Neurological Emergencies and Seizures Overview

Neurological Emergencies

• Neurological examination includes: mentation, gait & posture, cranial nerves, postural reactions, and spinal reflexes.
• Neurological examination findings can lead to a diagnostic and treatment plan.
• Thorough history is crucial to pinpoint the cause of neurologic changes.
• Includes patient history and physical evaluation.
• Examination should pinpoint the affected anatomic region.
• Neurological issues can arise from changes in mentation, vitals, posture, and reflexes.
• Altered breathing or loss of spontaneous ventilation can indicate brain stem or mentation changes.
• Monitoring blood gases and hemoglobin levels are essential, which should be above 98%.
• Oxygenation and ventilation are vital to a patient's well-being.
• Partial pressure of arterial carbon dioxide (PaCO2) control is important.

Seizures

• Three primary causes of strange animal behavior include intoxications, metabolic illness, and seizures originating in the brain.
• Seizure types include tonic, clonic, atonic, myoclonic, and absence.
• Focal seizures can be petit mal or simple/complex partial seizures.
• Generalized seizures involve tonic-clonic seizures with stiff limb movements and loss of consciousness.
• Status epilepticus—a continued seizure activity beyond 20 minutes—requires immediate treatment.
• Seizures longer than 5 minutes or clustered seizures (3–4 in 30 minutes, or numerous over a day) are concerning.
• Emergency treatment is crucial, especially for high frequency seizures.
• Treatment depends on if it's the patient's first seizure or if epilepsy is a pre-existing condition.
• Serious concerns, such as neurologic or cardiovascular issues, should be promptly addressed.
• Diazepam is a common first-line treatment for seizures, given via IV if possible.

Metabolic

• Metabolic conditions are addressed with administering appropriate fluids and electrolytes to address dehydration and electrolyte imbalance, as well as hyperthermia.
• Managing patients not responsive to Diazepam involves inducing general anesthesia, administering necessary drugs, and ensuring proper airway protection (intubation).
• Maintaining a stable blood pressure is important in cases of head trauma.
• Mannitol is an osmotic diuretic, used to improve cerebral blood flow and reduce intracranial pressure.

Head Trauma

• Head trauma, often caused by falls or blunt force, is a common occurrence.
• Assessments examine pupil size and responsiveness, mentation, posture, and other relevant clinical signs.
• Assessment involves examining pupils (PLR-pupillary light reflex); size (miosis or mydriasis), responsiveness to light(direct and consensual reflexes).
• Miosis and mydriasis can indicate potential brain damage.
• Opisthotonus, where the neck is extended and the head is pointed towards the mid-back, indicates a serious condition.
• Injuries like lacerations, abrasions, fractures, or hypothemia are indicative of head trauma.
• Secondary injuries result in secondary complications.

Spinal Cord Injury

• Spinal cord injuries can arise from various causes including degenerative and acute changes impacting the nucleus pulposus.
• Degenerative changes weaken and thicken the annulus fibrosus.
• Limiting movement, providing IV access and pain relief are important interventions following neurologic examinations of patients with spinal cord injuries.
• Comprehensive neurologic examination, bloodwork, radiography, and computed tomography scans (or MRI) are necessary for diagnostics.
• Opioids, IV corticosteroids; and strict cage rest are potential components of treatment.

Peripheral Nervous System Emergencies

• Peripheral nervous system emergencies, such as weakness, paralysis, and other significant symptoms, require urgent attention.
• Acquired myasthenia gravis involves antibodies affecting acetylcholine receptors at neuromuscular junctions.
• Botulism, a rapidly ascending motor paralysis in dogs caused by ingestion of botulinum toxin produced by Clostridium botulinum.
• Idiopathic old dog or feline idiopathic vestibular syndrome are common, but various conditions like otitis media/interna or horner's syndrome are also possible.

This quiz covers essential aspects of neurological emergencies, including examination techniques, patient history, and vital assessments. It also emphasizes the importance of identifying causes of altered behavior, particularly seizures. A comprehensive understanding is crucial for effective diagnostic and treatment strategies in veterinary neurology.