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TOP TIPS PART 2

Laurent Garosi  DVM, Dip ECVN, MRCVS, RCVS & European Specialist in Veterinary Neurology
Head of Neurology/Neurosurgery, Davies Veterinary Specialists

Top Tip No.6

 

 

   

Top Tip No.6
Mannitol has an immediate plasma-expanding effect that reduces blood viscosity, increases cerebral blood flow and oxygen delivery that is very useful in the treatment of intracranial hypertension. Thus intracranial pressure decreases secondary to a decreased cerebral blood volume despite maintained cerebral blood flow. Repeated dosing (0.2 to 1.0 g/kg intraveinous) every 4 to 6 hours can be used if necessary but ultimately causes volume depletion. Mannitol should be avoided in hypovolemic animals until intraveinous fluid therapy has achieved adequate volume expansion to maintain systemic blood pressure, and thus cerebral perfusion pressure.

Top Tip No.7
Benzodiazepines such as diazepam or midazolam are the drugs most commonly used in veterinary medicine for the initial treatment of status epilepticus (SE). With their relatively brief duration of action however, benzodiazepines are not a definitive therapy for SE. If benzodiazepines do not control the seizures, the use of phenobarbitone should be considered. An intraveinous loading dose of phenobarbitone (18 mg/kg) can be used to achieve a rapid rise in serum blood concentration as part of the emergency treatment of SE in a patient not already on maintenance oral phenobarbitone. Constant rate infusion of propofol can be used in SE that does not respond to a benzodiazepine or phenobarbital.

Top Tip No.8
When the spine is subjected to exogenous injury such as a road traffic accident, the impact often causes vertebral fracture or luxation.  Alignment and stabilisation of the vertebral column is indicated in animals that demonstrate severe displacement or instability of a fracture or luxation.  Decompression is indicated if myelography confirms spinal cord compression from intervertebral disc rupture or hematoma

Top Tip No.9
Tetanus is potentially a life-threatening disease in dogs. Clinical signs of tetanus include a stiff gait, prolapse of the third eyelid, and risus sardonicus (i.e., sardonic grin). Tetanus may culminate in death from respiratory failure and/or autonomic dysfunction. Treatment classically involves antitoxin, antimicrobial therapy, wound management, central and peripheral muscle relaxants to control hypertonicity and supportive care. The prognosis for survival in dogs is good if abnormalities in heart rate or blood pressure values do not develop.

Top Tip No.10
Long-term administration of metronidazole can cause neurotoxicoses in dogs and cats. Most animals present with subacute to acute neurological signs that often refers to bilateral central vestibular and cerebellar anatomic diagnosis. Neurological signs tend to resolve within days of initiating supportive therapy and withdrawal of the drug. Diazepam can be used as symptomatic treatment.

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