The Neuro Consult - Understanding Neurological Disease in Animals

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Clinical case focusing on the topic of neurological disease. The case aims to highlight commonly presenting neurological concerns and how the similar presenting complaints can represent very different disease processes. The cases are presented in a fashion so that they can be worked through in the same approach a working vet would. The level is intended for pre-veterinary students and veterinary students.

Find out more at http://www.IWantToBecomeAVet.com

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The Neuro Consult - Understanding Neurological Disease in Animals

  1. 1. The Neuro consultThe Neuro consult Sit back, relax and lets learn about neurology! Yeah Baby!
  2. 2. IWantToBecomeAVet.com HistoryHistory Sausage was walking a little funny over the weekend and went off her back legs completely yesterday!! Her right leg is worse than her left She yelps when we try to pick her up She isn’t herself Anorexic, lethargic, increased vocalisations Sausage 4yo FN Dachshund
  3. 3. IWantToBecomeAVet.com Refine the problemRefine the problem Acute Progressive Aaymmetrical Painful WHAT CLUES FROM THE HISTORY HELPED US REFINE THE LESION?
  4. 4. IWantToBecomeAVet.com Physical ExamPhysical Exam Depressed mentation Dehydration- skin tent, sunken eyes, dry MM Tachycardia Tachypnea
  5. 5. IWantToBecomeAVet.com Diagnostic ApproachDiagnostic Approach Hx+CS
  6. 6. D Degenerative A Anomalous M Metabolic N Neoplastic Nutritional I Infectious Inflammatory Iatrogenic Idiopoathic T Toxic Traumatic V Vasular
  7. 7. IWantToBecomeAVet.com Diagnostic ApproachDiagnostic Approach Hx+CS PE + Musculoskeletal Exam Neurological Examination Neurolocalization Forebrain Cerebellum Brainstem Spinal Cord Neuromuscular Diagnostic Imaging Myelogram CT MRI Rx Dx Refer? Clin PathBiochem CBC CSF tap DDX
  8. 8. IWantToBecomeAVet.com Neurological ExamNeurological Exam Mentation Posture Spinal Reflexes Postural Reactions Gait Cranial Nerves Nociception Palpation Level of consciousness; (cerebral, brainstem or systemic dz) alert, obtudned, stupor, coma and quality of consciousness; appropriate if inappropriate (compulsion, delirium) Head- tilt (vestibular dz) or turn (forebrain dz) Limbs- wide based stance (proprioceptive loss), narrow based stance (weakness), decreased weight bearing (pain) Body- decerebrate (FL, HL and neck extended), decerebellate (FL extension, nexk extended, HL flexed), Schiff- Scherrington (rigid FL) Normal or abnormal? What limbs affected? Paresis- decreased voluntary movement (UMN or LMN?- asses postural, spinal reflexes and muscle tone) Ataxia- incoordiantion, sensory (wide based stance, increased stride length, knuckling) or cerebellar ( disorder of rate and range, hypermetria intention or postural tremor) or vestibular (unilateral or bilateral, cicrling, head tilt, crouched) Lameness? A combination? Integration of proprioceptive and motor systems Paw positioning, hopping, wheelbarrowing, hemiwalking, placing tactile, placing visual, extensor postural thrust Testing: SENSORY, CENTRAL and MOTOR (* UMN indirectly) Tendon reflexes: biceps musculocutanous C6-8, triceps radial C7-T2, patellar femoral L4-s2, Gastrocnemius sciatic L6-S2 Flexor withdrawal: Thoracic multiple nn C6-T2, pelvic limb sciatic L6-S2 Additional: perineal pudendal S1-S3, Cutaneous trunci Vision: II optic -> forebrain Menace response: II-> forebrain-> cerebellum->brainstem->VII