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VMCVM SAM 2 > DAIM - Diseases of Abnormal Movement > Flashcards

DAIM - Diseases of Abnormal Movement Flashcards

1
Q

Define DAIM

A

abnormal, involuntary skeletal muscle contractions in the conscious animal
- can arise from skeletal muscle, peripheral nerve or CNS

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2
Q

Are majority of DAIM diseases HYPERkinetic or HYPOkinetic?

A

HYPERkinetic!

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3
Q

What are the 5 cardinal phenotypes of DAIM?

A
  1. Myotonia
  2. Myokymia/neuromyotonia
  3. Tetany
  4. Myoclonus
  5. Dyskinesia
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4
Q

What is myotonia?

A

HYPERkinetic – persistent, sustained muscle contraction with delayed muscle relaxation
- disease of Skeletal Muscle

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5
Q

What breeds predisposed to myotonia congenita?

A

Min. Schnauzer and Chow

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6
Q

What history and exam of myotonia congenita?

A

Clinical signs in first few months of life

  • stiff saw-horse like gait that improves with exercise
  • double muscled appearance
  • dysphagia from tongue hypertrophy
  • percussion dimpling of muscles
  • signs get worse in cold weather
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7
Q

What pathophysiology of myotonia congenita?

A

autosomal recessive mutation in *Voltage-gated Chloride Channel mutation that causes issues with incomplete repolarization, prolonger depolarization and spontaneous depolarization

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8
Q

How do you DX myotonia congenita?

A
  • Signalment (Min Schnauzer or Chow)
  • History (CS in first few months of life)
  • CS (stiff pelvic limbs with big proximal limb muscles, …)

EMG waxing and waning

  • Also, genetic testing
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9
Q

How do you TX myotonia congenita?

A

Mexilitene, Procainamide, or Regular exercise program

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10
Q

PX and prevention of myotonia congenita

A

Fair to Good prognosis unless severe dysphagia present

Don’t breed these animals as it is autosomal recessive

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11
Q

What is acquired myotonia/pseudomyotonia?

A

most commonly a complication of Cushing’s (hyperadrenocorticism) but rare (<1%)

  • can be seen with muscular dystrophy and 2,4-D tox
  • may be French Poodle genetics
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12
Q

What are clinical signs of acquired myotonia/pseudomyotonia?

A

Comes with Cushing’s signs

Pathophys it unknown

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13
Q

How do you DX acquired myotonia/pseudomyotonia?

A

Cushing’s tests (ACTH stim, LDDS, etc.)
CS, HX, Signalment

EMG not waxing and waning but HIGH-frequency

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14
Q

How do you treat acquired myotonia/pseudomyotonia?

A

Also use, Procainamide

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15
Q

PX of acquired myotonia/pseudomyotonia?

A

:( does not resolve in most dogs with Cushing’s, even with treatment :(

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16
Q

what is myokymia?

A

vermicular (undulating, wavelike) muscle contraction that spreads across the surface of the muscle
- focal or generalized

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17
Q

what is neuromyotonia?

A

persistent muscle stiffness

- ranges from subclinical to intense contracture of distal extremities and face or episodic collapse

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18
Q

How are myokymia/neuromyotonia different from myotonia?

A

myokymia/neuromyotonia are a disease of motor axons or motor nerve terminals

myotonia is a disease of skeletal muscle

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19
Q

What is typical signalment of myokymia/neuromyotonia?

A

Jack Russell Terriers. It’s a.k.a. Continuous muscle fiber activity of the Terrier.

  • young to adult dogs
  • rarely in cats
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20
Q

What breed is predisposed to myokymia/neuromyokymia?

A

Jack Russell Terriers – Potassium gated channel defect

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21
Q

DX myokymia/neuromyotonia

A

Signalment (Jack Russell young to old); HX and CS

Characteristic EMG

22
Q

can myokymia/neuromyotonia develop secondary to compressive, infiltrative, or degenerative disease?

A

YES but RARELY

23
Q

Define Tetany and Tetanus

A

Tetany: intermittent sustained contraction of extensors mostly
Tetanus: persistent sustained contraction w/o relaxation

24
Q

Causes of Tetany:

A

Anomalous: Familial Reflex Myoclonus (misnomer) of Labradors
Metabolic: Hypocalcemia (1˚ hypOpth), hypomagnesemia (grass tetany)
Toxic: C. tetani, strychnine
Traumatic: rostral cerebellum, midbrain, T-L spine

25
Q

Pathophys of Familial Reflex Myoclonus of Labradors

A

glycine receptor deficiency in CNS

26
Q

Dx, Tx, and Px of familial reflex myoclonus of labradors?

