Small Animal Neurology

Learning objectives:

• Recognize the main anatomical structures of the central and peripheral nervous systems
• Recall the function and the functional organization of the key components of the peripheral and central nervous systems
• Select key information in the signalment and history of the patient to support the differential diagnoses
• Select the steps of the general physical examination to support the neurological examination
• Identify and reproduce the key steps of, and the techniques used for, the neurological examination using a systematic approach
• Interpret the results of the neurological examination, showing an ability to identify the neuroanatomical structures tested
• Summarize the abnormal findings of the neurological examination and use the information to localize the lesion within the nervous system
• Memorize and apply the sign-time graph and the acronym VITAMIN-D to list the differential diagnoses
• Apply the information collected from the signalment, history, and neurological examination to list a differential diagnosis

Learning objectives

• Describe the neuroanatomical and pathophysiological basis of seizure activity
• Summarize the classification of seizures and the different stages of a seizure
• Discuss how to perform a diagnostic evaluation of seizures (including history, general and neurological examination, and key ancillary tests) and list differential diagnoses based on the clinical findings
• Explain the main criteria used in the selection of AEDs (antiepileptic drugs) in dogs and cats
• Explain the contraindications, the side effects, and the monitoring of the most common AEDs
• Describe how to manage refractory epilepsy
• Indicate the pathophysiology, the clinical evaluation, and the diagnosis of paroxysmal involuntary movement disorders (tremors, myoclonus, dyskinesia, myokymia, and neuromyotonia)
• Discuss the treatment and prognosis of the different paroxysmal involuntary movement disorders
• Describe the diagnosis and the treatment of narcolepsy

Learning objectives:

• Demonstrate how to clinically localize a disease process to the encephalon
• List differential diagnoses appropriate to the localization (encephalon)
• Summarize the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the brain, using the acronym VITAMIN-D
• Establish a protocol for diagnostic tests suitable to each disease process (encephalon)
• Indicate appropriate treatment options and prognostic factors for common encephalopathies

Learning objectives

• Identify the main use of survey radiographs of the skull and spine
• Recognize the limitations of survey radiographs and justify the use of radiographs in the unanaesthetised patient
• Identify abnormal changes in images collected (radiography) and associate them with disease processes
• Summarise clinical indications for, and the technique of, contrast radiology (myelography, epidurography, discography)
• Identify abnormal changes in images collected (contrast radiography) and associate them with disease processes
• Recognize the limitations of contrast radiography
• Explain the principles and the clinical application of computer tomography (CT) with and without contrast medium
• Identify the risks and advantages associated with the use of CT
• Identify abnormal changes in images collected (computed tomography) and associate them with disease processes
• Explain the principles and the clinical application of magnetic resonance imaging (MRI) with and without contrast medium
• Summarize basic MRI physics, MRI sequences, and functional imaging
• Identify the risks and advantages associated with the use of MRI
• Identify artifacts and abnormal changes in images collected (MRI) and associate them with disease processes
• Describe the use of ultrasonography in neurology, especially as a supportive diagnostic tool

Learning objectives:

• Explain how to perform a comprehensive cranial nerve assessment
• Explain how to perform a neuro-ophthalmological assessment (including pharmacological evaluation of pupil function)
• Distinguish the different neuro-ophthalmic syndromes, their neurolocalisation and causes
• Outline the diagnostic evaluation and treatment of the different neuroophthalmic syndromes
• Identify the pathophysiology and neurolocalisation of the most common disorders of the head and face: laryngeal paralysis, masticatory muscle abnormalities, facial paralysis, trigeminal neuropathy, Horner’s syndrome
• Discuss the differential diagnoses, neurodiagnostic investigation, treatment, and prognosis of the most common disorders of the head and face
• Illustrate how to evaluate the function of the vestibular system and how to distinguish between central and peripheral lesions
• Illustrate how to evaluate the function of the auditory system (including BAEP)
• List the diseases affecting the vestibular system (based on localization), their diagnostic evaluation, treatment, and prognosis
• List the diseases affecting the auditory system, their diagnostic evaluation, treatment, and prognosis
• Describe the functional neuroanatomy of the key areas of the cerebellum
• Summarize the clinical signs of cerebellar dysfunction
• List the diseases affecting the cerebellum, their diagnostic evaluation, treatment, and prognosis

