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Neurological Diseases PNS Nervous System • CNS – ___________, spinal cord • PNS (Links CNS to_____________) – _______________(from brain) – Peripheral nerves (from ____________) • Autonomic nervous system smooth muscle and cardiac muscle : (PNS and SNS) • Somatic (voluntary) system –____________m. Cranial nerves 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” NUMBER NAME TYPE KEY FUNCTION I Olfactory S Smell II Optic S Vision III Occulomotor M Eye movement, pupil size, focusing lens IV Trochlear M Eye movement V Trigeminal B Sensations – head & teeth; chewing VI Abducent M Eye movement VII Facial B Face and scalp movement, salivation, tears, taste VIII Vestibulococlear S Balance, hearing IX GLossopharangeal B Tongue movement, swallowing, salivation, taste X Vagus B Sensory from: GI, respiratory; Motor: larynx, pharynx, parasympathetic, abdomen and thoracic organs XI Accessory M Head movement, accessory motor with vagus XII Hypoglossal M Tongue movement Neurological Exam • Attitude, Level of consciousness, Gait • Cranial Nerves – I (S) ___________: ether on cotton—will ______ away – ______ (S) Optic: follow moving objects; drop cotton ball – III (M), IV (M), VI (M) Oculomotor, trochlear, abducent: _________ up, down, sideways – V (B) Trigeminal: sensory to _______, motor to mastication; anesthesia to face, weakness in jaw muscles Neurologic Exam – VII (M) Facial: ________droop; drool; no menace – VIII (S) Vestibulocochlear: _________ (nystagmus, head tilt); hearing – IX (B), X (B), XI (M) Glossopharyngeal, Vagus, Accessory:______________; muscle atrophy – XII (M) Hypoglossal: loss of tongue movement; ______________ atrophy Female Brain Male Brain LOCATION Neurologic Exam • Observe – Mentation (alert, lethargic, coma, etc) • Agitation, anxiety • Seizures – Posture (Higher center) • _______ or sternal • Head tilt (vestibular?___) • Wide based stance (ataxia, weakness) Neuro Exam • Gait – Walking and running on flat, nonslippery surface • Walk slowly back and forth with turns and circles – Proprioceptive deficits –__________? (spinal cord defect) – Paresis (_______)/paralysis (________) – cerebral cortex, brainstem, spinal cord or peripheral spinal nerves or muscles – Circling/pacing – • Tight circling with head tilt – ___________ (VIII) • With ______________– ipsilateral cerebral cortex Posterior Paresis • Reflexes present in the rear legs T3-L3 • Reflexes are diminished or absent in the rear legs L4-S2 Neuro Exam – Ataxia/incoordination –_________, vestibular system, or spinal cord – Dysmetria - cerebellar • ____________– too long movements • Hypometria – ___________________ Neuro Exam • Postural reactions – – – – __________ Hopping Wheelbarrowing Hemiwalking • Muscle Tone – Atrophy – occurs slowly from disuse • Rapidly from nerve damage – LMN – ________________ – UMN – extensor muscle tone increased – Test by flexing/extending joints Knuckling Neuro exam – Spinal Reflexes • • • • Thoracic limb withdrawal – _______________ Patellar – strike patellar ligament – extension of stifle Pelvic limb withdrawal – _______________ Sciatic – Strike between greater trochanter and ischium –_______ of stifle and hock • Cranial tibial – strike cranial tibial m just below proximal end of tibia – __________ hock • Perineal – pinch perineum/anus – anal sphincter contraction, tuck tail • Panniculus – stimulate skin over dorsum just lateral to vertebral column – twitch of ______________m. Patellar Reflex Reflex examination • http://www.youtube.com/watch?v=NFqFABsIa 7Q&feature=related Pelvic Limb Withdrawal – Or Not Panniculus Test Palpebral reflex • http://video.google.com/videosearch?q=neurol ogical+exam+in+dogs&hl=en&emb=0&aq=f# Neuro Exam – Summary UMN vs LMN • • • • • • Muscle tone Spinal reflexes Motor fxn Muscle atrophy Bladder UMN N or I N or I Spastic Mild disuse Tense LMN D D Flaccid Severe neuro Flaccid Neuro Exam – Cranial Nerves • • • • __________ No menace Anisocoria ________ of temporal II II/VII II, III V Muscles • Dropped jaw • Nares, lip pinch, cornea V V – Inside ear • Lip/ear droop • No blink • Head tilt ______ VII ______ Neuro exam – Cranial Nerves • • • • • • Nystagmus Deafness Difficulty swallowing Loss of gag reflex Laryngeal paralysis Weakness, assymmetry – Of tongue VIII VIII ________ IX, X IX, X _________ Cranial nerve • http://www.youtube.com/watch?v=S8f9GPW9IE&feature=related The Nervous System And its associated diseases Diseases of Brain: Trauma Dog skull and brain 1º Trauma—Direct trauma to brain tissue 2º Trauma: edema, hemorrhage (↑ intracranial pressure) Brain Trauma • Signs: – ______________ – 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 Brain Trauma • Treatment—aimed at reducing 2° effects (edema) – Osmotic agents: _________ (20-50%) IV slow bolus – Diuretics: Furosemide IV q4h – Anti-seizure Rx if needed:___________, Phenobarbital • Client info – Some brain injury is irreversible – Dog in coma >___________ usually does not survive – Worsening neuro signs → bad prognosis Idiopathic Vestibular Disease • Signs – – – – – – Loss of balance Head tilt ________________ Disorientation Ataxia Vomiting/anorexia Signalment: Dogs (middle aged) and cats, acute IVD: NYSTAGMUS Click for video Idiopathic Vestibular disease http://www.youtube.com/watch?v=Y25T7dZ77T4&feature=related http://www.youtube.com/watch?v=HjwGY2vJk0E&feature=related IVD: Ataxia Click for video Idiopathic Vestibular Disease • Dx – – – • Clinical signs Blood work to r/o other diseases of ____________ Ear exam to r/o _______________ 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 PEOPLE “The man who smiles in the face of trouble… Has found someone to blame it on.”