Nervous System Disease
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What is part of the CNS (central nervous system)?
What is part of the peripheral nervous system?
- cranial nerves
- peripheral nerves
What are the different CNS diseases?
- idiopathic epilepsy
- intervertebral disc disease
- atlantoaxial subluxation
- cervical spondylomyelopathy
What is idiopathic epilepsy?
- convulsions, fits, spells
- repeated episodes of seizures
When do idiopathic epilepsy usually occur?
seizures usually begin between 1 and 3 years of age
What are the different stages of an idiopathic epilepsy?
- aura (pre-ictus)
- post ictus
What is the aura stage? How long does it last? What kind of behavior do we see during this stage?
- just before the seizure
- lasts minutes to hours
- abnormal behavior - pace, seek companionship, hide, bark, salivate
What is the ictus stage? What are the signs of this stage?
- actual seizure event
- many forms exist - full body, focal, petit mal, behavioral
What is the post-ictus stage? What are the signs of this stage?
- after the actual seizure
- disorientation, inappropriate bowel/bladder activity, increased thirst/appetite, weakness, blindness
How do we diagnose idiopathic epilepsy?
- serum profile
- CT scan
How do we treat idiopathic epilepsy?
- treat primary disease if present
- initiate treatment if more than 1 per month
What is the realistic goal when treating idiopathic epilepsy?
to reduce the frequency, severity, and duration of the seizures
How long does phenobarbital take to reach a steady state in the blood?
7 - 10 days
What should we monitor when a patient is on phenobarbital?
What are some side effects of phenobarbital?
What can we combine with phenobarbital to treat idiopathic epilepsy?
- potassium bromide
- valproic acid
How do we educate clients on idiopathic epilepsy?
- no cure
- reduce frequency, severity, and duration
- spaying or neutering may help to prevent hormonal influences
- medication will probably be required for life
- check serum drug levels frequently
- rectal diazepam
What is status epilepticus?
- continued seizures for prolonged periods of time
- more than 5 - 10 minutes
Is status epilepticus a medical emergency?
yes due to hyperthermia and difficulty breathing
What can status epilepticus cause?
irreversible coma or death
Should we treat status epilepticus aggressively?
How do we treat status epilepticus?
- diazepam IV
- pentobarbital IV
- establish an ariway, oxygen as needed
- IV catheter
- monitor body temperature
What does IVD stand for?
intervertebral disc disease
What is the most common disorder involving the spinal cord?
What is extrusion?
rupture of nucleus pulposus into vertebral canal
What is protrusion?
disc bulges into vertebral canal
What is IVD?
compression of the spinal cord
Where can IVD occur?
- caudal thoracic
- lumbar disc
What is IVD usually secondary to?
degenerative changes in the disc
Can a spinal cord injury cause IVD?
What are the clinical signs of IVD?
- muscle spasms
- reluctance to move
- hunched up
- abdominal muscle rigidity
- loss of proprioception - the body's awareness of posture, position, movement, changes in balance
- paresis - partial paralysis, weakness
- loss of deep pain perception
How do we diagnose IVD?
- plain radiography - accurate in 70% of cases
- myelography - more definitive location of lesion
- MRI - accurate in 85 - 97% of cases
When do we treat IVD medically?
painful, no or mild neurological deficits
How do we treat IVD medically?
- strict confinement, 2 - 3 weeks
- anti-inflammatory drugs
- urinary and fecal incontinence management
When do we treat IVD surgically?
- substantial neurological deficits
- medical treatment failure
- recurrent episodes
- urinary and fecal incontinence mangement
How do we educate clients on IVD?
