Term
| Which anticonvulsant drug has a longer half-life: phenobarbitone or potassium bromide? |
|
Definition
Potassium bromide
- this both means it will stay in effect longer (can be administered once a day) and that it takes longer to establish steady state blood levels |
|
|
Term
| What can be used for emergency treatment of status epilepticus? |
|
Definition
DIAZEPAM
propofol
pentobaritone
Ketamine/iso (anesthetize them)
body cooling
*may need to give glucose |
|
|
Term
| Which anticonvulsant is more likely to cause toxicity phenobarbitone or potassium bromide? |
|
Definition
phenobarbitone
can cause liver toxicity |
|
|
Term
| What are the two primary (and basic) functions of the nervous system? |
|
Definition
To DETECT changes
and RESPOND to them
** this means that there must be a sensor - intact pathway - and responding organ |
|
|
Term
Which of the following is not considered a sensory organ?
A) Skin receptors
B) Brain stem
C) muscle spindles
D) olfactory mucosa
E) Organ of corti
F) all of the above are sensory organs |
|
Definition
Answer: Brain stem
the rest are all considered sensory organs |
|
|
Term
| What is the basic functional unit of the nervous system? |
|
Definition
The reflex arc!!
Consists of:
recrptor->sensory fiber (afferent) -> dorsal root ganglion -> synapse -> motor fiber -> effector (ie. skeletal muscle) |
|
|
Term
| Where does the synapse between afferent and efferent (motor) fibers occur specifically? |
|
Definition
the gray matter of the spinal cord
*afferents = dorsal root
*efferents - ventral root |
|
|
Term
Where do afferent fibers enter the gray matter of the spinal cord?
Where do efferent fibers enter? |
|
Definition
Dorsal root = afferent
Ventral root = efferent |
|
|
Term
| What coordinates reflex arcs? |
|
Definition
The brain.
derp.
This is super important though because there is a reflex arc for each segment and they need to be coordinated to prevent chaos |
|
|
Term
| Where can ascending and descending motor tracts be found? |
|
Definition
| In the WHITE MATTER of the spinal cord |
|
|
Term
| Where are the two primary destinations of ascending tracts? |
|
Definition
Cerebrum (conscious sensation)
Cerebellum (cor-ordination) |
|
|
Term
| Conscious sensation is controlled by: cerebellum or cerebrum ? |
|
Definition
|
|
Term
| Coordination of motor activity is controlled by: Cerebellum or Cerebrum? |
|
Definition
|
|
Term
| What are the ascending tracts that head to the cerebrum through the thalamus? |
|
Definition
Dorsal columns (gracile and cuneate fasciculus
Spinothalamic tract |
|
|
Term
| What are the ascending tracts that head to the cerebellum? |
|
Definition
Dorsal Spinocerebellar tract
Ventral spinocerebellar tract |
|
|
Term
Dorsal columns:
What kind of tracts are they?
Where are they located?
Where do they go?
What type of information do they carry? |
|
Definition
DORSAL COLUMNS
- ascending tracts
- located down the middle of the white matter of spinal cord
-goes to the cerebrum through thalamus
- carries low threshold skin sensation, "conscious" proprioception |
|
|
Term
Spinothalamic tract:
What kind of tract is it?
Where is it located?
Where does it go?
What type of information does it carry? |
|
Definition
SPINOTHALAMIC TRACT
- ascending tract
- located in the lateral aspects of the white matter in spinal cord
- goes to the cerebrum through thalamus
- carries high threshold sensation, pain
*multisynaptic pathway that crosses multiple times.
* only finely myelinated or unemyelinated!! |
|
|
Term
Dorsal Spinocerebellar tract:
What kind of tract is it?
Where is it located?
Where does it go?
What type of information does it carry? |
|
Definition
DORSAL SPINOCEREBELLAR TRACT
- ascending tract
- dorsolateral aspects of white matter in spinal cord
Dorsal Lateral Funiculus
- goes to cerebellum
- "direct" spinocerebellar tract |
|
|
Term
Ventral Spinocerebellar tract:
What kind of tract is it?
Where is it located?
Where does it go?
