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                    [post_date] => 2013-06-18 17:21:16
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                    [post_content] => Signalment: 6 yr FS Chesapeake Bay Retriever

History: The patient was presented for evaluation of a 3-day history of difficulty eating and being a sloppy eater.

 

Case Video:


Physical Exam: No significant abnormalities

NEUROLOGICAL EXAM

Mental status: BAR
Gait/posture: Normal gait/posture
Cranial nerves: Dropped jaw, unable to physically close the jaw, remainder WNL
Postural reactions: Normal CP/hop x 4
Spinal reflexes: WNL x 4
Withdrawal: WNL x 4
Spinal pain: None
Muscle tone: Normal x 4
Muscle atrophy: None
Pain sensation: Normal x 4
Cutaneous trunci: WNL bilaterally

 

What is your neuroanatomic localization?
Scroll down to see the answer

 

 

 

 

 

 

 

 

 

 

Neurolocalization:  Bilateral mandibular branch of trigeminal nerves (cranial nerve V)

 

What are the differential diagnoses and what is the primary differential diagnosis for this patient? How do you treat this condition?

SCROLL DOWN TO SEE NEURO EXAM DETAILS AND ANSWERS

 

 

 

 

 

 

 

 

 

 

Differential diagnoses:



Diagnostics
The patient was current on all vaccines, including rabies.  A CBC, biochemical profile and total T4 were performed to rule out other possible metabolic/systemic causes of dropped jaw. The results were within normal limits.


Presumptive diagnosis: Idiopathic Trigeminal Neuritis

Treatment
Supportive care with small frequent feedings with a gruel consistency to allow the dog to lap up the food.  Some people suggest a tape muzzle to keep the mouth partially closed allowing the dog to eat better, but this is rare needed in my experience.  In rare cases, a feeding tube may need to be placed to ensure adequate nutrition.  However, most dogs are able to lap up enough food to maintain adequate nutrition.  No medications, including corticosteroids, have been proven to speed or improve recovery.

Prognosis & Outcome
The prognosis for Idiopathic Trigeminal Neuritis is very good to excellent with supportive care and time.  The patient made a full recovery in 3-4 weeks.

 NOTES:
Idiopathic Trigeminal Neuritis has no known cause; some speculate an immune-mediated cause, but corticosteroids have not been shown to shorten or improve recovery.  Histologically, there is a nonsuppurative neuritis characterized by demyelination and axonal loss.  It usually affects primarily the mandibular (motor) branches of the trigeminal nerve which leads to a dropped jaw (inability to close the mouth) with secondary drooling (unable to keep saliva in mouth to swallow) and sloppy eating/drinking.  The patients are often noted to lap their food only.  In one study, 35% of patients also had sensory deficits, 8% had facial nerve paresis/paralysis, and 8% had Horner's Syndrome.  There is no antemortem test that will definitively diagnose the condition.  The minimum database includes CBC, biochemical profile, and total T4.  Advanced diagnostics (see below) can help rule out other causes for dropped jaw.  IMPORTANT: You should always verify a current rabies vaccine status since rabies can cause a dropped jaw and drooling.  If you are unable to verify rabies vaccine status, be sure to wear exam gloves and limit interaction with personnel until the patient's status is obtained.

Advanced diagnostics



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                    [post_date] => 2013-04-01 18:57:45
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                    [post_content] => Signalment: 6 mos MI Lab / Pitbull cross

History: Patient was referred for evaluation of a sudden onset of possible seizures

Physical Exam: No significant abnormalities

NEUROLOGICAL EXAM

Mental status: BAR
Gait/posture: Normal gait/posture
Cranial nerves: WNL
Postural reactions: Normal CP/hop x 4
Spinal reflexes: WNL x 4
Withdrawal: WNL x 4
Spinal pain: None
Muscle tone: Normal x 4
Muscle atrophy: None
Pain sensation: Normal x 4
Cutaneous trunci:WNL bilaterally

 

Neurolocalization:  Normal neurological exam between episodes

 

Case Video:


 

What is the primary differential diagnosis for this patient? How do you treat this condition?

SCROLL DOWN TO SEE NEURO EXAM DETAILS AND ANSWERS

 

 

 

 

 

 

 

 

 

 

Working diagnosis: Narcolepsy / Cataplexy
The audio has been muted on the video, but, in person, the patient could be heard snoring from several feet away during the attacks.

Diagnostics
A CBC and biochemical profile were performed to rule out other possible metabolic/systemic causes of episodic events. The results were within normal limits.

