSE
reflexes are preserved (but easily exhausted) but there is usually no muscle atrophy (just weakness)
Term
What is the mechanism of myasthenia gravis?
Definition
Auto-antibodies bind to nicotinic cholinergic receptor (inhibits acetylcholine)
- or it can be a dysfunctional AChR
Term
If you are presented with a middle aged dog with megaesophagus, what should be at the top of your differential diagnosis list?
Definition
MYASTHENIA GRAVIS
Term
How is myasthenia gravis diagnosed?
Definition
blood test to find autoantibody (against NM junction)
- test with anti-cholinesterase
Term
What is status epilepticus?
Definition
State of continuous seizuring
Term
What are some metabolic causes of seizures?
Definition
Liver failure
Hypoglycemia
ischemia/hpoxia
electrolyte imbalance (especially calcium)
Renal failure
Term
What are some toxic causes of seizures?
Definition
Lead
organophosphates
chocolate
garbage (tremorogens)
Term
What are some differential diagnoses for seizures?
Definition
Syncope
obsessive compulsive behavior
sleep disorders (narcolepsy/cataplexy)
breed specific disorders
VEstibular disorders
tremors
muscle disorders
Myasthenia gravis
Term
How do you diagnose seizures?
Definition
Extracranial causes: blood samples
Intracranial causes: Brain scan CSF analysis
Term
How do you treat seizures?
Definition
Remove underlying cause
anticonvulsants (phenobarbitol and potassium bromide)
Term
What are some long term side effects of anti-convulsant use ?
Definition
toxicity (liver)
causes restlessness, increased appetite
Term
What are the common causes of LMN lameness?
Definition
Nerve root impingement
nerve tumor
Term
What is the difference between UMN and LMN type urinary incontinence?
Definition
UMN - loss of control, reflexes are intact
LMN - loss of reflex, easily expressed
Term
Which nerve controls the external urethral sphincter ?
Definition
Pudendal nerve
Term
Which nerve inhibits the detruser muscle of the bladder? It that a sympathetic or parasympathetic nerve?
Definition
Hypogastric
SYMPATHETIC
Term
Which nerve activates the detruser muscle of the bladder? Is this nerve sympathetic or parasympathetic?
Definition
Pelvic Nerve
Parasympathetic
Term
Which nerve controls the internal urethral sphincter?
Definition
Hypogastric nerve
PARASYMPATHETIC
Alpha adrenergic receptors!
Term
What is spay incontinence and how can it be treated?
Definition
Spay incontinence - estrogen decreased which reduces sensitivity of alpha-adrenergic receptors of the internal urethral sphincter. decrease in ability to hold urine.
Can be treated with Alpha agonists because of the A1 receptors on the IUS
Term
How can you treat urinary dyssynergia?
Definition
Alpha BLOCKERS
because the sphincter and detruser are contracting at the same time, alpha blockers will decrease the tone of the sphincter allowing urine to pass
Term
Depression is always a neurological sign.
True or False?
Definition
TRUE
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