What type of information does it carry? |
|
Definition
VENTRAL SPINOCEREBELLAR TRACT
- ascending tract
- located on most lateral edge in the white matter of the spinal cord
- goes to the cerebellum
- "indirect" spinocerebellar tract |
|
|
Term
| What does the cerebellum do? |
|
Definition
| Recieves both actual and planned movements - to compare and regulate movement |
|
|
Term
| What does the cerebellum do? |
|
Definition
| Recieves both actual and planned movements - to compare and regulate movement |
|
|
Term
| Pyramidal come from the cerebrum and their loss is more important in humans or animals? |
|
Definition
HUMANS
if the pyramidal tract is lost with a human motor function ceases, but this is less important with domestic species |
|
|
Term
| What are the two major types of descending motor tracts in humans? |
|
Definition
| Pyramidal and extra-pyramidal |
|
|
Term
| What are the descending tracts in animals? |
|
Definition
Corticospinal tract (pyramidal)
rubrospinal
vestibulospinal
tectospinal
reticulospinal
above are all extrapyramidal pathways |
|
|
Term
| Which descending tract is more important in humans that animals? |
|
Definition
|
|
Term
Ascending tracts collectively constitute the upper motor neuron centers.
True or False? |
|
Definition
FALSE
DESCENDING tracts compose the upper motor neuron center |
|
|
Term
| Where do lower motor neurons originate? |
|
Definition
in the gray matter of the brainstem or spinal cord
they they innervate the effector organ |
|
|
Term
| What would happen if a lower motor neuron stopped working? |
|
Definition
- loss of muscle tone
- loss of decrease of reflex
(hypotonus and hyporeflexia) |
|
|
Term
| Muscle flaccidity is characterisitic of upper or lower motor neuron disease? |
|
Definition
|
|
Term
| Rapid muscle atrophy is characteristic of upper or lower motor neuron disease? |
|
Definition
|
|
Term
| Hyporeflexia is characteristic of upper or lower motor neuron disease? |
|
Definition
|
|
Term
| In domestic species, UMN influence LMN directly or indirectly? |
|
Definition
INdirectly
they change the sensitivity of a reflex |
|
|
Term
| What controls the sensitivity of a reflex: UMN or LMN? |
|
Definition
Upper motor neuron
can increase or decrease sensitivity |
|
|
Term
| What are the effects of chronic upper motor neuron damage? |
|
Definition
- increased muscle tone
- increased reflex sensitivity
(hypertonia and hyperreflexia) |
|
|
Term
| Muscle spasticity is characteristic of UMN or LMN disease? |
|
Definition
|
|
Term
| Hyperreflexia is characteristic of UMN or LMN disease? |
|
Definition
|
|
Term
| Muscle wasting/atrophy will be seen with UMN or LMN disease? |
|
Definition
|
|
Term
| If there is damage to a peripheral nerve, UMN or LMN are damaged? |
|
Definition
|
|
Term
| What do reflex tests asses? |
|
Definition
they assess function of the reflex arc ONLY
*evaluate if intact or exaggerated* |
|
|
Term
| What is the blink reflex and what nerves does it test? |
|
Definition
touch canthus and side of face - animal should blink
- tests cranial nerves V and VII |
|
|
Term
| Pupillary light reflexes test what nerves? |
|
Definition
| optic nerve, Cranial nerve III (controls contriction), lateral geniculate body |
|
|
Term
Pupillary light reflex i a subcortical reflex and requires no conscious input.
