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Neurological Diseases

Neurological Diseases. PNS. Nervous System. CNS Brain, spinal cord PNS (Links CNS to body) Cranial nerves (from brain) Peripheral nerves (from spinal cord) Autonomic nervous system smooth muscle and cardiac muscle : (PNS and SNS) Somatic (voluntary) system – skeletal m. Cranial nerves .

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Neurological Diseases

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  1. Neurological Diseases PNS

  2. Nervous System • CNS • Brain, spinal cord • PNS (Links CNS to body) • Cranial nerves (from brain) • Peripheral nerves (from spinal cord) • Autonomic nervous system smooth muscle and cardiac muscle : (PNS and SNS) • Somatic (voluntary) system – skeletal m.

  3. Cranial nerves

  4. Mnemonics • “Oh, Oh, Oh, To Touch And Feel Various Girl's Very Angelic Hands” • Olfactory, Optic, Oculomotor, Troclear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal • “Some Say Marry Money, But My Brother Says Big Business Makes Money”

  5. Neurological Exam • Attitude, Level of consciousness, Gait • Cerebral cortex, thalamus, hypothalamus • Cranial Nerves • I (S) Olfactory: SMELL • ether on cotton—will pull away • II (S) Optic: VISION • follow moving objects; drop cotton ball

  6. Neurological Exam • III (M), IV (M), VI (M) : look up, down, sideways: strabismus, aniscoria (PNS/SN) • Oculomotor: Eye movement, pupil size, focusing lens • Trochlear: Eye movement • Abducent: Eye movement • V (B) Trigeminal: sensory to face, motor to mastication (Chewing); • anesthesia to face, weakness in jaw muscles. • Head and teeth e.g dropped jaw

  7. Neurologic Exam • VII (M) Facial: Face/Scalp, salivation, tears, taste • unilateral droop; drool; no menace • Paralysis: eyelid, lip, ear • VIII (S) Vestibulocochlear: • balance (nystagmus, head tilt, circling); deafness

  8. Neurologic Exam • IX (B), X (B), XI (M): swallowing (9 and 10); muscle atrophy • Glossopharyngeal: tongue movement, swallowing, salivation, taste, dysphagia • Vagus: Sensory: GI/resp; Motor: larynx, pharynx, parasympathetic, abdomen and thoracic organs. Dysphagia. Megaesophagus. • Accessory: head movement, accessory motor with vagus. Laryngeal paralysis. • XII (M) Hypoglossal • loss of tongue movement; unilateral atrophy

  9. Female Brain

  10. Male Brain

  11. LOCATION

  12. Neurologic Exam • Observe • Mentation (alert, lethargic, coma, etc) • Agitation, anxiety • Seizures • Posture (Higher center) • Upright or sternal • Head tilt (vestibular?VIII) • Wide based stance (ataxia, weakness)

  13. Neuro Exam • Gait • Walking and running on flat, nonslippery surface • Walk slowly back and forth with turns and circles • Proprioceptive deficits – knuckling? (spinal cord defect) • Paresis (Deficient)/paralysis (No) – cerebral cortex, brainstem, spinal cord or peripheral spinal nerves or muscles • Circling/pacing – • Tight circling with head tilt – vestibular (VIII) • With dementia – ipsilateral cerebral cortex

  14. Posterior Paresis (T-L) ‘My dog is draggin’ • Reflexes present • in the rear legs • T3-L3 • Reflexes are • diminished or • absent in the rear legs • L4-S2 • IVDD/Trauma

  15. Neuro Exam • Ataxia/incoordination – cerebellum (coordinates motor activity), vestibular system, or spinal cord • Dysmetria - cerebellar • Hypermetria – too long movements • Hypometria – movements too short

  16. Neuro Exam • Postural reactions • Knuckling • Hopping • Wheelbarrowing • Hemiwalking • Muscle Tone • Atrophy – occurs slowly from disuse • Rapidly from nerve damage • LMN – decreased • UMN – extensor muscle tone increased • Test by flexing/extending joints

  17. Knuckling

  18. Neuro exam – Spinal Reflexes • Thoracic limb withdrawal – pinch toe • Patellar – strike patellar ligament – extension of stifle • Pelvic limb withdrawal – pinch toe • Sciatic – Strike between greater trochanter and ischium – flexion of stifle and hock • Cranial tibial – strike cranial tibial m just below proximal end of tibia – flex hock • Perineal – pinch perineum/anus – anal sphincter contraction, tuck tail • Panniculus – stimulate skin over dorsum just lateral to vertebral column – twitch of cutaneous trunci m.