Facial PLR: II->brainstem->III Occulomotor (direct and indirect) Fundic exam: Optic II Horner’s Syndrome: miosis, ptosis, enopthalamus (sympathetic denervation) Strabismus: eye position VIII Vestibulocochlear -> central vestibular/braistem-> III,IV, VI Nystagmus: eye movement VIII-> CV/brainstem-> III,IV Trochelar, VI Facial sensation-:V Palpebral: V-> brainstem -> VII Corneal: V -> brainstem -> VI Abducent Muscles of mastication: V Muscles of facial expression and lacrimal glands: VII Gag reflex: IX&X -> Brainstem -> IX &X Motor to tongue: XII Hypoglossal Light palpation: swelling or atrophy of HEAD, SPINE and LIMBS Deep palpation: pain perception in HEAD, SPINE and LIMBS Conscious perception of pain Superficial: skin Deep: bone
  9. 9. WHY DID WE DO ALLWHY DID WE DO ALL OF THAT????????OF THAT???????? Neurolocalization C1-C5 C6-T2 L4-Cd Cerebellum FOREBRAI N Brainstem T3-L3 Neuromuscular
  10. 10. Back to Sausage!Back to Sausage!
  11. 11. IWantToBecomeAVet.com DiagnosticsDiagnostics Neurological Exam Imaging: Rx Referral Myelogram CT MRI
  12. 12. IWantToBecomeAVet.com Sausage’s Neuro ExamSausage’s Neuro Exam Mentation Posture Spinal Reflexes Postural Reactions Gait Cranial Nerves Nociception Palpation Level of consciousness: alert quality of consciousness: appropriate Normal or abnormal? Abnormal What limbs affected? Paresis- HL plegia right> left Integration of proprioceptive and motor systems Paw positioning, hopping, placing tactile, placing visual- decreased to absent in HLs, right> left Testing: SENSORY, CENTRAL and MOTOR (* UMN indirectly) Tendon reflexes: patellar femoral L4-s2 exaggerated response, increased muscle tone to HLs Flexor withdrawal: pelvic limb sciatic L6-S2 absent Additional: Light palpation: pain on palpation of thorcolumbar spine Conscious perception of pain Superficial: skin present Deep: bone present
  13. 13. Neurolocalization C1-C5 C6-T2 L4-Cd Cerebellum FOREBRAI N Brainstem T3-L3 Neuromuscular T3-L3 Myelopathy
  14. 14. IWantToBecomeAVet.com DDX for SC DzDDX for SC Dz D A M N I T V IVDD Congenital vertebral malformations Extradural tumours Granulomatous meningoencephalomyelitis Fracture/luxation FCE Cervical Spondylomyelopathy Syringomyelia Intramedullary tumors Corticosteroid repsonsive memingitis IVDD Haemorrhage Extradural Synovial Cysts Spinal Dysraphism Mixed compartment tumours Discospindylitis Alantoaxial subluxation Degenerative Myelopathy Dermoid sinus Hypervitaminosis A Spinal epidural empeyema Leurkenecephalomyelopathy Spinal arachnoid diverticula Methionine deficiency Distemper Hereditary ataxias Meningocele FIP
  15. 15. IWantToBecomeAVet.com RadiographRadiograph HINT: there are 5!
  16. 16. IWantToBecomeAVet.com Rx InterpretationRx Interpretation
  17. 17. IWantToBecomeAVet.com
  18. 18. IWantToBecomeAVet.com MyelogramMyelogram What abnormalities do you see?? Compression of SC at T12-T13
  19. 19. IWantToBecomeAVet.com CT and MRICT and MRI CT MRI MRI
  20. 20. Hansen Type 1Hansen Type 1 Intervertebral Disc DiseaseIntervertebral Disc Disease
  21. 21. IWantToBecomeAVet.com HUH??
  22. 22. IWantToBecomeAVet.com TreatmentTreatment
  23. 23. IWantToBecomeAVet.com TreatmentTreatment
  24. 24. IWantToBecomeAVet.com PrognosisPrognosis Dependent on Dx and Function in neurological cases THE most important prognostic indicator is perception of deep pain Good for Sausage Following surgery very careful and slow return to normal exercise
  25. 25. Ok. Thank you. THE ENDTHE END

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