True or False? |
|
Definition
|
|
Term
| What is mydraisis? What controls it? |
|
Definition
myDraisis = Dilation of pupil
controlled by sympathetic nervous system |
|
|
Term
| What is miosis and what controls it? |
|
Definition
Miosis - constriction of pupil
controlled by the parasympathetic NS by Cranial Nerve III |
|
|
Term
| Jaw tone assesses what nerve(s)? |
|
Definition
|
|
Term
| Gag reflex assesses which nerve(s)? |
|
Definition
Cranial nerve IX
** important in semicomatose animals* |
|
|
Term
| What nerve(s) do vestibular eye movements assess? |
|
Definition
Eye muscles: III, IV, VI
Vestibular function: VIII |
|
|
Term
| Menace response assesses which nerve(s)? |
|
Definition
Cranial nerve II (afferent)
Cranial nerve III (efferent - blinking) |
|
|
Term
| What are the two most consistent reflexes that can be used to evaluate spinal reflexes of the pelvic limb? |
|
Definition
|
|
Term
| What nerves does the patellar reflex assess? What segment of the spinal cord does it assess? |
|
Definition
Femoral nerve
spinal cord segments L4-L6 |
|
|
Term
| What nerve(s) and spinal segments are assessed by the withdrawal reflex of the pelvic limb? |
|
Definition
SCIATIC nerve
Spinal cord segments L6- S1 |
|
|
Term
| Loss of pelvic limb withdrawal reflex is most consistent with damage to what nerve? |
|
Definition
|
|
Term
| Why is spinal palpation important when evaluating neurologic disease? |
|
Definition
| Spinal injuries are often painful, so the site of a spinal lesion may be localized by palpating a region of intense pain. |
|
|
Term
| Which segments of the spinal cord are associated with the thoracic limb? |
|
Definition
|
|
Term
| What segments of the spinal cord are associated with the pelvic limb? |
|
Definition
|
|
Term
| If there is damage to the spinal cord in the C1-C5 region, what would you expect postural reaction and reflexes to look like in both thoracic and pelvic limbs? |
|
Definition
- abnormal postural reaction in all limbs
- intact reflexes in all limbs
*may drag feet and need support to stand |
|
|
Term
| If there is damage to the spinal cord in the C6-T2 region, what would you expect postural reaction and reflexes to look like in both thoracic and pelvic limbs? |
|
Definition
- abnormal posture reactions in all limbs
- depressed forelimb reflexes
- intact hindlimb reflexes |
|
|
Term
| If there is damage to the spinal cord in the T3-L3 region, what would you expect postural reaction and reflexes to look like in both thoracic and pelvic limbs? |
|
Definition
- abnormal postural reactions in HINDlimbs only
- intact reflexes of all limbs |
|
|
Term
| If there is damage to the spinal cord in the L4-S3 region, what would you expect postural reaction and reflexes to look like in both thoracic and pelvic limbs? |
|
Definition
- abnormal reflexes of hindlimbs only
- abnormal postural reactions of hindlimbs only
- forelimbs have normal reflexes and postural reactions |
|
|
Term
| If there is damage to a local peripheral nerve, what would you expect reflexes and postural reactions to show? |
|
Definition
Depressed reflexes
abnormal postural reactions |
|
|
Term
| If there is an injury to the brainstem, what would you expect of the limbs postural reactions and reflexes? |
|
Definition
Abnormal POSTURAL reactions of limbs
Normal limb reflexes
**cranial nerve deficits present** |
|
|
Term
| What would you expect of limb reflexes, postural reactions and cranial nerve function with an injury to the cerebellum? |
|
Definition
- abnormal postural reactions of limbs
- normal limb reflexes
- normal cranial nerve reflexes
* may have tremors, head tilt * |
|
|
Term
What would you expect to see with an injury to the 'forebrain'?
postural reactions, limb reflexes, cranial nerves, etc... |
|
Definition
- ABnormal postural reactions of limbs
- normal limbs reflexes
- may have cranial nerve deficits
***circling and altered mentation present** |
|
|
Term
| What ancillary diagnostic tests may be preformed when suspecting neurological disease? |
|
Definition
-Imaging: myelography and MRI
-electrdiagnostics
-CSF sampling |
|
|
Term
CSF sampling can be used to help diagnose the type of neurological disease present.
True or False? |
|
Definition
TRUE
will not determine location though |
|
|
Term
|
Definition
Diagnostics...
D= degenerative
A= anomalous
M= metabolic
N= nutritional, neoplasia
I= Inflammatory, infectious
T= Traumatic, toxic
V= Vascular |
|
|
Term
Non compressive spinal cord injuries may require surgery to alleviate neurologic symptoms.
True or False? |
|
Definition
FALSE
there is no surgical option for non compressive spinal cord lesions |
|
|
Term
| What are some causes of compressive spinal cord injuries? |
|
Definition
Intervertebral disc disease
fracture
luxation
tumors (neoplasia)
bone or ventricular malformation |
|
|
Term
| What are some causes of non-compressive spinal cord injuries? |
|
Definition
CONTUSION
infectious/inflammatory
Vascular
malformations
Degeneration
Toxic |
|
|
Term
| Single, localized, painful lesions of the spinal cord are characteristics of compressive or non-compressive injuries? |
|
Definition
COMPRESSIVE
non-compressive injuries tend to be poorly localized and more diffuse |
|
|
Term
| What are some causes of secondary non-compressive spinal cord injury? |
|
Definition
Elevated Intracellular calcium
inflammation |
|
|
Term
| How does elevated intracellular calcium cause secondary non compressive spinal cord injury? |
|
Definition
Enter neurons (via ion or gated channels)or axons (via reverse operation of Na/Ca exchanger).