Learning objectives:

• Demonstrate how to clinically localize a disease process to the cervical spinal cord
• List differential diagnoses appropriate to the localization (cervical)
• Summarize the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the cervical spinal cord, using the acronym VITAMIN-D
• Establish a protocol for diagnostic tests suitable to each disease process (cervical)
• Indicate appropriate treatment options and prognostic factors (cervical)

Learning objectives:

• Demonstrate how to clinically localize a disease process to the thoracolumbar spinal cord
• List differential diagnoses appropriate to the localization (thoracolumbar)
• Summarize the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the thoracolumbar spinal cord, using the acronym VITAMIN-D
• Establish a protocol for diagnostic tests suitable to each disease process (thoracolumbar)
• Indicate appropriate treatment options and prognostic factors (thoracolumbar)

Learning objectives:

• Demonstrate how to clinically localise a disease process to the lumbosacral junction and cauda equina 

• List differential diagnoses appropriate to the localisations 

• Summarise the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the lumbar spinal cord and the cauda equina, using the acronym VITAMIN-D 

• Establish a protocol for diagnostic tests suitable to each disease process 

• Indicate appropriate treatment options and prognostic factors 

• Explain the physiology of micturition and the neurolocalisation of the disorders of micturition based on the clinical signs 

• Differentiate between upper motor neuron and lower motor neuron bladder dysfunction 

• List the most common differentials for the disorders of micturition, their treatment and the important prognostic factors 

Learning objective:

• Demonstrate how to clinically localize a disease process to the peripheral nervous system
• List differential diagnoses appropriate to the localization (peripheral nervous system)
• Summarize the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the peripheral nervous system, using the acronym VITAMIN-D
• Establish a protocol for diagnostic tests suitable to each disease process (peripheral nervous system)
• Indicate appropriate treatment options and prognostic factors (peripheral nervous system)

Learning objectives:

• Define status epilepticus and cluster seizures, and describe their etiology and pathophysiology
• Outline appropriate at-home and in-hospital emergency treatment of status epilepticus and cluster seizures
• List the supportive care needed by a patient with status epilepticus and cluster seizures
• Describe the diagnostic procedures required in case of status epilepticus and cluster seizures
• Recognise prognostic factors and possible complications in a patient with status epilepticus and cluster seizures
• Discuss the pathophysiology of head trauma (primary and secondary brain injury, raised intracranial pressure)
• Describe how to assess the patient with head trauma (primary and secondary assessment) and the appropriate emergency treatment
• Choose the necessary diagnostic procedures and select the appropriate treatment for the patient with head trauma (medical and surgical)
• Assess the importance of intracranial pressure monitoring and the modified Glasgow coma scoring system in a patient with head trauma
• Recognize prognostic factors and possible complications in a patient with head trauma
• Discuss the pathophysiology of spinal trauma and the possible causes
• Describe how to assess the patient with spinal trauma and the appropriate stabilization and emergency treatment
• Choose the necessary diagnostic procedures and select the appropriate treatment (for primary injury and secondary injury) for the patient with spinal trauma including principles and indications for surgical vertebral stabilization
• Recognize prognostic factors and possible complications in a patient with spinal trauma

Learning objectives:

