Transcript The Nervous System - Dr. Brahmbhatt`s Class Handouts

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.”