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Flashcards in Neuro - Cases Deck (105)
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1

Winnifred is a 12 year-old female spayed dog that has been acting 'strangely' at home for the last few days. Upon examination she does not appear to be aware of the environment. She moves without direction or purpose, and does not appear to interact normally with the person in the room of the environment

Upon physical examination you note that her conscious proprioception is decreased in all four limbs. Her menance response is absent in both eyes. You note that her facial sensation is decreased bilaterally (she does not move rapidly away from stimulus to the nostrils, but the animal does blink and twitch its facial muscles from the stimulus). All of the other cranial nerve reflexes are present and normal. The rest of her neurologic examination is unremarkable.

Does this animal have neurologic disease?

Most likely yes

The clues are the behavior change, the menace deficits, the facial sensation deficits, and the tetraparesis with normal spinal reflexes.

2

Winnifred is a 12 year-old female spayed dog that has been acting 'strangely' at home for the last few days. Upon examination she does not appear to be aware of the environment. She moves without direction or purpose, and does not appear to interact normally with the person in the room of the environment

Upon physical examination you note that her conscious proprioception is decreased in all four limbs. Her menance response is absent in both eyes. You note that her facial sensation is decreased bilaterally (she does not move rapidly away from stimulus to the nostrils, but the animal does blink and twitch its facial muscles from the stimulus). All other cranial nerve reflexes are present and normal. The rest of her neurologic examination is unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Intracranial - bilateral supratentorial

3

Winnifred is a 12 year-old female spayed dog that has been acting 'strangely' at home for the last few days. Upon examination she does not appear to be aware of the environment. She moves without direction or purpose, and does not appear to interact normally with the person in the room of the environment

Upon physical examination you note that her conscious proprioception is decreased in all four limbs. Her menance response is absent in both eyes. You note that her facial sensation is decreased bilaterally (she does not move rapidly away from stimulus to the nostrils, but the animal does blink and twitch its facial muscles from the stimulus). All other cranial nerve reflexes are present and normal. The rest of her neurologic examination is unremarkable.

What are the suspected causes?

Tumor, hydrocephalus, cerebrovascular disease, inflammatory brain disease and traumatic injury

4

Winnifred is a 12 year-old female spayed dog that has been acting 'strangely' at home for the last few days. Upon examination she does not appear to be aware of the environment. She moves without direction or purpose, and does not appear to interact normally with the person in the room of the environment. 

Upon physical examination you note that her conscious proprioception is decreased in all four limbs. Her menance response is absent in both eyes. You note that her facial sensation is decreased bilaterally (she does not move rapidly away from stimulus to the nostrils, but the animal does blink and twitch its facial muscles from the stimulus). All other cranial nerve reflexes are present and normal. The rest of her neurologic examination is unremarkable.

What diagnostic tests would be most helpful?

Routine laboratory assessments, coagulation assessments if clinical signs indicate, blood pressure. If no obvious systemic abnormality is found then advanced imaging (MR) and CSF assessment if the imaging were normal (take from the lumbar region)

5

Bobbard is an 8 year-old male-castrated dog that has been acting 'strangely' at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard's concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

Does this animal have neurologic disease?

Yes

The clues are the behavior change, the menace deficint, the facial sensation deficit, and the tetraparesis with normal spinal reflexes.

6

Bobbard is an 8 year-old male-castrated dog that has been acting 'strangely' at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard's concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Intracranial - right supratentorial

7

Bobbard is an 8 year-old male-castrated dog that has been acting 'strangely' at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard's concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

What are the suspected causes?

Tumor, hydrocephalus, cerebrovascular disease, inflammatory brain disease, traumatic injury, and metabolic diseases

8

Bobbard is an 8 year-old male-castrated dog that has been acting 'strangely' at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard's concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

What diagnostic tests would be most helpful?

In order of completion: Routine laboratory assessments, coagulation assessments if indicated by clinical signs, blood pressure. If no obvious systemic abnormality found, then advanced imaging (MR) and CSF assessment (if MR is normal)

9

Bobbard is an 8 year-old male-castrated dog that has been acting 'strangely' at home for last week. He appears to not react normally to the environment. He has a head turn and circles to the right. The movements of the thoracic limb are exaggerated.

Bobbard's concious proprioception is significantly decreased on the left side and mildly decreased on the right side. His menace response is absent in the right eye. His facial sensation is absent on the left (when the nostril is stimulated the animal blinks and twitches its facial muscles, but does not move its head rapidly from the stimulus.) All other cranial nerve reflexes are present and normal. He is painful when his cervical area is palpated. The rest of the neurologic examination was unremarkable.

If CSF assessment was indicated in this patient, where would you collect the CSF from?

The lumbar region

10

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

Does this animal have neurologic disease?

Yes 

The clues are the tetraparesis with normal spinal reflexes and the nystagmus

11

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand. 

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Intracranial infratentorial (brain stem)

Worse on the right hand side

12

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand. 

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

What are the suspected causes?

Tumor, hydrocephalus, cerebrovascular disease, inflammatory brain disease, traumatic injury, and metabolic diseases

13

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand. 

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

What diagnostic tests would be most helpful?

In order of completion: Routine laboratory assessments, potentially coagulation assessments if clinical signs indicate, blood pressure, advanced imaging, and CSF if the imaging studies are normal

14

Geoffrey is a 4 year old male castrated cat that has had an acute onset of inability to stand. Upon examination, he is in lateraly recumbency and unable to stand. 

His proprioception is significantly decreased on the left hand side and absent on the right hand side. All of his cranial nerve reflex tests are present and normal. You note that he has positional horizontal nystagmus with the fast phase to the left. Everything else on the neurologic examination is unremarkable.

