the brain is wimpy. What does it require to function?
- glucose (No anaerobic metabolism)
- stable (pH, Ca, Na, BUN)
- LOTS of blood flow
- MAP between 60-180 mmHg
What’s the only primary intracranial disease you’d consider in a young puppy?
hydrocephalus
renal encephalopathy
example patients?
severe azotemia causing uremia (BUN>150, Crea >10)
- feline renal transplant
- dialysis disequilibrium
hypoglycemic boxer episode?
Whats your top differential?
How do you test for it?
ddx: insulinoma
do a paired insulin/glucose test when BG is under 50
Treat with prednisone (causes peripheral insulin resistance)
what neuropathy does hypoglycemia cause
seizure/seizure-like episodes
treating hypoglycemia
increase BG.
Diazepam won’t hurt but fix the real problem:
1. immature - feed it
2. insulinoma - prednisone
what neuropathy does hyperglycemia cause?
concurrent changes that cause main effects?
no overt signs, but is chronically bad for neurons
ex/ diabetic neuropathy (loss of sensory and motor function, think plantigrade cat)
-dehydration and hyperosmolarity : Hyperosmolar syndrome
What is hyperosmolar hyperglycemic sydrome?
What do you need to consider when treating it?
- BG>800, Azotemic, hypernatremic; stuporous to comatose patients
- IV fluids MUST have sodium to avoid cerebral edema
- avoid dropping glucose by more than 75-100 mg/dL per hour
3 target organs of hypertension?
kidney
retina
BRAIN
neurologic signs of hypertension
ocular signs?
depends on the area affected - seizures, vestibular, collapse, paralysis
- hypertensive encephalopathy: focal edema, ischemic/hemorrhagic infarcts, acute neuro signs
anisocoria, blindness, NAT, rolling
what vessels are affected by hypertension?
small capillaries cannot insulate with loss of autoregulation
treatment for hypertensive encephalopathy
- control BP (amlodipine +/- ACE-inhibitor
2. treat underlying disease
underlying causes of hypertension?
dogs: PLN, HAC, PHT, Pheochromocytoma
cats: HCM, Hyperthyroid, idiopathic
How does heart base tumor cause neuro sings?
compresses pulmonary artery causing pulmonary hypertension and seizures.
Arrythmias in general all _____ CO causing ______.
decrease, low oxygen delivery to brain
With hyperviscosity, what are clinical signs attributed to?
hypoxia, reduced perfusion
usually present for seizures
causes of polycythemia
polycythemia vera
EPO secreting tumor
R>L shunting PDA
treatment polycythemia
phlebotomy, hydroxyurea
differentials for hyperglobulinemia
dogs: multiple myeloma, plasma cell tumor, infectious (Ricketsia)
cats: FIP, infectious
hyperviscosity due to cholesterol/triglycerides.
breed?
tx?
mini schnauzers
tx: diet, thyroid supplement
hypercoagulability differentials?
PLN (losing anti-thrombin)
HAC (Cushing)
Sepsis/DIC
IMHA
hypocoagulability differentials?
toxicity heatstroke sepsis/DIC thrombocytopenia factor deficiency (vWf, hemophilia)
Rare congenital hypothyroidism in cat
abnormal gait, stunted with open physes, cornealdystrophy, seizures