Explain the differential diagnose of seizure in small animal

1. Veterinary Teaching Hospital
Airlangga University
Small Animal Practice
Differential
Diagnose

2. 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
triakoso 2014

3. 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)
triakoso 2014

4. 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
Neoplasia : primary or metastatic
Electrolyte dearrangement
Common breeds : Poodle, Beagle,
German shepherd, Retrievers
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
triakoso 2014

5. Differentiating Seizure from Syncope
Syncope
Precipitating event/timing Exercise, excitement, stress, cough,
Seizure (generalized)
Often at rest or on walking
urination, defecation
Pre event
Acute weakness, staggering,
vocalisation
Anxiety, attention-seeking
Event
Usually flaccid limb but maybe rigid
Jaw motion, hypersalivation, tonicclonic 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
Rapid recovery
Slow recovery, prolonged post-event
disorientation
Post event
triakoso 2014

6. triakoso 2014

7. 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
triakoso 2014

8. 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]
triakoso 2014

9. 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]
triakoso 2014

10. Intracranial
• Inflammatory/immune-mediated disease
– Breed-specific necrotising meningoencephalitis
– Distemper-vaccine-associated (Dog)
– Eosinophilic meningoencephalitis
– Granulomatous meningoencephalomyelitis* (Dog)
– Steroid-responsive meningoencephalitis
• Physical
– Trauma
triakoso 2014

11. 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]
triakoso 2014

12. Intracranial
• Vascular
– Haemorrhage, e.g.
•
•
•
•
Coagulopathy
Feline ischaemic encephalopathy (Cat)
Hypertension
Trauma
– Infarction, e.g.
• Thromboembolism
triakoso 2014

13. Extracranial
• Metabolic
– Electrolyte imbalances*, e.g. [Hypernatraemia;
Hypocalcaemia; Hyponatraemia]
– Hepatic encephalopathy*
– Hypoglycaemia
– Renal failure*
• Nutritional
– Thiamine deficiency
triakoso 2014

14. Extracranial
• Drugs/toxins
– Alphachloralose
– Arsenic
– Baclofen
– Blue-green algae
– Borax
– Cannabis
– Carbamate
– Doxapram
triakoso 2014

15. Extracranial
• Drugs/toxins
– Ethylene glycol
– Glyphosphate
– Honeysuckle
– Hymenoptera stings
– Ibuprofen
– Iodine-containing myelographic contrast media
– Laburnum
– Lead
triakoso 2014

16. Extracranial
• Drugs/toxins
– Lignocaine
– Metaldehyde
– Metronidazole
– Mexiletine
– Mistletoe
– Organophosphates
– Paracetamol
– Petroleum distillates
triakoso 2014

17. Extracranial
• Drugs/toxins
– Phenoxy acid herbicides
– Piperazine
– Plastic explosives
– Pyrethrin/pyrethroids
– Risperidone
– Salt
– Selective serotonin reuptake inhibitors
– Strychnine
triakoso 2014

18. Extracranial
• Drugs/toxins
– Terfenadine
– Theobromine
– Theophylline
– Tricyclic antidepressants
– Vitamin D rodenticides
– Yew
triakoso 2014

19. Thank you.....