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Neuro > Intracranial Diseases Part 2 > Flashcards

Intracranial Diseases Part 2 Flashcards

1
Q

Cerebellomedullary Junction Tumors

A
  • Meningioma
  • Choroid Plexus Tumor
  • Nerve Sheath Tumor (NST)
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2
Q

treatment of NST

A 
- Surgical resection 􀃆􀃆 technically difficult,
difficult to get clean margins, cosmetic
consequences
- Fractionated radiation therapy
- Radiosurgery (< 2cm)
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3
Q

Pituitary Macroadenoma location in the brain

A

􀂄􀂄 Stella or suprasellar location

􀂄􀂄 >1 cm, expands into diencephalon

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4
Q

Treatment of pituitary macroadenoma

A 
􀂄􀂄 Treatment
􀃆􀃆 fractionated radiation therapy
18 treatments at 2.5 Gy
􀃆􀃆 radiosurgery (< 2cm)
􀃆􀃆 median survival ~ 1-2 years
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5
Q

Tocagen Gene Therapy Principle

A

􀂄􀂄 Murine Leukemia Virus (MLV) to deliver
the cytosine deaminase gene
􀂄􀂄 MLV should technically only replicate in
dividing cells so should not affect
surrounding brain
􀂄􀂄 Once the gene is in brain tumor cells,
cytosine deaminase can then convert 5-FC
(a oral antifungal drug) to 5-FU which can
kill cancer cells

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6
Q

bacterial diseases of Meningitis / Encephalitis / Neuritis

A

2º to endocarditis, pyometra,

foreign body, nasal passages, middle ear

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7
Q

fungal diseases of Meningitis / Encephalitis / Neuritis

A

􀂄􀂄 Fungal – crypto (cats), blasto, coccidio

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8
Q

viral diseases of Meningitis / Encephalitis / Neuritis

A

distemper, herpes, parvo, parainfluenza,

rabies, FIP, FIV

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9
Q

protozoa diseases of Meningitis / Encephalitis / Neuritis

A

toxoplasma, neospora

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10
Q

rickettsials diseases of Meningitis / Encephalitis / Neuritis

A

– ehrlichia, RMSF (vestibular)

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11
Q

parasitic diseases of Meningitis / Encephalitis / Neuritis

A

cuterebra, toxocara, heartworm

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12
Q

Distemper in older vs younger dogs

A 
􀂄􀂄 Polioencephalomyelopahy
– younger dogs, seizures,
rarely survive
􀂄􀂄 Leukoencephalomyelopathy
– older dogs, less severe,
brainstem/cerebellar/vestib
ular signs
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13
Q

Myoclonus

A

Myoclonus – rhythmic,
repetitive movement of a
group of muscles, present
even under anesthesia

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14
Q

What is Granulomatous

Meningoencephalits (GME)

A

􀂄􀂄 Inflammatory disease
- granulomatous
infiltration of lymphocytes, plasma
cells, macrophages

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15
Q

Groups more affected with GME

A

􀂄􀂄 Young to middle age

􀂄􀂄 small breed dogs – poodles, terriers

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16
Q

Treatment of GME

A

􀃆􀃆 corticosteroids, azathioprine,
cyclosporin, cytosine arabinoside, procarbazine
􀂄􀂄 Prognosis generally poor – survival weeks to years;
worst prognosis with diffuse form

17
Q

Two types of necrotizing encephalitis

A

necrotizing leukoencephalitis and necrotizing meningoencephalitis

18
Q

What breed is predisposed to NLE?

A

Yorkies, juvenile to young adults

19
Q

Signs and brain regions associated with NLE

A

Forebrain, brainstem; white matter necrosis

20
Q

What breed is predisposed to NME

A

Pugs, maltese, juvenile to young adults

21
Q

Signs and brain regions associated with NME

A

Grey and white matter necrosis; forebrain signs (seizures)

22
Q

CSF tap on a dog with generalized tremor disorder

A

mild lymphocytic

pleocytosis (encephalitis)