Treatment
Methylphenidate (Ritalin) 7.5mg PO TID

Prognosis
The prognosis for Narcolepsy / Cataplexy is generally good with treatment. Owners should be instructed to try to avoid the stimuli that trigger episodes.

Outcome
Within 2 weeks of starting treatment, the narcoleptic attacks had reduced in number significantly and were generally only occurring with extreme excitement or when the next dose of medication was delayed.
                    [post_title] => Neurology Case of the Month (April 2013): Episodes in a Lab/Pitbull cross
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                    [post_date] => 2013-03-11 02:41:53
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                    [post_content] => A recent study showed that mice become smarter after human glial progenitor cells are implanted into their brains.

Read more

Study abstract
                    [post_title] => Random Neuro: Will mice take over the world?
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                    [post_date] => 2013-03-01 06:00:21
                    [post_date_gmt] => 2013-03-01 11:00:21
                    [post_content] => Signalment: 4yr FS Rottweiler

History: Patient was referred to the Surgery Department for evaluation of left pelvic limb lameness of 1-month duration. No improvement with Rimadyl and tramadol. Orthopedic examination was within normal limits so a neurology consultation was requested.

Case Video:


 

Questions to ask yourself: 
  1. What is your neurolocalization?
  2. What are the top differential diagnoses?
  3. Why are the patellar reflexes exaggerated?
SCROLL DOWN TO SEE NEURO EXAM DETAILS AND ANSWERS                 Neurological exam: Mental status: BAR Gait/posture: Ambulatory with a somewhat crouched HL gait, short/choppy hind limb gait at times, and intermittent LHL lameness Cranial nerves: WNL Postural reactions: Absent CP/hop boths HLs Spinal reflexes: Exaggerated patellar reflexes bilaterally, markedly decreased cranial tibial LHL Withdrawal: Absent at hocks bilaterally, normal FLs Spinal pain: LS vs. hip pain Muscle tone: Normal x 4 Muscle atrophy: None Pain sensation: Normal x 4 Cutaneous trunci:WNL bilaterally   Neurolocalization: L6-S1 spinal cord / Cauda equina     Differential diagnoses   Diagnostics   Preliminary diagnosis L7-S1 disk protrusion with secondary neuritis vs. lymphoma vs. other neuritis   Treatment   Prognosis The prognosis for LS intervertebral disk protrusion/herniation is generally good to excellent in pet dogs that are treated by dorsal laminectomy.   Why were the patellar reflexes exaggerated? This patient had a lower motor neuron (LMN) lesion affecting the L6-S1 portion of the spinal cord or sciatic nerves. As a result, there was decreased tone in the flexor muscles of the stifle. The flexor muscles normally dampen the patellar reflex to a degree. Without that normal antagonism in this patient, the knee jerk becomes exaggerated. This is in contrast to the norm in which increased reflexes are usually a sign of upper motor neuron (UMN) disease. Lesions affecting the UMNs lead to decreased inhibitory influence on LMNs. As a result, there is an excessive motor response. An increased patellar reflex usually suggests the lesion is cranial to L3. So, how do you tell whether the patellar reflex is exaggerated due to an UMN lesion or sciatic dysfunction? Patients with an UMN lesion should have an intact withdrawal reflex, while patients with L6-S1 spinal cord/sciatic nerve dysfunction will have decreased to absent withdrawal in the affected limb(s). [post_title] => Neurology Case of the Month (March 2013): HL Lameness [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => neurology-case-of-the-month-march-2013-hl-lameness [to_ping] => [pinged] => [post_modified] => 2013-02-26 12:53:31 [post_modified_gmt] => 2013-02-26 17:53:31 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.ivghospitals.com/?p=4068 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 3981 [post_author] => 12 [post_date] => 2013-02-14 05:45:11 [post_date_gmt] => 2013-02-14 10:45:11 [post_content] => From BBC News: "Dogs are more capable of understanding situations from a human's point of view than has previously been recognised, according to researchers. They found dogs were four times more likely to steal food they had been forbidden, when lights were turned off so humans in the room could not see. This suggested the dogs were able to alter their behaviour when they knew their owners' perspective had changed." Read more [post_title] => Dogs understand human perspective [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => dogs-understand-human-perspective [to_ping] => [pinged] => [post_modified] => 2013-02-14 05:45:11 [post_modified_gmt] => 2013-02-14 10:45:11 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.ivghospitals.com/?p=3981 