“The truth is, everyone is going to hurt you. You
just have to find the ones worth suffering for.”
- Bob Marley
And its associated diseases
Diseases of the Brain: Head Trauma
Dog skull and brain
1º Trauma—Direct trauma to brain tissue
2º Trauma: edema, hemorrhage (↑ intracranial pressure)
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
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 >48 hrs usually does not survive
 Worsening neuro signs → bad prognosis
Idiopathic Vestibular Disease
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Signs - ACUTE
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Loss of balance
Head tilt
Nystagmus
Disorientation
Ataxia
Vomiting/anorexia
SIGNALMENT: Middle-aged dogs & cats
Idiopathic Vestibular disease
http://www.youtube.com/watch?v=Y25T7dZ77T4&feature=related
Idiopathic Vestibular Disease
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Diagnosis
History & clinical signs
Blood work to r/o other diseases of nervous system
Otoscopic exam to r/o inner ear infection
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Treatment
No specific treatment recommended; does not alter
course of disease
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antibiotics, steroids often given to cover possible causes not
found by PE and lab work
Clinical signs resolve in 3-6 wks
Brain Disorders: Neoplasia
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Enlarging mass in brain; causes compression of
healthy tissue or replacement with cancerous
tissue
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Signs - usually progressive
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Depends on tumor location
Seizures increasing in frequency and intensity
Vestibular signs (depending on location)
Tremors, ataxia
Neoplasia
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Diagnosis
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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
Brain disorders: Neoplasia
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Treatment:
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Surgical removal of superficial single lesions
Radiation therapy
Chemotherapy; efficacy varies with tumor type
(lymphomas respond well; other less so)
Anti-epileptic medication - Phenobarbital
Corticosteroids—prednisone
Client info
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Unless tumor is surgically removed, medications will not
cure disease
Symptoms will worsen as tumor grows larger
Brain Disorders: Epilepsy
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Signs of seizure
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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
 http://www.thepetcenter.com/gen/epilepsy.html
Epilepsy
 Diagnosis
 CBC, chem panel—r/o metabolic diseases causing seizures
 hypoglycemia
 hypocalcemia
 hepatic encephalopathy
 Radiographs—r/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 >1 every mo or two (may not completely stop seizures)
 Phenobarbital is treatment of choice
 Potassium Bromide may be added if seizures not controlled
Status Epilepticus
 prolonged, uninterrupted seizures
 Treatment
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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)
Phenobarbital—IV or IM
 Drugs
 Diazepam (2-10 mg to effect); can be repeated over several
minutes
Phenobarbital -
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Time to steady state blood levels: 7-10 days
Side effects: sedation, ataxia, PU/PD/PP, hepatotoxicity, blood
dyscrasias (Rare)
Epilepsy
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Client info
Epilepsy is an incurable disease
Even with treatment, animal may still seize;
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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
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
Spinal Cord: Anatomy
Like brain, spinal cord enclosed in hard covering
IVDD problem in both humans and canine
Anatomical differences—cervical same; lumbar—human bears weight, canine doesn’t
Attached rib (thorax) helps stabilize the IV joint; worse at T-L junction (dogs)
Intervertebral Disk Disease
Normal spinal column and disk
1/3 thickness
nucleus fibrosus
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
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
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Dachshunds, shih tzus, Lhasa apsos, beagles, basset hounds
(poodles also affected)
Acute onset
Can occur at any age, but generally younger dogs
Intervertebral Disk Disease
Prolapsed Disk
Intervertebral Disk disease
 Hansen TYPE 2: dorsal protrusion of the annulus into
the spinal canal
 Common in older dogs and nonchondrodystrophic breeds
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Occurs over a longer period of time
Clinical signs may be less severe
Generally older dogs
Intervertebral Disk Disease
 Signs
 Pain
 Paresis/paralysis; nerve function is lost in this order:
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Proprioception—largest fibers; most susceptible to
pressure; signs are ataxia
Motor fibers—next smallest fibers; signs are
weakness/paresis
Cutaneous sensory fibers—small; require a lot of pressure
to disrupt function; decreased panniculus reflex
Deep pain fibers—smallest fibers; require the most
pressure to disrupt; loss is associated with poor prognosis
Intervertebral Disk disease
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Severity of clinical signs depends on:
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Speed at which disk material is deposited
Degree of compression
Duration of compression
IVDD: Paralysis of rear legs
http://www.youtube.com/watch?v=vPIXafwGVU
Cervical IVDD
Loss of Deep Pain
IVDD: Spinal Radiographs
Normal
horse’s head
consistent IV space
Subluxation L2-3
(old lesion)
IV Disk Disease: Myelogram
Which disk space?
IV Disk Disease: Myelogram
Which disk space?
Cervical IVDD
Myelogram: Disk herniation at C2-3 (narrowed IV space, narrowed spinal canal)
IVDD
 TYPE I, acute onset
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Medical Rx is recommended for animals, with deep pain
intact
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High levels of corticosteroids is CONTROVERSIAL
Strict confinement—6-8 wk minimum
Nursing care
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Soft padded cage
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Urinary cath or express bladder several times/day
Surgery is recommended for
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repeat offenders
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No voluntary motor function
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loss of deep pain (needs to be done QUICKLY!)
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worsening neuro signs (poor prognosis)
Surgery: Laminectomy
IVDD: Possible sequela
IVDD
IVDD: Rehabilitation
http://www.youtube.com/watch?v=7AkNVDc4
lig&feature=related
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
Veterinary Acupuncture
• http://www.youtube.com/watch?v=ZJjZPnk_Mw&feature=related
• http://www.youtube.com/watch?v=vJIJDUQyOm
w&feature=fvw
IVDD
 Client info
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Do not let susceptible breeds get overweight
Encourage animals to keep spine parallel to ground
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No jumping on/off couch
No begging on hind legs
No stair climbing
Loss of deep pain >24 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