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PEOPLE

PEOPLE. “The man who smiles in the face of trouble… Has found someone to blame it on.”. Anatomy. forebrain is responsible for "thinking," behavior, and final integration of sensory information. Brain: Neoplasia.

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PEOPLE

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

  2. Anatomy forebrain is responsible for "thinking," behavior, and final integration of sensory information

  3. Brain: Neoplasia Enlarging mass in brain; causes compression of healthy tissue or replacement with cancerous tissue • Primary:____________,______________, choroid plexus papilloma, pituitary adenoma or adenocarcinoma (____________), and others. • Secondary (metastasis): hemangiosarcoma, mammary carcinoma and melanoma • Dogs most common meningiomas and gliomas • Sagittal MRI of the brain of an 8 year old female German Shepherd dog. • Seizure • Well encapsulated mass in the olfactory bulb and frontal cortex of the brain • Meningioma (histopathology) • TX: surgical removal of the tumor followed by radiation • PX: Good not touching brain (unlike gliomas: radiation therapy)

  4. Hemangiosarcoma

  5. Brain: Neoplasia • Forebrain • Behavior • ______________, loss of learned behavior • Seizures: acute onset, 5-6 yrs old • Pacing and circling (Vestibular signs) • Ipsilateral vision: bump • E.g. Glioma’s and new treatments • ___________________breeds: such as the Boxer, the Boston terrier, and the French and English bulldog

  6. Brain - Neoplasia • The Brainstem • ___________ function (the ability to walk, CV and resp function), consciousness and balance • 1st signs: loss of balance (vestibular signs) and paresis of one side of the body • Dysphagia, change in voice and inability to move the eyes • Progresses into paralysis, coma and death. • Vestibular signs: • Head __________________ • Leaning and falling to the side of the head tilt • Drunken gait with loss of balance (ataxia) • ________________ to the side of the head tilt • nystagmus • Anorexia and vomiting • Strabismus

  7. Kasey, a 10-year-old female Golden retriever • trigeminal nerve root tumor • sensation to the face and motor function to the muscles of mastication • 15 months

  8. Brain - Neoplasia • The Cerebellum - coordination of movements and interacts closely with the vestibular system to control ____________ and posture. • Uncoordinated gait characterized by dramatic goosestepping (___________________) • Intention tremors: Head tremors that are worst when the animal is intent on something (i.e., food) but disappear when the animal is relaxed Swaying of the trunk • Wide based stance • Sometimes there can be vestibular signs such as a head tilt • The animal's strength remains ____________________

  9. Brain: Neoplasia • Dx • Systematic screening for tumors in other organs • CBC, chem panel • Radiographs: _______________ • CSF tap to assess increased cerebral spinal pressure • Ophthalmic exam may indicate optic nerve edema • Computed tomography (CT) scanning or magnetic resonance imaging (MRI) to locate tumor

  10. CT or MRI • MRI • shows the brain in ________________ than CT • the test of choice when assessing for brain tumors • more expensive test and less widely available • CT images (more artifacts for brainstem/ cerebellum): meningiomas, choroid plexus papillomas • MRI:______________, brainstem or cerebellar disease or Boston Terrier.

  11. Brain: Neoplasia • Rx— surgical removal, radiation therapy, chemotherapy, and palliative treatment of the symptoms • Surgical removal of superficial single lesions • Tumors of the brainstem pose problems • Forebrain: you can resect certain parts of the forebrain without long-term effects. • _________________ tend to be located on the surface of the brain and are therefore the best candidates for surgical removal. • Gliomas are more difficult to remove because they lie deep within the substance of the brain.

