Small Animal Practice

Veterinary Teaching Hospital

Airlangga University

Differential Diagnose

Seizure

• Seizure defined as the physical manifestation of an abnormal balance between excitatory and inhibitory tone in central nervous system

• Terms used by clients: epilepsy, fit, convulsion

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Basic Catagories

• Focal (partial) – Localized area of neuronal dysfunction – Usually acquired – Psycomotor seizure (hallucinations/fly bitting) – Unilateral, stereotypical or bizzare behavior – Simple partial : no loss conciousness – Complex partial : altered mentation, or loss of conciousness

• General – Loss of conciousness – Tonic, clonic, myoclonic activity – Absence of local signs – Classify :

• Presence of violent muscular activity (grand mal seizure) • Absence of such activity (petit mal seizures)

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Seizure Classification and Causes

Structural Epileptic Seizure Reactive Epileptic Seizure Primary Epileptic Seizure

Congenital : hydrocephalus Hypoglycemia Unknown Cause

Hereditary : lysosomal storage

disease

Hyperammonemia Common age : >1 but <5 years

Toxin Common breeds : Poodle, Beagle,

German shepherd, Retrievers Neoplasia : primary or metastatic Electrolyte dearrangement

Hypertension

Infectious : viral, bacterial, tick

borne, fungal, protozoal, parasitic

Polycytemia

Coagulopathy

Inflammatory : Pug dog encephalitis,

granulomatous meningoencephalitis,

necrotizing encephalitis of Maltese

and Yorkshire Terriers

Trauma

Vascular or Thromboembolic

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Differentiating Seizure from Syncope

Syncope Seizure (generalized)

Precipitating event/timing Exercise, excitement, stress, cough, urination, defecation

Often at rest or on walking

Pre event Acute weakness, staggering, vocalisation

Anxiety, attention-seeking

Event Usually flaccid limb but maybe rigid Jaw motion, hypersalivation, tonic-clonic limb motion or limb rigidity

Duration less than 1 minute Duration often greater than 1 minute

Rarely urination/defecation Urination and/or defecation

Usually retain conciousness, but may lose conciousness

Loss of conciousness

Abnormal heart rhythm or rate may or may not be palpated/auscultated

Often sinus tachycardia

Post event Rapid recovery Slow recovery, prolonged post-event disorientation

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Intracranial

• Idiopathic* • Congenital

– Ceroid lipofuscinosis – Chiari-like malformation – Cortical dysplasia – Hydrocephalus – Intracranial arachnoid cysts – Lissencephaly – Lysosomal storage diseases – Organic acidurias, e.g.

• L-2-hydroxyglutaric aciduria

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Intracranial

• Infectious

– Bacterial, e.g. [Nocardiosis; Pasteurellas pp; Staphylococcusspp]

– Fungal [Aspergillosis; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Histoplasmosis; Mucormycosis]

– Parasitic [Aberrant migration of Cuterebras pp; Dirofilariasis]

– Protozoal, e.g. [Neosporosis (Dog); Toxoplasmosis]

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Intracranial

• Infectious

– Rickettsial encephalitis [Ehrlichiosis/anaplasmosis; Rocky Mountain Spotted Fever]

– Viral [Canine distemper* (Dog); Canine herpes virus (Dog); Eastern equine encephalitis; Feline immunodeficiency virus* (Cat); Feline infectious peritonitis* (Cat); Feline leukaemia virus* (Cat); Pseudorabies; Rabies]

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Intracranial

• Inflammatory/immune-mediated disease

– Breed-specific necrotising meningoencephalitis

– Distemper-vaccine-associated (Dog)

– Eosinophilic meningoencephalitis

– Granulomatous meningoencephalomyelitis* (Dog)

– Steroid-responsive meningoencephalitis

• Physical

– Trauma

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Intracranial

• Neoplasia

– Primary intracranial [Astrocytoma; Choroid plexus tumours; Ependymoma; Ganglioblastoma; Glioma; Medulloblastoma; Meningioma; Neuroblastoma; Oligodendroglioma]

– Local extension [Middle-ear tumour; Nasal/paranasal sinus tumour; Pituitary tumour; Skull tumour]

– Metastatic, e.g. [Haemangiosarcoma; Lymphoma; Malignant melanoma; Mammary carcinoma; Prostatic carcinoma; Pulmonary carcinoma; Teratoma]

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Intracranial

• Vascular

– Haemorrhage, e.g.

• Coagulopathy

• Feline ischaemic encephalopathy (Cat)

• Hypertension

• Trauma

– Infarction, e.g.

• Thromboembolism

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Extracranial

• Metabolic

– Electrolyte imbalances*, e.g. [Hypernatraemia; Hypocalcaemia; Hyponatraemia]

– Hepatic encephalopathy*

– Hypoglycaemia

– Renal failure*

• Nutritional

– Thiamine deficiency

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Extracranial

• Drugs/toxins – Alphachloralose

– Arsenic

– Baclofen

– Blue-green algae

– Borax

– Cannabis

– Carbamate

– Doxapram

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Extracranial

• Drugs/toxins – Ethylene glycol

– Glyphosphate

– Honeysuckle

– Hymenoptera stings

– Ibuprofen

– Iodine-containing myelographic contrast media

– Laburnum

– Lead

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Extracranial

• Drugs/toxins – Lignocaine

– Metaldehyde

– Metronidazole

– Mexiletine

– Mistletoe

– Organophosphates

– Paracetamol

– Petroleum distillates

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Extracranial

• Drugs/toxins – Phenoxy acid herbicides

– Piperazine

– Plastic explosives

– Pyrethrin/pyrethroids

– Risperidone

– Salt

– Selective serotonin reuptake inhibitors

– Strychnine

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Extracranial

• Drugs/toxins

– Terfenadine

– Theobromine

– Theophylline

– Tricyclic antidepressants

– Vitamin D rodenticides

– Yew

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Thank you.....