If you end up taking CSF in the case, where would you get the sample from?

the lumbar region

15

Veronica is a 9 year old female spayed dog that has been acting 'this way' for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

Does this animal have neurologic disease?

Yes

16

Veronica is a 9 year old female spayed dog that has been acting 'this way' for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

The signs are fairly localizing for a left-sided central vestibular abnormality

17

Veronica is a 9 year old female spayed dog that has been acting 'this way' for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

What are the suspected causes?

Tumor, hydrocephalus, inflammatory brain disease, traumatic injury, cerebrovascular disease, and metronidazole toxicity

18

Veronica is a 9 year old female spayed dog that has been acting 'this way' for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

What diagnostic tests would be most helpful?

In order of completion: Routine laboratory assessments, coagulation assessments if clinical signs indicate, blood pressure, advanced imaging, and CSF assessment if advanced imaging studies are normal

19

Veronica is a 9 year old female spayed dog that has been acting 'this way' for the last 10 days. You notice that she has a head tilt to the left side and that she is moving her head in swaying movements from side to side.

Veronica has decreased proprioception on the left side and normal proprioception on the right hand side. All cranial nerve reflex tests are present and normal. She has a positional horizontal nystagmus with the fast phase to the right. The remainder of the neurologic examination was unremarkable.

If you need to take a CSF sample from this patient, where would you take it from?

the lumbar region

20

Paco is an 8 year old male-castrated cat who has been acting 'this way' for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

Does this animal have neurologic disease?

yes

21

Paco is an 8 year old male-castrated cat who has been acting 'this way' for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Signs could reflect either a central or a peripheral vestibular abnormality

22

Paco is an 8 year old male-castrated cat who has been acting 'this way' for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

What are the suspected causes?

Central vestibular abnormalities: tumor, hydrocephalus, inflammatory brain disease, traumatic injury, and cerebrovascular disease

Peripheral vestibular abnormalities: Middle/inner ear infection, middle/inner ear tumor, traumatic injury, and idiopathic feline vestibular disease

23

Paco is an 8 year old male-castrated cat who has been acting 'this way' for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

What diagnostic tests would be most helpful?

In order of completion: Otoscopic examination, routine laboratory asssessments, coagulation assessments if indicated by clinical signs, blood pressure, advanced imaging (MR), and CSF assessment if imaging studies are normal

24

Paco is an 8 year old male-castrated cat who has been acting 'this way' for the last 10 days. You notice that he has a severe head tilt to the right hand side.

All proprioceptive and cranial nerve reflexes are present and normal. You note that he has spontaneous rotary head tilt and that his head seems to move similarly with each beat of the nystagmus. The rest of the neurologic examination was unremarkable.

If you were to evaluate the CSF, where would you get the sample from?

the lumbar region

25

Squidward is an 8 year old male castrated dog that has been acting this way for the  last 7 days and the owner noticed that he 'looked funny.' You notice that Squidward has an asymmetrical facial appearance.

His menace response is absent on the left side, however he does appear to retract the eye during menace testing. His blinking and palpebral reflex is absent on the left side, however he does appear to retract the eye during palpebral testing. Squidward does not appear to move the facial muscle and ear on the right side. All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable.

Does he have neurologic disease?

Yes

26

Squidward is an 8 year old male castrated dog that has been acting this way for the  last 7 days and the owner noticed that he 'looked funny.' You notice that Squidward has an asymmetrical facial appearance.

His menace response is absent on the left side, however he does appear to retract the eye during menace testing. His blinking and palpebral reflex is absent on the left side, however he does appear to retract the eye during palpebral testing. Squidward does not appear to move the facial muscle and ear on the right side. All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable.

What is the neuroanatomical diagnosis (where is the lesion)?

Right facial nerve 

27

Squidward is an 8 year old male castrated dog that has been acting this way for the last 7 days and the owner noticed that he 'looked funny.' You notice that Squidward has an asymmetrical facial appearance.

His menace response is absent on the left side, however he does appear to retract the eye during menace testing. His blinking and palpebral reflex is absent on the left side, however he does appear to retract the eye during palpebral testing. Squidward does not appear to move the facial muscle and ear on the right side. All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable.

What are the suspected causes?

Idiopathic facial nerve paralysis, tumor, middle/inner ear inflammation, traumatic injury, and also consider central causes

28

Squidward is an 8 year old male castrated dog that has been acting this way for the last 7 days and the owner noticed that he 'looked funny.' You notice that Squidward has an asymmetrical facial appearance.

His menace response is absent on the left side, however he does appear to retract the eye during menace testing. His blinking and palpebral reflex is absent on the left side, however he does appear to retract the eye during palpebral testing. Squidward does not appear to move the facial muscle and ear on the right side. All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable.

What diagnostic tests would be most helpful?

In order of completion: Routine laboratory assessments, coagulation assessments if clinical signs indicate, blood pressure, advanced imaging (MR), and CSF assessment if MR is normal.

29

Squidward is an 8 year old male castrated dog that has been acting this way for the last 7 days and the owner noticed that he 'looked funny.' You notice that Squidward has an asymmetrical facial appearance.

His menace response is absent on the left side, however he does appear to retract the eye during menace testing. His blinking and palpebral reflex is absent on the left side, however he does appear to retract the eye during palpebral testing. Squidward does not appear to move the facial muscle and ear on the right side. All other cranial reflexes are present and normal. The remainder of the neurologic exam was unremarkable.

If you were to take a CSF sample in this patient, where would you take it from?

the lumbar region

30

Walter is a 6 year old male castrated dog that has been having intermittent seizure-like episodes.

All reflexes are present and normal. You recognize during your examination that Walter is experiencing a classic grand mal seizure. The rest of the neurologic exam is unremarkable.

Does this animal have neurologic disease?

Yes

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