  12. MRI of a 6 year female old Boxer oligodendroglioma

  13. Brain: Neoplasia • Radiation therapy • Chemotherapy; efficacy varies with tumor type (lymphomas respond well; other less so) • Palliative: Anti-seizure medication (Phenobarbital PO 2-3 times/day), Corticosteroids—prednisone • Client info • The more severe the signs, the worse the outcome • The larger the tumor, the worse the outcome • _________________________ tumors (tumors of the forebrain) have a better prognosis than infratentorial tumors (tumors of the brainstem and cerebellum) • Radiation therapy does prolong lifespan in most cases • Meningiomas have a better outcome than tumors that lie within the brain (e.g. gliomas)

  14. Epilepsy • Signs of seizure • short aura (stare into distance, seek comfort/protection from someone, vocalize) • seizure lasts_________________ ; may consist of total body muscle twitching with extended arms and legs and arching of neck dorsally (opisthotonus) • dog will be disoriented/blind for a few minutes • may be a single event (no veterinary intervention needed) or followed shortly by other seizures (__________________; requires veterinary intervention) • may be incited by certain events • normal at other times Click for video

  15. http://www.thepetcenter.com/gen/epilepsy.html

  16. Epilepsy • Dx • CBC, chem panel—r/o metabolic diseases causing seizures • ________________________________ • hypocalcemia • hepatic encephalopathy (failure to detox blood) • Shunt • Cirrhosis • Pb poisoning • Radiographs—r/o head trauma or __________________ • CT scan or MRI—r/o space-occupying lesion in brain • Rx—directed at cause if one can be found • treat if >1 every mo or two (Rx will not completely stop seizures) • Phenobarbital is _________________________

  17. Status Epilepticus • Signs—prolonged, uninterrupted seizures (>5-10 minutes) • Rx • Diazepam (2-10 mg to effect); can be repeated over several minutes • Phenobarbital - • Time to steady state blood levels: 10-14 days • Side effects: sedation, ataxia, PU/PD/PP, hepatotoxicity, blood _______________________ (Rare) • Establish an open airway • IV cath with IV fluids to keep an open vein • Monitor blood Ca and glucose; treat is needed • Monitor body temp; if elevated, treat appropriately • If cerebral edema is suspected, treat with _____________(IV) • Phenobarbital—IV or IM

  18. Status Epilepticus • Client info— • Epilepsy is an __________________ disease • Even with treatment, animal may still seize; • goal is to reduce frequency and intensity of seizures • Spaying/neutering will remove any hormonal influence on seizures • Medications will probably be required for life • Most animals that seize can live a normal life • If seizure free for 6-9 mo, may reduced or discontinued Rx

  19. LIFE “Life is the art of drawing without an eraser.” -John w. Gardner

  20. Spinal Cord • Function • Nerve fibers carry signals between brain - rest of body • Anatomy • Like brain, protected by hard covering – _______________ Intervertebral disk (cushion): • between vertebral body • increases range of motion • prevents vertebrae rubbing

  21. Spinal Cord: Anatomy Like brain, spinal cord enclosed in hard covering IVDD problem in both humans and canine Anatomical differences—cervical same; lumbar—human bears weight, canine doesn’t Attached rib (thorax) helps stabilize the IV joint; worse at T-L junction (dogs)

  22. Degenerative Disc Disease: Humans Degeneration of disk occurs with age Dries out, shrinks (we get shorter as we age)

  23. IV Disk Disease: Anatomy Normal spinal column and disk Prolapsed disk 1/3 thickness nucleus fibrosus

  24. Intervertebral Disk Disease • Etiology • IVD dries out with age →_____________, less compliant • ↑Pressure from jumping • Occurs most commonly in_____________, caudal thoracic, and lumbar vertebrae • Most __________________ spinal cord disorder in companion animals

  25. Intervertebral Disk Disease • Hansen TYPE I: ________________ herniates upward; narrowest part of annulus fibrosus • TYPE I: Most common in chondrodystrophic (“faulty development of cartilage”) breeds • ______________________ , shih tzus, Lhasa apsos, beagles, basset hounds (poodles also affected) • Acute onset • Can occur at any age, but generally younger dogs

  26. Intervertebral Disk disease • Hansen TYPE 2: dorsal protrusion of the annulus into the _____________________ • Common in older dogs and nonchondrodystrophic breeds • Occurs over a longer period of time • Clinical signs may be less severe • Generally ________________ dogs

