Vascular events
What are the two types of vascular events/strokes? Bonus 100- which is more common?
Ischemic (more common; 80-85% of cases)
Hemorrhagic
Name the 4 components of Horners syndrome
2) Raised third eyelid
3) Enophthalmos
4) Ptosis (droopy upper eyelid)
What does ANNPE stand for and what is the layman's term for this?
Acute non-compressive nucleus pulposus extrusion
Missile disc
Forebrain
You have a down dog that presents to you. You try to walk it and it can't walk. You support under the pelvis and there is no voluntary movement of the back legs, even with support. The front legs are normal. What is this dog considered and what is the next test?
Paraplegic
Pain testing (superficial first)
Describe ___ for a stroke in dogs or cats:
1) typical age (young, middle-age, older)
2) nature of onset of clinical signs (how fast/slow do signs come on)
3) typical progression (static, worsening, improving)
1) older
2) acute (pretty sudden onset)
3) static for a few hours/day or so, then improving
What is the bare minimum clinical sign an animal must have to be considered Horners? (of the 4 components)
Miosis
What is the classic history of a dog with an FCE or ANNPE? Include comfort/pain in the description.
Sudden (peracute) onset of inability to use legs after high velocity activity. Painful at first, then non-painful.
What are the 4 spinal cord segments we can localize to?
1) C1-C5
2) C6-T2
3) T3-L3
4) L4-S1/S3
Name a test on the face that may be absent after a seizure.
Menace
Nasal sensation
What type of neurologic signs are most common for dogs with strokes?
Cerebellar signs (truncal sway, intention tremors, wide-base stance, hypermetria) +/- vestibular signs (off-balance to one side, head tilt) = "cerebellovestibular localization"
Name the most common cause of Horners in dogs. Bonus 100 if you know the % of all cases that get this type of Horners.
Idiopathic
50% of all dog cases
What is the treatment for an ANNPE or FCE?
Physical therapy
Light pain meds for ANNPE for a few days if needed
In a dog with a right forebrain tumor, what eye would have an absent menace?
Left eye
You are testing panniculus/cutaneous truncii reflex. You start testing at L5 and work your way up. It is absent until you get to T13 when the back twitch comes back. Where is the lesion?
T11 or T12 are both acceptable answers
Name 2 conditions that predispose a patient to an ischemic stroke and a corresponding diagnostic test to screen for these conditions.
Hypercoaguable states (Cushings, diabetes, PLN, PLE); TEG, endocrine testing, UPC
Hypertension; BP testing
Endocarditis; echocardiogram
A cat presents for Horners. You detect miosis as the only exam abnormality. What test do you want to do next to rule out a very important differential diagnosis?
Fluorescein stain for a corneal ulcer
What part of the spinal cord is *most* affected in an FCE?
A) White matter
B) Gray matter
C) Meninges
D) Vertebral body
B) Gray matter
Where do you localize?
http://www.neurovideos.vet.cornell.edu/Video.aspx?vid=12-01#
Left vestibular (peripheral)
Name 2 places in the body (non-brain) where the sympathetic nerve (the nerve that causes Horners) can be affected by disease/trauma?
Tympanic bulla
Mediastinum
Brachial plexus
Neck
Open "Jeopardy 1"
Where is the stroke and is it ischemic or hemorrhagic?
Cerebellum (cranial cerebellum)
Ischemic
You have a cat with Horners and MRI shows middle-ear infection (otitis media). What two other cranial nerve problems might you find on this cat's exam (think about the two other nerves that travel in the bulla with the sympathetic nerve)?
Facial nerve paralysis
Vestibular disease
Pull up the following MRI. Is this an FCE or ANNPE?
ANNPE
Menace tests 3 separate places/areas; what are they?
Please use words ipsilateral/contralateral to describe same side (ipsi) or opposite side (contra)
Ipsilateral CN2/retina
Contralateral forebrain
Ipsilateral cerebellum