- weight control, especially in predisposed breeds
- avoid back strain
- dogs treated medically only - recurrence rate is 40%
- lack of deep pain for more than 24 hours (poor prognosis)
- lack of deep pain for less than 24 hours (guarded prognosis)
Which breeds are predisposed to IVD?
chondrodystrophic breeds - dachshunds, pekingese, lhasa apso
What breeds do we typically see atlantoaxial subluxation in?
toy breeds - yorkshire terrier, miniature poodle, toy poodle, chihuahua, pekingese
What age do we usually see atlantoaxial subluxation?
young dogs - under 1 yar old
How does atlantoaxial subluxation occur?
- instability of the atlantoaxial joint
- C2 luxates dorsally
- compression of the spinal cord
What are the clinical signs of atlantoaxial subluxation?
- reluctance to be patted on the head
- neck pain, low head carriage
- gait dysfunction
- tetraparesis, tetraplegia
- sudden death due to respiratory paralysis
How do we diagnose atlantoaxial subluxation?
- radiographs - be careful not to cause further trauma when positioning the animal
- if animal is under general anesthesia for films, may need to splint neck
- must be very careful with neck during anesthetic recovery
How do we treat atlantoaxial subluxation medically?
- splint neck in extension for 6 weeks
Why do most cases of atlantoaxial subluxation treated surgically?
to relieve pressure on the spinal cord
How do we surgically fix atlantoaxial subluxation?
What percent of surgeries for atlantoaxial subluxation are successful?
What is another name for cervical spondylomyelopathy?
What is cervical spondylomyelopathy?
- cervical vertebral malformation of misarticulation - C5 - 7
- compression of the spinal cord
Which breeds are common for having cervical spondylomyelophathy?
- doberman pinschers
- great dane
What age do we typically see clinical signs for cervical spondylomyelopathy?
seen by 1 - 2 years old
What are the clinical signs of cervical spondylomyelopathy?
- ataxia of rear limbs, +/- fore limbs
- abnormal wear of dorsal surfaces of rear paws
- swinging, wobbling gait in rear
- proprioception deficits
- rigid flexion of neck
- neck pain is variable
How do we diagnose cervical spondylomyelopathy?
- myelography, CT, or MRI to localize lesion
How do we treat cervical spondylomyelopathy medically?
- restrict activity
What does surgical treatment of cervical spondylomyelopathy do?
- decompresses spinal cord
- stablizes vertebral column
What is the percent recovery for patients who have surgical treatment of cervical spondylomyelopathy?
40 - 80%
What causes peripheral nervous system diseases?
- idiopathic vestibular disease
- neuropathies - metabolic - hypothyroid, diabetes mellitus
- laryngeal paralysis
- tick paralysis
- coonhound paralysis
Which animals do we see idiopathic vestibular disease in?
- middle aged dogs
- cats of all ages
What are the clinical signs of idiopathic vestibular disease?
- loss of balance
- head tilt to the side of the lesion
- rolling or circling to side of lesion
How do we diagnose idiopathic vestibular disease?
- clinical signs
- blood work to rule out underlying disease
- otic exam to rule out ear disease
How do we treat idiopathic vestibular disease?
- no definitive therapy
- condition usually resolves on its own
- supportive therapy if needed - fluids, force feed
- residual head tilut or ataxia may persist
What is metabolic neuropathy?
disease of the nervous system due to a metabolic disease - hypothyroidism, diabetes mellitus
What can hypothyroid neuropathies occur with?
What are the clinical signs of hypothyroid neuropathy?
- progressive generalized weakness
- muscle atrophy
- dimished spinal reflexes
- laryngeal paralysis
- facial nerve paralysis
- vestibular disease
What is the treatment for hypothyroid neuropathy?
- thyroid supplementation (soloxine)
- may take several months to see improvement
- may not fully recover
What are the clinical signs of diabetes mellitus neuropathy?
- pelvic limb weakness
- muscle atrophy
- depressed spinal reflexes
- cats can have plantigrade stance and pelvic limb weakness
How do we treat diabetes mellitus neuropathy?
treat the diabetes
What is laryngeal paralysis?
- paralysis of laryngeal muscles
- airway obstruction occurs on inspiration
What are the different types of laryngeal paralysis?