  27. Intervertebral Disk Disease • Signs: • Pain • Paresis/paralysis; nerve function is lost in this order: • _____________________—largest fibers; most susceptible to pressure; signs are ataxia • ____________ fibers—next smallest fibers; signs are weakness/paresis • Cutaneous sensory fibers—small; require a lot of pressure to disrupt function; decreased panniculus reflex • _______________ fibers—smallest fibers; require the most pressure to disrupt; loss is associated with poor prognosis • Severity of clinical signs depends on: • Speed at which disk material is deposited • Degree of compression • Duration of compression

  28. IVDD – Paralysis of rear legs

  29. Cervical IVDD

  30. Loss of Deep Pain

  31. IVDD Dx: Spine X-Rays Normal horse’s head consistent IV space Subluxation L2-3 (old lesion)

  32. IV Disk Disease: Myelogram: Definitive diagnosis Which disk space?

  33. IV Disk Disease: Myelogram Which disk space?

  34. Cervical IVDD Myelogram: Disk herniation at C2-3 (narrowed IV space, narrowed spinal canal)

  35. IVDD • Rx TYPE I, acute onset • Medical Rx is recommended for animals, with deep pain intact, with or w/o neuro deficit • High levels of corticosteroids is CONTROVERSIAL • Strict _________________—2 wk minimum (easy when dog hurts; not so easy after steroids/other pain medications take effect) • Nursing care • Soft padded cage • Urinary cath or express bladder several times/day • Surgery is recommended for • repeat offenders • No voluntary motor function • loss of deep pain (needs to be done QUICKLY!) • worsening neuro signs (_____________________)

  36. Laminectomy

  37. IVDD: Possible sequela

  38. IVDD

  39. IVDD - rehabilitation http://www.youtube.com/watch?v=7AkNVDc4lig&feature=related

  40. IVDD – Alternative/Optional Treatment • __________________ (muscle relaxant)15-20 mg/kg q 8hr • High-dose Methylprednisolone sodium succinate (CONTROVERSIAL!) and should be given within 8 hours • Although there is proven benefit in humans, results have not been proven in dogs • Low dose prednisone – various regimens • NSAIDS • Carprofen, deracoxib, etodolac • Gastroprotectants • Acupuncture

  41. Veterinary Acupuncture • http://www.youtube.com/watch?v=Z-JjZPnk_Mw&feature=related • http://www.youtube.com/watch?v=vJIJDUQyOmw&feature=fvw

  42. IVDD • Client info • Do not let susceptible breeds get _________________ • Encourage animals to keep spine parallel to ground • No jumping on/off couch • No begging on hind legs • No stair climbing • Loss of deep pain >24 h has ________________ prognosis • If surgery is done soon enough, there is a good Px of recovery • Almost half of animals treated medically will have recurrence • Extensive home care is required for medical and surgical patients • Severe damage to spinal cord is not reparable

  43. Atlantoaxial Joint Atlanto-Axial Joint

  44. Atlantoaxial Instability (Subluxation) • Signs • ________________ and miniature breeds (<1 yr) • Reluctance to be patted on head • Neck pain • May have ____________________ (weakness in all 4 limbs) or tetraplegia (paralysis in all 4 legs) • Sudden death due to respiratory paralysis • Diagnosis— • Radiographs: lateral x-ray of neck in slight ventroflexion • avoid further spinal cord damage with positioning

  45. Atlantoaxial Instability (Subluxation) Normal toy breed dog Toy breed dog with atlantoaxial subluxation Narrowed spinal canal CT scan: dens is marked by * X-rays of same dogs; note separation of C1 and C2 when dog’s neck is flexed in B

  46. Atlantoaxial Instability (Subluxation) • Treatment— • Medical • splint neck in extension with cage _________________ x 6 weeks • treat like other spinal cord trauma • Surgical (if unresponsive to medical Rx) • stabilize/decompress • attach dorsal process of axis to arch of atlas • fuse atlas and axis joint with pins and bone graft • ________________________ to relieve spinal cord compression • Client info— • prognosis is fair to good for animals with mild signs • animals should not be used for breeding; may be hereditary

  47. Atlantoaxial Instability: Surgical Correction Stabilization using trans-articular screws Stabilization using screws and bone cement

  48. References • Alleice Summers, Common Diseases of Companion Animals • http://cvm.ncsu.edu/vhc/tc/clinical_services/neuro/brain_tumor.html

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