23
Q

Idiopathic Trigeminal Neuritis - clinical signs

A 
􀀹 Dropped jaw
􀀹 Masseter / temporalis
atrophy
􀂄􀂄 Bilateral mandibular
branch problem
􀂄􀂄 +/- sensory branch
problem
􀂄􀂄 +/- Horner’s syndrome
􀂄􀂄 Nutritional support and
PT
􀂄􀂄 Recovery of jaw function
in 4-6 weeks
􀂄􀂄 Persistent muscle atrophy
24
Q

Idiopathic Facial Paralysis

A 
􀂄􀂄 Unilateral or bilateral CN 7
palsy
􀂄􀂄 Usually no other neuro deficits
􀂄􀂄 +/- CN 8 vestibular problem
􀂄􀂄􀂄􀂄 Exposure keratitis
􀂄􀂄 CS max at 7 days
􀂄􀂄 Recovery 3-6 weeks
􀂄􀂄 Some do not fully recover
􀂄􀂄 Diagnosis of exclusion
􀂄􀂄 Always R/O inner ear disease,
hypothyroidism
􀂄􀂄 No treatment, lubricate eyes
25
Q

Idiopathic old dog vestibular disease

A

􀂄􀂄 Older dogs
􀂄􀂄 Acute onset of peripheral vestibular signs
􀂄􀂄 Mild head tilt to severe imbalance / rolling
􀂄􀂄 Usually unilateral signs
􀂄􀂄 No treatments
􀂄􀂄 Improve rapidly, although can take 2-3 wks for complete
recovery
􀂄􀂄 Can have residual head tilt
􀂄􀂄 Can be relapsing
􀂄􀂄 Diagnosis of ruling out other causes of peripheral
vestibular disease
􀂄􀂄 Idiopathic vestibular disease can happen in cats but at
any age and is rare

26
Q

Bilateral miotic pupils indicates what?

A

diffuse cerebrocortical

disease

27
Q

Unilateral mydriasis indicates what?

A

unilateral caudal transtentorial herniation

28
Q

Bilateral dilation of pupils

A

bilateral caudal
transtentorial herniation
or foramen magnum
herniation

29
Q

Cushings reflex

A

hypertension and reflex

bradycardia

30
Q

Indications for
craniotomy or
craniectomy:

A
  • Open skull fractures
  • Depressed skull fractures
  • Foreign body removal
  • Hematoma removal
  • Deteriorating neurologic
    status despite aggressive
    medical therapy
    ** Intracranial imaging is required prior to surgery **
31
Q

Metronidazole Toxicity mechanism and toxic dose

A

Inhibits GABA release

Dose > 50 mg/kg/day

32
Q

Metronidazole toxicity in cats and dogs - clinical signs?

A

Dogs - vestibular signs – typically central

Cats – cerebral signs – blindness, seizures

33
Q

Treatment and recovery for dogs and cats with metronidazole toxicity

A 
Treatment:
 discontinue metronidazole
 IV fluids
 Diazepam can speed up recovery
 Recovery usually takes 1-2 weeks
34
Q

differentials for vascular encephalopathies

A

Cerebral vascular accident (CVA) – strokes
Hemorrhage – coagulopathy
AV malformation
Feline ischemic encephalopathy

35
Q

Causes of feline ischemic encephalopathy

A

ischemic necrosis of one side of cerebrum
middle cerebral artery
cuterebra migration?
** can improve

36
Q

Cerebral Vascular Accidents (CVAs)

A

An acute disorder of the brain resulting from cerebral

ischemia or spontaneous hemorrhage

37
Q

Thrombus formation (ischemic strokes) - causes

A
  • hypercoagulable states
  • vasculitis
  • atherosclerosis
  • parasite migration
38
Q

Hemorrhage (hemorrhagic strokes)

A

􀃆􀃆 hypertension

􀃆􀃆 coagulopathy

39
Q

Diagnosis of a cerebral vascular accident

A 
􀂄􀂄 Clinical signs - acute-onset, asymmetric,
variable (location dependent), nonprogressive
after 24-48 hrs
􀂄􀂄 Metabolic workup - CBC/Chem/UA/Bile
acids/endocrine testing
􀂄􀂄 Coagulation panel
􀂄􀂄 Serial blood pressure monitoring
􀂄􀂄 Advanced imaging – MRI, MRA
􀂄􀂄 CSF
HIGH BLOOD PRESSURE***

Neuro (7 decks)

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