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 3798 [post_author] => 12 [post_date] => 2013-02-11 06:48:03 [post_date_gmt] => 2013-02-11 11:48:03 [post_content] => I thought I would share this abstract with all of you. It is very disconcerting, to say the least, to think that we veterinary professionals may be inadvertently harming our patients. I frequently am asked to evaluate patients, especially cats, that are acutely blind and/or showing other neurological signs after a "routine" procedure, such as a dental cleaning. We often try to blame the anesthesia protocol/monitoring, apnea, or hypotension as the cause, but a recent study suggests that the use of spring-held mouth gags may predispose cats to post-anesthetic neurological complications. Although not proven in this study, the authors theorize that "it is possible that the use of a spring-held mouth gag reduces blood flow to the brain through the maxillary artery by stretching of the vasculature and/or adjacent muscles with resulting vascular compromise." This clearly isn't the only reason since mouth gags were not used in 4/20 cats in the study, but decreasing the use of mouth gags during procedures is definitely something we should consider. Post-anesthetic cortical blindness in cats: Twenty cases. Vet J. August 2012;193(2):367-73. J Stiles1; A B Weil; R A Packer; G C Lantz 1Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA. Article Abstract The medical records of 20 cats with post-anesthetic cortical blindness were reviewed. Information collected included signalment and health status, reason for anesthesia, anesthetic protocols and adverse events, post-anesthetic visual and neurological abnormalities, clinical outcome, and risk factors. The vascular anatomy of the cat brain was reviewed by cadaver dissections. Thirteen cats were anaesthetised for dentistry, four for endoscopy, two for neutering procedures and one for urethral obstruction. A mouth gag was used in 16/20 cats. Three cats had had cardiac arrest, whereas in the remaining 17 cases, no specific cause of blindness was identified. Seventeen cats (85%) had neurological deficits in addition to blindness. Fourteen of 20 cats (70%) had documented recovery of vision, whereas four (20%) remained blind. Two cats (10%) were lost to follow up while still blind. Ten of 17 cats (59%) with neurological deficits had full recovery from neurological disease, two (12%) had mild persistent deficits and one (6%) was euthanased as it failed to recover. Four cats (23%) without documented resolution of neurological signs were lost to follow up. Mouth gags were identified as a potential risk factor for cerebral ischemia and blindness in cats. [post_title] => Post-anesthetic cortical blindness in cats [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => post-anesthetic-cortical-blindness-in-cats [to_ping] => [pinged] => [post_modified] => 2013-02-12 05:48:39 [post_modified_gmt] => 2013-02-12 10:48:39 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.ivghospitals.com/?p=3798 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [6] => WP_Post Object ( [ID] => 3789 [post_author] => 12 [post_date] => 2013-02-10 13:41:10 [post_date_gmt] => 2013-02-10 18:41:10 [post_content] => Signalment: 2yr FS Corgi Mix History: Referred to MVRH for evaluation of difficulty walking. Three days prior to admission, she was less willing to walk in the evening and was unable to go down stairs. The following day she was ataxic in the pelvic limbs and was taken to another referral hospital's emergency department. At that time, she was still ambulatory and was discharged with activity restriction, Piroxicam, and misoprostol. That night she became progressively weaker and was unable to walk the following morning. No known trauma. No prior neurological conditions. No past medical history. Good appetite. No weight loss. No C/S/OND/V/D/PU/PD Case Video: What is your neurolocalization? What are the top differential diagnoses? (SCROLL DOWN TO SEE NEURO EXAM DETAILS AND ANSWERS)                 Neurological exam: Mental status: BAR Gait/posture: Nonambulatory paraparesis & HL proprioceptive ataxia; FLs appeared normal Cranial nerves: WNL Postural reactions: Absent CP/hop boths HLs Spinal reflexes: WNL x 4 Spinal pain: None Muscle tone: Normal x 4 Muscle atrophy: None Pain sensation: Normal x 4 Cutaneous trunci: WNL bilaterally   Neurolocalization = T3-L3 spinal cord     Differential diagnoses   Diagnostics   Diagnosis Inflammatory spinal cord disease (presumptive GME)   Treatment   Prognosis The prognosis for inflammatory spinal cord disease is generally fair to good if treated early and aggressively.   