Top Tip No.1
The primary goal for a clinician evaluating an animal with acute vestibular system dysfunction is to determine whether the animal has evidence of central or peripheral vestibular disorder. Correctly identifying central vestibular disorder requires identification of clinical signs that cannot be attributed to disease of the peripheral vestibular system. The presence of postural reaction deficits, altered mental status, cerebellar dysfunction, vertical nystagmus or nystagmus that changes direction with changes in head position are clinical signs suggestive of central vestibular disorder.
Top Tip No.2
Vascular disorders of the central nervous system (CNS) can results from loss of blood supply (ischemia/infarction) or from hemorrhage into the nervous system. Vascular diseases such as cerebrovascular accident (stroke) or fibrocartilaginous embolism (FCE) are characterised clinically by a peracute or acute onset of non-progressive or regressive neurological signs. Deficits are usually initially focal and often asymmetrical. These historical and clinical characteristics can be used to differentiate vascular disease from other causes of acute CNS dysfunction.
Top Tip No.3
When evaluating animals with head injury, it is important to realise that extracranial disturbances, such as systemic hypotension or hypoxemia, can have a dramatic influence on outcome. The initial assessment of brain-injured patient should therefore focused on the ‘ABC’ (airway, breathing, cardiovascular) of emergency care and not the patient’s neurological status. The most important consideration in head trauma is maintenance of cerebral perfusion by treatment of hypotension and minimising increases in intracranial pressure.
Top Tip No.4
Nociception is the most important prognostic indicator of severity that can be obtained from the neurological examination of an acutely paralysed animal. It is tested by pinching the digits with the fingers or with hemostats and observing a behavioural response to the noxious stimulus. Simply pulling the foot away from the stimulus does not indicate conscious recognition of pain. Misinterpretation of this withdrawal reflex may lead to a falsely optimistic prognosis.
Top Tip No.5
Lactulose can be administered as an enema in comatose patients with hepatic encephalopathy. Its mechanism of action involves reducing the amount of colonic ammonia production by changing the bacterial flora, ‘trapping’ ammonia by acidifying the gut content and having a cathartic effect.
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