LOVE

1
LOVE FRIENDSHIP

• The truth is, everyone is going to hurt you. You
  just have to find the ones worth suffering for.
• - Bob Marley

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The Nervous System

• And its associated diseases

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Diseases of the Brain Head Trauma

• Dog skull and brain
• 1º TraumaDirect trauma to brain tissue
• 2º Trauma edema, hemorrhage (? intracranial
  pressure)

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Head Trauma

• Signs
• Seizures
• Blood in eyes, ears, nose, oral cavity
• Loss of consciousness or decrease in response to
  external stimuli
• Shock, altered respiratory patterns
• Diagnosis
• History of trauma (HBC, falling)
• Chem panel to rule out other metabolic diseases

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Head Trauma

• Treatment aimed at reducing 2 effects (edema)
• Osmotic agents Mannitol
• Diuretics Furosemide
• Anti-epileptics diazepam, phenobarbital
• Client info
• Some brain injury is irreversible
• Dog in coma gt48 hrs usually does not survive
• Worsening neuro signs ? bad prognosis

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Idiopathic Vestibular Disease

• Signs - ACUTE
• Loss of balance
• Head tilt
• Nystagmus
• Disorientation
• Ataxia
• Vomiting/anorexia

SIGNALMENT Middle-aged dogs cats
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Idiopathic Vestibular disease
http//www.youtube.com/watch?vZccUdSH91zcfeature
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http//www.youtube.com/watch?vY25T7dZ77T4feature
related
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Idiopathic Vestibular Disease

• Diagnosis
• History clinical signs
• Blood work to r/o other diseases of nervous
  system
• Otoscopic exam to r/o inner ear infection
• Treatment
• No specific treatment 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

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Brain Disorders Neoplasia

• Enlarging mass in brain causes compression of
  healthy tissue or replacement with cancerous
  tissue
• Signs - usually progressive
• Depends on tumor location
• Seizures increasing in frequency and intensity
• Vestibular signs (depending on location)
• Tremors, ataxia

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Neoplasia

• Diagnosis
• 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

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Brain disorders Neoplasia

• Treatment
• Surgical removal of superficial single lesions
• Radiation therapy
• Chemotherapy efficacy varies with tumor type
  (lymphomas respond well other less so)
• Anti-epileptic medication - Phenobarbital
• Corticosteroidsprednisone
• Client info
• Unless tumor is surgically removed, medications
  will not cure disease
• Symptoms will worsen as tumor grows larger

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Brain Disorders Epilepsy

• Signs of seizure
• short aura (stare into distance,
• seek comfort/protection from
• someone, vocalize)
• seizure lasts 1-2 min 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
  (status epilepticus- requires veterinary
  intervention)
• may be incited by certain events

13

• http//www.thepetcenter.com/gen/epilepsy.html

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Epilepsy

• Diagnosis
• CBC, chem panelr/o metabolic diseases causing
  seizures
• hypoglycemia
• hypocalcemia
• hepatic encephalopathy
• Radiographsr/o head trauma or hydrocephalus
• CT scan or MRI rule out a brain tumor
• Treatment directed at cause if one can be found
• treat if gt1 every mo or two (may not completely
  stop seizures)
• Phenobarbital is treatment of choice
• Potassium Bromide may be added if seizures not
  controlled

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Status Epilepticus

• prolonged, uninterrupted seizures
• Treatment
• Establish an open airway
• IV cath with IV fluids to keep an open vein
• Monitor blood Ca and glucose
• Monitor body temp
• If cerebral edema is suspected, treat with
  mannitol (IV)
• PhenobarbitalIV or IM
• Drugs
• Diazepam (2-10 mg to effect) can be repeated
  over several minutes
• Phenobarbital -
• Time to steady state blood levels 7-10 days
• Side effects sedation, ataxia, PU/PD/PP,
  hepatotoxicity, blood dyscrasias (Rare)

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Epilepsy

• Client info
• Epilepsy is an incurable 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 reduce or
  discontinue Rx

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Diseases of the Spinal Cord

• Function
• Nerve fibers carry signals between brain and rest
  of body
• Anatomy
• Like brain, protected by hard covering, the
  vertebral canal

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Spinal Cord Anatomy
Like brain, spinal cord enclosed in hard
covering IVDD problem in both humans and
canine Anatomical differencescervical same
lumbarhuman bears weight, canine
doesnt Attached rib (thorax) helps stabilize the
IV joint worse at T-L junction (dogs)
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Intervertebral Disk Disease
Normal spinal column and disk
1/3 thickness
nucleus fibrosus
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Intervertebral Disk Disease

• Etiology
• IVD dries out with age ? hardened, less compliant
• ?Pressure from jumping
• Occurs most commonly in cervical, caudal
  thoracic, and lumbar vertebrae

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Intervertebral Disk Disease

• Hansen TYPE I Nucleus pulposus herniates upward
  narrowest part of annulus fibrosus
• TYPE I Most common in chondrodystrophic (faulty
  development of cartilage) breeds
• Dachshunds, shih tzus, Lhasa apsos, beagles,
  basset hounds (poodles also affected)
• Acute onset
• Can occur at any age, but generally younger dogs

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Intervertebral Disk Disease
Prolapsed Disk
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Intervertebral Disk disease

• Hansen TYPE 2 dorsal protrusion of the annulus
  into the spinal canal
• Common in older dogs and nonchondrodystrophic
  breeds
• Occurs over a longer period of time
• Clinical signs may be less severe
• Generally older dogs

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Intervertebral Disk Disease

• Signs
• Pain
• Paresis/paralysis nerve function is lost in this
  order
• Proprioceptionlargest fibers most susceptible
  to pressure signs are ataxia
• Motor fibersnext smallest fibers signs are
  weakness/paresis
• Cutaneous sensory fiberssmall require a lot of
  pressure to disrupt function decreased
  panniculus reflex
• Deep pain fiberssmallest fibers require the
  most pressure to disrupt loss is associated
  with poor prognosis

25
Intervertebral Disk disease

• Severity of clinical signs depends on
• Speed at which disk material is deposited
• Degree of compression
• Duration of compression

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IVDD Paralysis of rear legs
http//www.youtube.com/watch?vvP-IXafwGVU
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Cervical IVDD
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Loss of Deep Pain
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IVDD Spinal Radiographs
Normal horses head consistent IV space
Subluxation L2-3 (old lesion)
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IV Disk Disease Myelogram
Which disk space?
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IV Disk Disease Myelogram
Which disk space?
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Cervical IVDD
Myelogram Disk herniation at C2-3 (narrowed IV
space, narrowed spinal canal)
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IVDD

• TYPE I, acute onset
• Medical Rx is recommended for animals, with deep
  pain intact
• High levels of corticosteroids is CONTROVERSIAL
• Strict confinement6-8 wk minimum
• 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 (poor prognosis)

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Surgery Laminectomy
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IVDD Possible sequela
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IVDD
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IVDD Rehabilitation
http//www.youtube.com/watch?v7AkNVDc4ligfeature
related
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IVDD Medical Management

• Methocarbamol
• 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
• NSAIDS
• Carprofen, deracoxib, etodolac
• Gastroprotectants
• Acupuncture

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Veterinary Acupuncture

• http//www.youtube.com/watch?vZ-JjZPnk_Mwfeature
  related
• http//www.youtube.com/watch?vvJIJDUQyOmwfeature
  fvw

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IVDD

• Client info
• Do not let susceptible breeds get overweight
• 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 gt24 h has poor prognosis
• If surgery is done soon enough, there is a good
  prognosis
• 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