Outcome The patient made a full recovery and was weaned off prednisone & cytarabine over 12 months. To date (6 years later), the patient has had no recurrence of inflammatory spinal cord disease. She had an acute on chronic T12-13 intervertebral disk herniation 3 years later that was treated with a right T12-13 hemilaminectomy. [post_title] => Neurology Case of the Month (Feb 2013): Paraparetic dog [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => neurology-case-of-the-month-feb-2013-paraparetic-dog [to_ping] => [pinged] => [post_modified] => 2013-02-10 13:41:10 [post_modified_gmt] => 2013-02-10 18:41:10 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.ivghospitals.com/?p=3789 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [7] => WP_Post Object ( [ID] => 3473 [post_author] => 12 [post_date] => 2012-12-03 07:23:49 [post_date_gmt] => 2012-12-03 12:23:49 [post_content] => Signalment: 5yr MC DSH History: Acute onset of right-sided weakness this morning. Pidgeon-toed in right thoracic limb and lifting right pelvic limb off ground higher than normal. He does not appear painful. No known trauma. He is an indoor/outdoor cat that is supervised in the back yard when he's outside. No prior symptoms like this. Good appetite. No weight loss. No C/S/OND/V/D/PU/PD Case Video: What is your neurolocalization? What are the top differential diagnoses? (SCROLL DOWN TO SEE NEURO EXAM DETAILS AND ANSWERS)                 Neurological exam: Mental status: QAR Gait/posture: Vestibular ataxia - frequently stumbles & falls, right-sided hypermetria (not observed on video) Cranial nerves: WNL Postural reactions: Normal x 4 Spinal reflexes: WNL x 4 Spinal pain: None Muscle tone: Normal x 4 Muscle atrophy: None Pain sensation: Normal x 4 Cutaneous trunci: WNL bilaterally   Neurolocalization = Right cerebellum     Differential diagnoses   Diagnostics   Diagnosis Cerebellar infarct   Treatment Physical therapy and supportive care   Prognosis The prognosis for cerebellar infarction is usually good to excellent. Most patients will recover if given enough time and supportive care.   Outcome The patient was brought in for a recheck examination 2 weeks later and the neurological exam was within normal limits. [post_title] => Neurology Case of the Month (Dec 2012): Hemiparesis & ataxia in a cat [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => neurology-case-of-the-month-dec-2012-hemiparesis-ataxia-in-a-cat [to_ping] => [pinged] => [post_modified] => 2012-12-03 07:23:49 [post_modified_gmt] => 2012-12-03 12:23:49 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.ivghospitals.com/?p=3473 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [8] => WP_Post Object ( [ID] => 3308 [post_author] => 12 [post_date] => 2012-11-01 06:00:42 [post_date_gmt] => 2012-11-01 10:00:42 [post_content] => Signalment: 7yr MC Lab History: The patient was referred to the Neurology Department for evaluation of a 6-month progressive gait abnormality. The patient had not responded to oral antibiotics (Clavamox) or a tapering course of prednisone. Case Video: What is your neurolocalization? What are the top differential diagnoses? (SCROLL DOWN TO SEE NEURO EXAM DETAILS AND ANSWERS) Neurological exam: Mental status: QAR Gait/posture: Marked cerebellar/vestibular ataxia, truncal ataxia, intermittent thoracic limb hypermetria, intention tremors Cranial nerves: WNL Postural reactions: Normal CP x 4 Spinal reflexes: WNL x 4 Spinal pain: None Muscle tone: Normal x 4 Muscle atrophy: None Pain sensation: Normal x 4 Cutaneous trunci: WNL bilaterally   Neurolocalization = Cerebellum     Differential diagnoses   Diagnostics   Diagnosis Presumptive cerebellar abiotrophy   Treatment Unfortunately, there are no effective treatment options available for cerebellar abiotrophy.   Prognosis The prognosis for cerebellar abiotrophy is generally poor. Most patients continue to progress despite supportive care, although some patients signs will stabilize.   Outcome The patient was humanely euthanized due to the progressive signs and guarded to poor prognosis. Necropsy confirmed the diagnosis of cerebellar abiotrophy.   CEREBELLAR HYPOPLASIA VS. ABIOTROPHY [post_title] => Neurology Case of the Month (Nov 2012): Chronic, progressive ataxia in a Labrador [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => neurology-case-of-the-month-nov-2012-chronic-progressive-ataxia-in-a-labrador [to_ping] => [pinged] => [post_modified] => 2012-11-03 06:24:08 [post_modified_gmt] => 2012-11-03 10:24:08 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.ivghospitals.com/?p=3308 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [9] => WP_Post Object ( [ID] => 3297 [post_author] => 12 [post_date] => 2012-10-23 08:29:12 [post_date_gmt] => 2012-10-23 12:29:12 [post_content] => I will always watch Shawshank Redemption or Field of Dreams if I see that it's on TV, while my wife can't get enough of Dirty Dancing. Why do we still watch these movies even though we've