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Neurology > Lecture: Neuromuscular Syndromes > Flashcards

Lecture: Neuromuscular Syndromes Flashcards

1
Q

Motor unit

A
  • Lower Motor Neuron
  • Neuromuscular Junction
  • Muscle
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2
Q

Maintenance of motor unit

A
  • Maintenance by tonic inputs from LMN
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3
Q

Denervation atrophy

A

rapid and severe (5-7 days)

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4
Q

LMN signs

A
  • Paresis to plegia
  • Muscle atrophy
  • poor/loss muscle tone
  • weakness to loss of reflexes
  • exercise intolerance
  • paretic, stiff gait
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5
Q

Ataxia and LMN dz

A
  • ataxia is an ulikely sign of LMN dz
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6
Q

LMN DZs

Tetanus

A

Happens at level of spinal cord

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7
Q

DZs of LMN

Nerve root

A

Polyradiculoneuritis

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8
Q

DZs of LMN

Nerve

A
  • (poly)Neuropathies
    • Axon
    • Myelin
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9
Q

DZs of LMN

Junction

A
  • Tick Paralysis
  • Botulism
  • Myasthenia Gravis
  • Snakes
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10
Q

DZs of LMN Muscle

A
  • Inflammatory
  • Infectious
  • Neoplastic
  • Snakes
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11
Q

Polyradiculoneuritis

Coonhound Paralysis, Guillan-Barre syndrome

A
  • Poly = multiple
  • Radiculo = root
  • Neuritis = inflammation of the nerve
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12
Q

Polyradiculoneuritis

About

A
  • Racoon saliva?
  • Demyelinating dz - rapid recovery
    • can get distal axonal degeneration
  • Root & proximal nerve disorder
  • mildly delayed nerve conduction velocity (NCV)
  • Albuminocytologic dissociation on CSF
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13
Q

Polyradiculoneuritis

CS

A
  • Acute, ascending flaccid paralysis
    • LOSS of reflexes and tone
    • motor, not sensory
    • atrophy
  • CN deficits common
    • CN VII, gag
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14
Q

Polyradiculoneuritis

TX

A
  • Variable dz course
  • may require ventilation
  • supportive care
  • aggressive physical therapy to avoid joint fibrosis
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15
Q

Polyneuropathy

A
  • Degenerative
  • Paraneoplastic
  • Endocrine
  • Genetic/heritable
  • Infectious
  • Toxic: Vincristine (microtubule disruptor)
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16
Q

Degenerative Polyneuropathies

Labrador retrievers

A
  • 10+ yo
  • Laryngeal paresis/paralysis
  • Dysphonia (bark change)
  • Esophageal dysfunction
  • Paresis worse in pelvic limbs
  • abnormal gait

*affects myelin & axons

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17
Q

Inherited polyneuropathy

A

Leonbergers

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18
Q

Endocrine Neuropathies

A
  1. Paraneoplastic - insulinoma
  2. Hypothyroidism
  3. Diabetic neuropathy - feline
    • plantigrade posture
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19
Q

Tick Paralysis

A
  • Presynaptic neuromuscular blockade
  • Dermacentor & Amblyomma most common
  • Dogs flaccid 5-9 days after tick attachement
    • cats resistent
  • +/- megaesophagus
  • In Australia
    • Ixodes holocyclus, Argasid ticks
    • MUCH Worse
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20
Q

Tetanus

about

A
  • Tetanospasmin must be cleaved to be activated
    • absorbed at the NMJ and travels retrograde to spinal cord
  • Inhibits glycine/GABA release at SPINAL CORD
    • leads to hyperactive alpha motor neurons = constant muscle contraction
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21
Q

Tetanus

CS

A
  • 5-10 days after infection
  • increased tone, stiffness, risus sardonicus, elevated tail, sawhorse stance, elevated nictitans
    • Extensors are stronger than flexors
  • external stimuli may exacerbate spasticity
22
Q

Tetanus

TX

A
  • Vaccination
  • Tetanus toxoid in horses
  • Antitoxin
  • Antibiotics and wound debridement
    • penicillin G, tetracycline, metranidazole
  • Sedatives
    • Phenothiazines, benzodiazepines, barbiturates
  • Supportive care
    • dark, quit, well padded, feeding tube
23
Q

Tetany

A
  • Hyperexcitability of membrane due to electrolyte imbalance
    • Na+, K+, Ca+, Cl-
    • Hypocalcemia
    • Hypomagnesemia
    • Strychnine
24
Q