  19. Patellar Reflex

  20. Reflex examination • http://www.youtube.com/watch?v=NFqFABsIa7Q&feature=related

  21. Pelvic Limb Withdrawal – Or Not

  22. Panniculus Test

  23. Palpebral reflex • http://video.google.com/videosearch?q=neurological+exam+in+dogs&hl=en&emb=0&aq=f#

  24. Neuro Exam – Summary UMN vs LMN UMN LMN • Muscle tone N or I D • Spinal reflexes N or I D • Motor fxn Spastic Flaccid • Muscle atrophy Mild Severe • disuse neuro • Bladder Tense Flaccid

  25. Neuro Exam – Cranial Nerves • Blind II • No menace II/VII • Anisocoria II, III • Atrophy of temporal V Muscles • Dropped jaw V • Nares, lip pinch, cornea V • Inside ear • Lip/ear droop VII • No blink VII • Head tilt VIII

  26. Neuro exam – Cranial Nerves • Nystagmus VIII • Deafness VIII • Difficulty swallowing IX, X • Loss of gag reflex IX, X • Laryngeal paralysis IX, X • Weakness, assymmetry XII • Of tongue

  27. Cranial nerve • http://www.youtube.com/watch?v=S8f9-GPW9IE&feature=related

  28. The Nervous System And its associated diseases

  29. Diseases of Brain: Trauma Dog skull and brain 2º Trauma: edema, hemorrhage 1º Trauma—Direct trauma to (↑ intracranial pressure) brain tissue

  30. Brain Trauma • Signs: • Seizures • Blood in eyes, ears, nose, oral cavity • Loss of consciousness or decrease in response to external stimuli • Shock, coma, altered respiratory patterns • Dx • Hx of trauma (HBC, falling) • Chem. panel to rule out other metabolic diseases

  31. Brain Trauma • Treatment—aimed at reducing 2° effects (edema) • Osmotic agents: Mannitol (20-50%) IV slow bolus • Diuretics: Furosemide IV q4h • Anti-seizure Rx if needed: Diazepam, Phenobarbital • Client info • Some brain injury is irreversible • Dog in coma >48 h usually does not survive • Worsening neuro signs → bad prognosis

  32. Idiopathic Vestibular Disease • Signs • Loss of balance • Head tilt • Nystagmus • Disorientation • Ataxia • Vomiting/anorexia Signalment: Dogs (middle aged) and cats, acute

  33. IVD: NYSTAGMUS Click for video

  34. Idiopathic Vestibular disease http://www.youtube.com/watch?v=ZccUdSH91zc&feature=PlayList&p=E13C63C661759E7C&playnext_from=PL&playnext=3&index=30 http://www.youtube.com/watch?v=Y25T7dZ77T4&feature=related http://www.youtube.com/watch?v=HjwGY2vJk0E&feature=related

  35. IVD: Ataxia Click for video

  36. Idiopathic Vestibular Disease • Dx • Clinical signs • Blood work to r/o other diseases of nervous system • Ear exam to r/o inner ear infection • Rx • Treatment is not recommended; does not alter course of disease (antibiotics, steroids often given to cover possible causes not found by PE and lab work) • Clinical signs resolve in 3-6 wks

  37. PEOPLE “The man who smiles in the face of trouble… Has found someone to blame it on.”

  38. References • Alleice Summers, Common Diseases of Companion Animals • http://neuro.vetmed.ufl.edu/neuro/courses/vem5171/Neuropharmacology.pdf

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