Which breeds are predisposed to congenital laryngeal paralysis?
- siberian husky
- bouvier des flandres
What causes acquired laryngeal paralysis?
- lead poisoning
- inflammatory cell infiltration
Which breeds usually get idiopathic laryngeal paralysis?
middle aged to older large and giant breeds
What are the clinical signs of laryngeal paralysis?
- high pitched inspiratory noise
- raspy inspiration
- worsens with exercise or heat stress
- voice change, gagging, coughing
How do we diagnose laryngeal paralysis?
- direct visualization of laryngeal motion - under opioid sedation or light general anesthesia
- failure of walls of larynx to abduct during inspiration
- cervical and thoracic radiographs
How do we treat laryngeal paralysis?
- surgical correction
- prognosis good to guarded
- do not breed animals that have hereditary paralysis
What kind of disease is megaesophagus?
What causes megaesophagus?
- lack of effective peristalsis of esophagus
- generalized esophageal dilation
- aspiration, aspiration pneumonia
What are the two types of megaesophagus?
When do we see congenital megaesophagus?
usually evident at weaning
What is congenital megaesophagus?
chronic regurgitation of undigested food
What is acquired megaesophagus?
dilation of esophagus
What are the clinical signs of megaesophagus?
- regurgitation of food and liquids (distinguish between regurgitation and vomiting)
- repeated swallowing attempts
- halitosis from fermented ingesta
- respiratory distress (aspiration pneumonia, moist cough, crackles, dyspnea)
How do we diagnose megaesophagus?
- radiographs - gas/fluid/ingesta in esophagus, aspiration pneumonia
- esophagography - barium mixed into dog food
- fluoroscopy - with a barium swallow
How do we treat megaesophagus?
- feed from elevated position
- keep animal elevated for 10 minutes postprandial
- frequent small meals
- vary consistency of food
- treat aspiration pneumonia
- motility modifiers of unproven benefit
Is the prognosis good for megaesophagus?
generally poor and patient usually dies or is euthanized
What causes tick paralysis?
prevents release of acetylcholine
Which ticks cause tick paralysis?
- Dermacentor variabilis (common dog tick)
- Dermacentor andersoni (Rocky Mountain wood tick)
What are the clinical signs of tick paralysis?
- develop 5 - 9 days after tick attachment
- weakness begins in rear legs
- ascends to thoracic limbs in 24 - 48 hours
- flaccid paralysis
- respiratory paralysis - death
How do we diagnose tick paralysis?
- clinical signs - ascending flaccid paralysis
- presence of ticks
- improvement within 24 hours of tick removal
How do we treat tick paralysis?
- remove ticks
- carefully examine for ticks - inside ears, interdigital spaces
- may need to clip long haired dogs
- Proban - cythioate can be used to remove hidden ticks
- supportive care
What is Coonhound paralysis?
When did we first see coonhound paralysis?
first seen in 1954 after exposure to raccoon saliva - however, it can occur wtihout exposure to raccoon saliva
What does the antigen in raccoon saliva cause?
What kind of nerve damage does coonhound paralysis cause?
peripheral nerve damage
Who gets coonhound paralysis?
adult dogs of any breed or sex
What are the clinical signs of coonhound paralysis?
- begin 7 - 14 days post exposure
- spontaneous recovery begins as early as 1 week post exposure
- recovery may take several months
- recovery may be incomplete
- ascending flaccid paralysis
- if severe: cranial nerve deficits, respiratory paralysis
How do we diagnose coonhound paralysis?
clinical signs and history
How do we treat coonhound paralysis?
- no specific therapy
- supportive care while recovering
- support respiration if needed
- maintain soft bedding
- turn frequently
- maintain hydration and nutrition
- physical therapy and massage
How do we educate clients on coonhound paralysis?
- dogs can get the disease without exposure to raccoons
- may require long-term nursing care
- may not regain total function
- may be prone to recurrence
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