• List the appropriate clinical parameters and blood tests needed to safely anaesthetise a patient with a neurological condition
• Summarize key aspects of the physiology and pathophysiology of anaesthesia, relevant to the neurological patient
• Choose the appropriate protocol, drugs and anaesthetic agents to safely anaesthetise a patient with an intracranial disease
• Describe suitable monitoring for the anaesthesia of a patient with an intracranial disease
• Outline the protocol needed for the safe recovery and analgesia of a patient with an intracranial disease
• Choose the appropriate protocol, drugs and anaesthetic agents to safely anaesthetise a patient with a spinal disease
• Describe suitable monitoring for the anaesthesia of a patient with a spinal disease
• Outline the protocol needed for the safe recovery and analgesia of a patient with a spinal disease
• Choose the appropriate protocol, drugs and anaesthetic agents to safely anaesthetise a patient with a peripheral nervous system disease
• Describe suitable monitoring for the anaesthesia of a patient with a peripheral nervous system disease
• Outline the protocol needed for the safe recovery and analgesia of a patient with a peripheral nervous system disease
• Describe the essential physiology of pain (including transduction, transmission and perception) and the mechanism of neuropathic pain
• Assess the importance and the limitations of pain scoring in a patient with a neurological condition
• Plan the most suitable analgesic protocol for the most common neurological disorders and surgical procedures, listing indications, contraindications, side effects, interactions
• Describe the use of fluid therapy in neurological patients during the preoperative, intra-operative and post-operative periods: indications, protocols, monitoring
• Explain how to evaluate and manage blood loss in the neurological patient

Learning objectives:

• Review the principles of physical rehabilitation, its indications, contraindications and benefits for the neurological patient
• Discuss the initial assessment of the patient and recognize its value in physical rehabilitation
• Evaluate the physical modalities of rehabilitation indicated in the neurological patient (physiotherapy, hydrotherapy, massages, passive range of motion, laser therapy, heat and cold, electrotherapy)
• Suggest therapeutic exercises for particular neurological diseases and justify any recommendations
• Indicate the risks, benefits, therapeutic time frames and monitoring of the therapeutic plans recommended
• Explain the modalities for the management of the bladder and bowel functions in the neurological patient and analyze their indications, possible complications, and appropriate monitoring
• Recognize how to care for the respiratory system in the neurological patient and how to monitor function and possible complications
• Assess the importance of appropriate nutrition in the neurological patient and indicate the neurological patient’s specific needs

Learning objective:

• Summarize the anatomy and the physiology of CSF production and drainage
• Illustrate suitable techniques to collect CSF from the cisterna magna and the lumbar spinal area and the risks involved
• Identify the contraindications of CSF sampling
• Identify the advantages and disadvantages of each type of CSF collection technique and their suitability to the different disease processes
• List the suitable tests and techniques to analyse CSF after collection
• Interpret the results of CSF analysis and how to relate them to the disease processes
• Identify the principles of electrodiagnostic evaluation of the neuromuscular system and the most appropriate technique for the clinical presentation
• Describe how to position the patient during electrodiagnostic evaluations
• Describe the correct positioning of the electrodes and the use of the computer for electrodiagnostic evaluations
• Interpret the results of electrodiagnostic tests (recognizing artifacts and incorrect positioning of the electrodes) and how to relate them to disease processes and clinical presentation
• Assess the use of muscle and nerve biopsies in the neurodiagnostic evaluation of a neuromuscular disease: indications, limitations, and contraindications
• Interpret the results of muscle and nerve biopsy analysis and how to relate them to the disease processes and clinical presentation

Learning Objectives

• Demonstrate how to position the patient during CSF collection
• Perform a CSF collection using the correct positioning for cisternal and lumbar areas
• Recognize how to analyze CSF composition (cell count, cytology, and protein content) using the correct equipment
• Demonstrate how to position the patient during muscle and nerve biopsies
• List the muscles and nerves suitable for biopsies and explain why
• Perform muscle and nerve biopsies using the correct surgical techniques
• Demonstrate how to handle, preserve, and submit the muscle and nerve biopsy samples for analysis

Learning Objectives

• Summarise the clinical application (including indications, advantages, disadvantages, assessment of the patient and complications) and describe patient positioning, surgical approach and procedure for the following surgical techniques:
• Ventral slot and cervical fenestration
• Hemilaminectomy and thoracolumbar fenestration
• Lumbo-sacral dorsal laminectomy and partial discectomy  

Learning Objectives

• Summarise the clinical application (including indications, advantages, disadvantages, and complications) for the following surgical procedures:
• Laminectomy
• Mini-hemilaminectomy
• Pediculectomy
• Corpectomy
• Vertebral stabilization