-this activates apoptotic cascade
-activates enzymes, generation of free radicals
-free radical damage to cell and mitochondria = cell death
- activation of phospholipase A which starts inflammatory cascade |
|
|
Term
| How does inflammation cause secondary non compressive lesions of the spinal cord? |
|
Definition
Increased inflammatory mediators
- vasospasm
- increased vascular permeability
Increase inflammatory cells
- cytokins affect neural function
- toxic products produced |
|
|
Term
| How can spinal cord contusion be treated? |
|
Definition
NOT SURGICALLY
- maintain perfusion (normotension)
- methyprednisolone (controversial) |
|
|
Term
| When intracranial pressure is increased the brain can only move in one direction. What direction is that, and what portions of the brain may then be compressed? |
|
Definition
moves CAUDALLY
- tentorium
- foramen magnum |
|
|
Term
| What is the clinical presentation of infratentorial compression? |
|
Definition
- depression, stupor, coma
- bilateral dilatation of pupils
- ventrolateral strabismus of eyes |
|
|
Term
| What are the clinical signs associated with herniation through foramen magnum? |
|
Definition
- tetraparesis, tetraplegia (rigid or flaccid)
- stupor, coma, death
- loss of vestibular reflexes
- loss of gag reflex (CN IX)
- abnormal breathing patterns |
|
|
Term
| What are some infectious causes of brain injury? |
|
Definition
Canine distemper virus
FIP
protozoa (inflammatory)
reticulosis |
|
|
Term
| How would you diagnose a brain injury of infectious origin? |
|
Definition
| Blood sample, CSF analysis |
|
|
Term
What is discospondylitis?
How would you diagnose and treat it? |
|
Definition
infection of the disc/vertebral endplate
that is blood borne with local extension.
DX: xrays, CBC/Chem?UA
TX: Abx, possible surgery |
|
|
Term
| What is the typical appearance of discospondylitis? |
|
Definition
| "eaten out" (tehehe) areas of bone adjacent to the disc space |
|
|
Term
| What are some causes of CNS degeneration? |
|
Definition
- degenerative myelopathy of german shepards
-breed-related spinal conditions
- storage disease
-cerebellar degeneration |
|
|
Term
| What is the treatment options for CNS degeneration? |
|
Definition
|
|
Term
| What vascular causes of non-compressive spinal cord injuries? |
|
Definition
Fibrocartilaginous embolism
idiopathic hemorrhage
bleeding disorders
stroke |
|
|
Term
|
Definition
| incomplete closure of the neural tube - ie. spina bifida |
|
|
Term
| What can cause toxic injury to the spinal cord? |
|
Definition
Cannabus (the wacky tabacky)
ingredients of slug/snail bait (ferric sodium hydroxy EDTA)
toxic injury uncommon |
|
|
Term
| What are the long term effects of compression to the spinal cord? |
|
Definition
| prolonged pressure -> impaired perfusion -> demyelination, axon and neuron loss |
|
|
Term
| How can you diagnose a compressive spinal cord lesion? |
|
Definition
Localize with neuro exam (often painful)
**Imaging**
-myelogram
- MRI |
|
|
Term
| What is the difference between type 1 and type II disc degeneration? |
|
Definition
Type I: annulus RUPTURED and nucleus expelled.