A

DX: signalment (lab puppies) and exam
TX: none
PX: Poor :(

27
Q

Tx of C. tetani

A
  1. clean/debride wound
  2. antitoxin!
  3. systemic abx - Penicillins/metronidazole
  4. muscle relaxants - Diazepam, methocarbamol, barbiturates
  5. Monitor autonomic function
  6. minimize stimulation
28
Q

Px of C. tetani

A

Good if no autonomic dysfunction; usually takes weeks or less but may take months
- so don’t want to see hyper/hypotension or brady/tachycardia

29
Q

Strychnine presentation

A

causes seizures and tetany

HX of eating poison or relay toxicosis (eating dead wild life)

30
Q

Strychnine pathophys

A

competetive and reversible glycine inhibitor

31
Q

Strychnine DX

A

strychnine contents in the stomach, liver, kidney or urine if acute

32
Q

Strychnine TX

A

stop the seizure; empty the stomach; diuresis; muscle relaxants; supportive care

33
Q

What is myoclonus?

A

the sudden contraction of muscle groups followed immediately by relaxation

a.k.a. “tremor”

constant - persists in sleep

34
Q

What is a major concern of myokymia/neuromyotonia?

A
  • can last hours and lead to hyperthermia
35
Q

What does EMG for myokymia/neuromyotonia sound like?

A

MOTORBOAT of UNDULATING frequencies

36
Q

What is most frequent etiology of hypocalcemic tetany?

A

Primary Hypoparathyroidism

37
Q

DX and TX of hypocalcemic tetany

A

Dx by Low Total and ionized Ca++, High Phosphorous, Low-NORMAL PTH

Tx: IV Calcium gluconate

38
Q

Name species in order of susceptibility most to least to Tetanus

A

HORSES > Humans > dogs > cats > ruminant

39
Q

What’s the name of the tetanus toxin?

A

Tetanospasmin - binds Renshaw cells and prevents release of neurotransmitter (Glycine and GABA)

40
Q

Sporadic vs repetitive myoclonus

A

Sporadic usually looks like focal seizure
Repetitive can be different types:
- Resting: only seen at rest
- action related: during voluntary muscle contraction (cerebellar lesions)
- constant/continuous: persists even in sleep (Distemper)

41
Q

What is usually the cause of constant/continuous, repetitive myclonus?

A

Distemper

42
Q

What is idiopathic steroid-responsive tremor syndrome?

A

White Shakers Disease (West Highland Whites)

  • diffuse, action related, repetitive myoclonus
  • Acute onset
  • Middle aged
  • Small and toy breeds

Tx: prednisone
Px: excellent (possible relapses)

43
Q

Head bobbers and shakers

A

Doberman, Bulldog, Boxer, Boston Terriers

  • non-progressive and no other clinical signs
  • VERY episodic, unpredictable
  • Triggered by excitement*
  • can interrupt the activity*
  • totally conscious*
44
Q

What does moldy cheese toxicity cause?

A

diffuse, action-related repetitive myoclonus

45
Q

What is an orthostatic tremor?

A

Giant breeds of dogs (Great Dane)

  • EMG Helicopter Rotor
  • *Occur only when standing and relieved when sit down
  • can INDUCE by simulating gravity on dogs paw

TX: Gabapentin, Pregabalin, Phenobarbital
PX: gets very bad eventually but may take a while (months to years)

46
Q

What are dyskenisias?

A

heterogeneous group of CNS disorders that disrupt normal posture or locomotion

  • Episodic
  • *- Paroxysmal**
  • triggered by excitement or stress
  • age 3-48 months onset
  • Episodes last seconds to minutes
47
Q

What is athetosis?

A

writhing of the trunk

48
Q

What is ballism?

A

flailing of the limbs

49
Q

What is chorea?

A

brief rapid muscle contractions that look like dancing

50
Q

What is dystonia?

A

sustained muscle contraction producing abnormal postures and inhibit normal movements

VMCVM SAM 2 (7 decks)

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