seen them dozens of times? This article from Scientific American Mind helps to explain why. Why you like to watch the same thing over, and over, and over again [post_title] => Why You Like to Watch the Same Thing Over, and Over, and Over Again [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => why-you-like-to-watch-the-same-thing-over-and-over-and-over-again [to_ping] => [pinged] => [post_modified] => 2012-10-23 08:29:12 [post_modified_gmt] => 2012-10-23 12:29:12 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.ivghospitals.com/?p=3297 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 10 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 4406 [post_author] => 12 [post_date] => 2013-06-18 17:21:16 [post_date_gmt] => 2013-06-18 21:21:16 [post_content] => Signalment: 6 yr FS Chesapeake Bay Retriever History: The patient was presented for evaluation of a 3-day history of difficulty eating and being a sloppy eater.   Case Video: Physical Exam: No significant abnormalities NEUROLOGICAL EXAM Mental status: BAR Gait/posture: Normal gait/posture Cranial nerves: Dropped jaw, unable to physically close the jaw, remainder WNL Postural reactions: Normal CP/hop x 4 Spinal reflexes: WNL x 4 Withdrawal: WNL x 4 Spinal pain: None Muscle tone: Normal x 4 Muscle atrophy: None Pain sensation: Normal x 4 Cutaneous trunci: WNL bilaterally   What is your neuroanatomic localization? Scroll down to see the answer                     Neurolocalization: Bilateral mandibular branch of trigeminal nerves (cranial nerve V)   What are the differential diagnoses and what is the primary differential diagnosis for this patient? How do you treat this condition? SCROLL DOWN TO SEE NEURO EXAM DETAILS AND ANSWERS                     Differential diagnoses: Diagnostics The patient was current on all vaccines, including rabies. A CBC, biochemical profile and total T4 were performed to rule out other possible metabolic/systemic causes of dropped jaw. The results were within normal limits. Presumptive diagnosis: Idiopathic Trigeminal Neuritis Treatment Supportive care with small frequent feedings with a gruel consistency to allow the dog to lap up the food. Some people suggest a tape muzzle to keep the mouth partially closed allowing the dog to eat better, but this is rare needed in my experience. In rare cases, a feeding tube may need to be placed to ensure adequate nutrition. However, most dogs are able to lap up enough food to maintain adequate nutrition. No medications, including corticosteroids, have been proven to speed or improve recovery. Prognosis & Outcome The prognosis for Idiopathic Trigeminal Neuritis is very good to excellent with supportive care and time. The patient made a full recovery in 3-4 weeks. NOTES: Idiopathic Trigeminal Neuritis has no known cause; some speculate an immune-mediated cause, but corticosteroids have not been shown to shorten or improve recovery. Histologically, there is a nonsuppurative neuritis characterized by demyelination and axonal loss. It usually affects primarily the mandibular (motor) branches of the trigeminal nerve which leads to a dropped jaw (inability to close the mouth) with secondary drooling (unable to keep saliva in mouth to swallow) and sloppy eating/drinking. The patients are often noted to lap their food only. In one study, 35% of patients also had sensory deficits, 8% had facial nerve paresis/paralysis, and 8% had Horner's Syndrome. There is no antemortem test that will definitively diagnose the condition. The minimum database includes CBC, biochemical profile, and total T4. Advanced diagnostics (see below) can help rule out other causes for dropped jaw. IMPORTANT: You should always verify a current rabies vaccine status since rabies can cause a dropped jaw and drooling. If you are unable to verify rabies vaccine status, be sure to wear exam gloves and limit interaction with personnel until the patient's status is obtained. Advanced diagnostics [post_title] => Neurology Case of the Month (June 2013): Chesapeake Bay Retriever with difficulty chewing [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => neurology-case-of-the-month-june-2013-chesapeake-bay-retriever-with-difficulty-chewing [to_ping] => [pinged] => [post_modified] => 2013-06-18 17:23:15 [post_modified_gmt] => 2013-06-18 21:23:15 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.ivghospitals.com/?p=4406 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 19 [max_num_pages] => 2 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => 1 [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => 1 [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => [is_404] => [is_comments_popup] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash] => ab5ab482926de3d6bfd2dc5b439d0b43 [query_vars_changed] => [thumbnails_cached] => [stopwords:WP_Query:private] => )