-chondrodystrophic, middle aged dogs
-sudden onset
Type II: annulus intact
-non chondrodystrophic breeds, older
-chronic onset |
|
|
Term
| What is Wobbler syndrome? |
|
Definition
disc disease of caudal cervical spine
**Type II disc at C5/6 or C6/7**
-more common in lrg breeds (doberman)
- causes ataxia and paresis or hindlimbs |
|
|
Term
| What is the most common disc injury associated with Wobbler syndrome? |
|
Definition
| Type II disc degeneration at C5/6 or C6/7 |
|
|
Term
| What is degenerative lumbosacral stenosis? |
|
Definition
Type II disc degeneration of large breed dogs (esp german shepards)
occurs in the lumbosacral area |
|
|
Term
| What is the treatment for a dog with short term pain only that is associated with a disc lesion? |
|
Definition
|
|
Term
| What is the treatment for a dog with chronic pain in the neck associated with a disc lesion? |
|
Definition
|
|
Term
| What type of decompressive spinal surgery should be preformed in the thoracolumbar region? |
|
Definition
Laminectomy or hemilaminectomy
(remove part of lamina) |
|
|
Term
| What type of decompressive spinal surgery should be preformed in the cervical region? |
|
Definition
|
|
Term
| When surgically treating for disc injuries, what is the prognosis if the animal has intact deep pain at the time of surgery? |
|
Definition
| Very good - almost all return to walk again with no pain |
|
|
Term
| What are the surgical treatment options available for Wobbler's syndrome? |
|
Definition
-remove disc via ventral slot
- stretch affected space |
|
|
Term
| What are the three classifications of spinal tumors? |
|
Definition
1) extradural (most common) - located outside CSF but compressive on cord
2) intradural/extramedullary - not in the spinal cord but in the CSF
3) Intramedullary - within the spinal cord |
|
|
Term
| What breeds are predisposed to brain tumors? |
|
Definition
|
|
Term
| What are the chronic effects of a brain tumor? |
|
Definition
Compresses the brain
destruction of brain tissue
herniation(through foramen magnum) |
|
|
Term
| How do neurons and axons recover from injury? |
|
Definition
They will not be regernated or replaced
they recover through 'plasticity' |
|
|
Term
If there is a lesions along the reflex arc the clinical signs will be of LMN.
True or False? |
|
Definition
|
|
Term
| What is the clinical presentation of an animal with myopathy? |
|
Definition
nonspecific
-reduced muscle strength (hypotonia)
and atrophy or hypertrophy
- weakness
- generalized
- difficulty with exercise and obstacles
- stiff gait, decreased joint amplitude
- reflexes and sensation normal
- direct percussion of muscle may be abnormal |
|
|
Term
| What are the clinical signs of neuropathy? |
|
Definition
- distal paresis/paralysis
- muscle atrophy
- fasciculations
- loss of reflexes
- abnormal sensation (placement)
- loss of pain/temp sensation
- direct percussion of muscle normal
- tendon reflex, flexion reflexes depressed |
|
|
Term
| What are some signs associated with neuromuscular disease ? |
|
Definition
-Megaesophagus
-opthalmoplegia, ptosis
-dyspnea
- dysphagia
-cardiac arythmia
- brown urine (myoglobinuria) |
|
|
Term
| What are some blood tests that can be preformed to help diagnose a neuromuscular disease? |
|
Definition
CK - if very increased its highly specific
biochem - r/o metabolic abnormalities (endocrinopathis, electrolyte imbalance like hyper/hypokalemia)
Specific tests like antibody titers, serology or PCR for agents |
|
|
Term
| Neck ventro-flexion is a common clinical presentation of myopathy in what species? |
|
Definition
|
|
Term
| What are the two types of electrodiagnostic tests that can be performed? What is the difference between them? |
|
Definition
EMG - measures electrical activity within a region of muscle. Very sensitive, NOT specific (will not differentiate between muscle and nerve dz)
NCV - measures nerve conduction velocity. (records action potential of the muscle) |
|
|
Term
| How is a muscle biopsy diagnostic of neuromuscular disease? |
|
Definition
it will differentiate between myositis, muscular dystrophy.
It confirms the ETIOLOGY, specific disease association |
|
|
Term
Which type of acquired myopathy is most common?
a) Endocrine
b) metabolic
c) traumatic
d) inflammatory |
|
Definition
|
|
Term
| What is masticatory myositis? How can you diagnose it? How is it treated? |
|
Definition
- swelling in acute phase (often unnoticed) then atrophy when chronic
- DX by finding anti-type 2 antibodies
- TX immunosuppression (steroids, azothioprine) |
|
|
Term
| What are some metabolic myopathies associated with dogs and cats? |
|
Definition
DOGS: cushings (steroid) myopathy - weakness and myotonia that is poorly reversible
CATS: Hypokalemix myopathy - reversible |
|
|
Term
| What are degenerative myopathies? What are the clinical signs? |
|
Definition
deficiency in muscle membrane proteins (ie dystrophine)
- causes stiff gait, dysphagia, tongue hypertrophy, megaesophagus
- CK will be VERY high (10K-50K) |
|
|
Term
| What is acute idiopathic polyradiculoneuritis ? |
|
Definition
Ascending flaccid paralysis with acute onset.
immune mediated attack of neural tissue, self resolving with spontaneous remission and Great prognosis.
