Neurologie, zintuigen & anesthesiologie
Inhoudsopgave
HC 1: Neuro-anatomie en neuro-fysiologie ...................................................................................................................... 4
HC 2: Reflexen .................................................................................................................................................................... 7
HC 3: Reactiepatronen van CZS ..................................................................................................................................... 11
HC 4: Oog .......................................................................................................................................................................... 17
HC 5: Gehoor .................................................................................................................................................................... 22
HC 6: Klinische diagnostiek ogen/ visus ......................................................................................................................... 33
HC 7: Aandoeningen van de ogen ................................................................................................................................... 35
HC 9: Neurale regulatie van motoriek en locomotie...................................................................................................... 47
Locomotie ................................................................................................................................................................. 47
Werking CPG ............................................................................................................................................................ 47
Afdalende banen, motorische kernen hersenstam en vestibulo- & spinocerebellum ................................................ 50
Decebratie regiditeit .................................................................................................................................................. 53
HC 10: Vestibulaire controle over blik en lichaamshouding ........................................................................................ 54
HC 11: Ataxie en incoördinatie ....................................................................................................................................... 60
Locatie UMN ............................................................................................................................................................ 61
Ataxie ........................................................................................................................................................................ 62
Proprioceptie ............................................................................................................................................................. 63
3 vormen van ataxie .................................................................................................................................................. 63
Oorzaken ataxie in grote lijnen ................................................................................................................................. 66
‘’Valse’’ ataxie .......................................................................................................................................................... 66
MTE: Thema A en B ........................................................................................................................................................ 67
1
, Casus thema A................................................................................................................................................................ 67
Casus thema B................................................................................................................................................................ 67
PR 3a/b – Klinische diagnostiek ZS hond en paard ....................................................................................................... 69
Hond/ Kat ....................................................................................................................................................................... 69
Paard ............................................................................................................................................................................. 71
HC 12: Aspecten van pijn ................................................................................................................................................ 79
HC 13: Anesthesiologie ..................................................................................................................................................... 85
HC 14: Klinische anesthesiologie en farmacologie ......................................................................................................... 88
Sedativa I - α2-adrenoceptor agonisten ......................................................................................................................... 89
Sedativa II - antipsychotica: dopamine (D2)-receptor antagonisten ............................................................................. 90
Sedativa III - benzodiazepines ....................................................................................................................................... 91
Pre-medicatie: anticholinergica .................................................................................................................................... 92
Inductie I: barbituraten .................................................................................................................................................. 92
Inductie II: non-barbituraten (hypnotica) ...................................................................................................................... 93
Inductie III - dissociativa (slaap + analgesie) ............................................................................................................... 93
Inductie IV – Inhalatie anesthetica ................................................................................................................................ 94
Inhalatie anesthesie ....................................................................................................................................................... 94
HC 15: Klinische pijnstilling en farmacologie ................................................................................................................ 96
Analgetica I – NSAID’s .................................................................................................................................................. 97
Analgetica II – opioïden ................................................................................................................................................. 98
Analgetica III – lokaalanesthetica ................................................................................................................................. 99
Analgetica IV – V – VI ................................................................................................................................................. 100
MTE: Thema C ............................................................................................................................................................... 102
Casus A ........................................................................................................................................................................ 102
Casus B ........................................................................................................................................................................ 102
, HC 1: Neuro-anatomie en neuro-fysiologie
Botulisme: een stofje dat de afgifte van acetyl-choline
bij de motorneuronen blokkeert. “Neurotoxine
voorkomt afgifte ACh door lower motoneuronen (a-
motorneuronen) en post-ganglionaire parasympatische
neuronen”.
→ Ook probleem met sympatisch en parasympatisch,
want beiden gebruiken ACh
Myasthenia gravis: auto-antilichamen tegen nicotine
ACh-receptoren van de willekeurige spieren
(somatische zenuwstelsel) van de lower
motorneuronen. Signaal kan dan niet worden
overgedragen: spierzwakte (parese slokdarm of
ledematen).
Therapie d.m.v. acetylcholine-esterase remmers: dan
voorkom je de afbraak van acetylcholine, dan komt er
een overmaat aan acetylcholine in de synapsspleet,
waardoor de skeletspiervezels toch nog geactiveerd
worden ondanks er minder receptoren zijn
Ruggenmerg:
Onderdeel CZS en zit binnen de ruggenwervels. Het
ruggenmerg van kat en hond bestaat uit 35 tot 38
segmenten
• 8 cervicaal (7 wervels), 1e zenuw komt voor de 1e
wervel naar buiten, 8e na de 7e. Daarna elke zenuw
caudaal van elke wervel naar buiten
• 13 Thoracaal
• 7 lumbaal
• 3 sacraal
• 4 tot 7 caudaal
C6 - T2 = aansturing voorpoten, daar liggen
patroongeneratoren die de benen in beweging kunnen
zetten. Daar zit de motoriek van de voorpoten
De ruggenwervelkolom is langer dan het ruggenmerg. Er
lopen dan losse zenuwen door de wervelkolom en dat heet
de paardenstaart = cauda equina, zodat ze alsnog bij de bijbehorende ruggenwervel naar buiten kunnen
komen.
L4 - S3 = Motoriek achterpoten
Parasympatische zenuwaansturing zit helemaal sacraal, de pelvic nerves: aansturing colon en blaas
Het ruggenmerg is altijd omgeven door 3 vliezen:
• Duramater
• Arachnoid membraan
• Piamater
Zenuw treedt caudaal van wervel uit (m.u.v. 1e zenuw!). Tussenwervelschijf
ligt onder het ruggenmerg. Als deze gaat uitpuilen = hernia, komt deze
gemakkelijk tegen een zenuw aan.
4
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