- sensation preserved
- occurs in dogs>cats |
|
|
Term
| A plantagrade stance in cats is almost pathognomonic for what? |
|
Definition
DIABEETUS
Diabetes Mellitus
- referred to as diabetic nephropathy
- can be reversed with treatment of diabetes |
|
|
Term
| What are some things that cause intereference with transmission across the neuromuscular juction? |
|
Definition
- botulism
- myasthenia gravis
- tick paralysis
- organophosphate toxicity |
|
|
Term
With myasthenia gravis, reflexes are often preserved but muscle atrophy is occurs.
True or False? |
|
Definition
FALSE
reflexes are preserved (but easily exhausted) but there is usually no muscle atrophy (just weakness) |
|
|
Term
| What is the mechanism of myasthenia gravis? |
|
Definition
Auto-antibodies bind to nicotinic cholinergic receptor (inhibits acetylcholine)
- or it can be a dysfunctional AChR |
|
|
Term
| If you are presented with a middle aged dog with megaesophagus, what should be at the top of your differential diagnosis list? |
|
Definition
|
|
Term
| How is myasthenia gravis diagnosed? |
|
Definition
blood test to find autoantibody (against NM junction)
- test with anti-cholinesterase |
|
|
Term
| What is status epilepticus? |
|
Definition
| State of continuous seizuring |
|
|
Term
| What are some metabolic causes of seizures? |
|
Definition
Liver failure
Hypoglycemia
ischemia/hpoxia
electrolyte imbalance (especially calcium)
Renal failure |
|
|
Term
| What are some toxic causes of seizures? |
|
Definition
Lead
organophosphates
chocolate
garbage (tremorogens) |
|
|
Term
| What are some differential diagnoses for seizures? |
|
Definition
Syncope
obsessive compulsive behavior
sleep disorders (narcolepsy/cataplexy)
breed specific disorders
VEstibular disorders
tremors
muscle disorders
Myasthenia gravis |
|
|
Term
| How do you diagnose seizures? |
|
Definition
Extracranial causes: blood samples
Intracranial causes: Brain scan CSF analysis |
|
|
Term
| How do you treat seizures? |
|
Definition
Remove underlying cause
anticonvulsants (phenobarbitol and potassium bromide) |
|
|
Term
| What are some long term side effects of anti-convulsant use ? |
|
Definition
toxicity (liver)
causes restlessness, increased appetite |
|
|
Term
| What are the common causes of LMN lameness? |
|
Definition
Nerve root impingement
nerve tumor |
|
|
Term
| What is the difference between UMN and LMN type urinary incontinence? |
|
Definition
UMN - loss of control, reflexes are intact
LMN - loss of reflex, easily expressed |
|
|
Term
| Which nerve controls the external urethral sphincter ? |
|
Definition
|
|
Term
| Which nerve inhibits the detruser muscle of the bladder? It that a sympathetic or parasympathetic nerve? |
|
Definition
|
|
Term
| Which nerve activates the detruser muscle of the bladder? Is this nerve sympathetic or parasympathetic? |
|
Definition
Pelvic Nerve
Parasympathetic |
|
|
Term
| Which nerve controls the internal urethral sphincter? |
|
Definition
Hypogastric nerve
PARASYMPATHETIC
Alpha adrenergic receptors! |
|
|
Term
| What is spay incontinence and how can it be treated? |
|
Definition
Spay incontinence - estrogen decreased which reduces sensitivity of alpha-adrenergic receptors of the internal urethral sphincter. decrease in ability to hold urine.
Can be treated with Alpha agonists because of the A1 receptors on the IUS |
|
|
Term
| How can you treat urinary dyssynergia? |
|
Definition
Alpha BLOCKERS
because the sphincter and detruser are contracting at the same time, alpha blockers will decrease the tone of the sphincter allowing urine to pass |
|
|
Term
Depression is always a neurological sign.
True or False? |
|
Definition
|
|