Botulism

about

A
  • Presynaptic neuromuscular blockade
  • Ingest preformed toxin
    • destroyed at 100 degrees
    • resistant to proteases
  • Toxin imported, blocks presynaptic release of ACh from nerve terminal
25
Q

Botulism

CS

A
  • 12 hrs-6 days
  • progressive, symmetric ascending paresis/paralysis
  • reflexes and tone are lost
  • CN VII, megaesophagus, decreased gag and jaw tone
  • +/- mydriasis, KCS, constipation, urinary retention
26
Q

Botulism

DX

A
  • Very difficult
    • detection of organism in ingesta, serum, vomit
27
Q

Botulism

Prognosis

A
  • Improvement in 1-3 weeks
  • must regenerate new motor endplates
    • 2-4 months in mammalian species
28
Q

Myasthenia Gravis

Congenital

A
  • Insufficient receptors
  • Negative AChRAb titer
  • rare
  • jack/parsons russel terriers
  • signs from birth
  • generalized weakness
29
Q

Myasthenia Gravis

Acquired

A
  • Autoantibodies against nicotinic acethylcholine receptors on post-synaptic membrane
    • receptor is blocked, causing muscle weakness
30
Q

Acquired Myasthenia Gravis

three forms

A
  • Focal: typically esophageal muscle weakness
    • dogs only; cats have smooth muscle
  • Generalized: exercise intolerance
  • Fulminant: 1/4 of the generalized patients
    • Grave
31
Q

Myasthenia Gravis

CS

A
  • Exercise intolerance
    • progressively stiff, stilted gait, crap walking, crouched
  • Postural rxns should be intact
  • Reflexes present/ withdrawels can tire
  • No CN deficits
    • may have weak gag, ptyalism, ptosis
  • Megaesophagus
32
Q

Acquired Myasthenia Gravis

Distribution

A
  • Bimodal
    • osteosarc is also bimodal
  • < 5 yrs old: immune mediated
  • > 7 yrs old
    • para/pre-neoplastic
    • treat/remove primary source to ease tx
33
Q

Myasthenia Gravis

DX

A
  • Tensilon test: edrophonium
    • ultra-short acting acetylcholinesterase inhibitor
  • Acetylcholine receptor antibody titer (GOLD STANDARD)
  • Electrodiagnostics: repetitive nerve stimulation (RNS)
34
Q

Myasthenia Gravis

TX

A
  • Acetylcholinesterase inhibitor
    • increases ACh at the NMJ
  • Immunosuppression
    • stops Ab production
  • Treatment of underlying dz
    • eliminates trigger
35
Q

Generalized Myopathy

A
  • Immune-mediated
  • Infectious
    • neospora caninum, Hepatozoon americanum
  • Pre-/Para-neoplastic
    • lymphoma
  • Dermatomyositis
  • Congenital
    • muscular dystrophies
36
Q

Generalized polymyositis

A
  • Generalized weakness, stilted gait, dysphagia, muscle atrophy
  • Myalgia is rare
  • DO NOT LOSE REFLEXES
  • Boxers and Newfies
    • Boxers: preneoplastic
    • Newfies: breed specific
37
Q

Masticatory myositis

DX

Acute

Chronic

TX

A

Type 2M and Type 1 variant muscle fibers

  • Autoantibodies to type 2M fibers (only expressed in masticatory mm)

Serum 2M antibody titer (easy dx)

Acute

  • pain opening mouth
  • mild exophthalmia

Chronic

  • masticatory m atrophy
  • not painful to open mouth
  • fibrosis of masticatory mm

TX

  • immunosuppression
38
Q

Extraocular Myositis

A

Acute phase: ze eyeballz don’t move

39
Q

Neospora caninum

A
  • Prenatal exposure
  • Polyradiculoneuritis and polymyositis
    • encephalomyelitis
  • Muscle atrophy
  • Contracture of Pelvic Limbs

*Spay the mom

40
Q

Endocrine Myopathies

A
  • Type 2 myofibers more affected
  • Hypothyroidism-dogs
  • Hyperthyroidism-cats
  • Glucocorticoid excess-dogs
  • Electrolyte derangements
41
Q

Cushing’s Myopathy

A

Stiff, not flexing, hypertrophic, stiff muscles

42
Q

Cat anatomical anomaly

A

No nuchal ligament

43
Q

Feline Hyperthyroidism

A
  • T3 & T4 effects on sarcoplasm
  • CS
    • Paresis
    • ventroflexion
    • tremors
    • abnormal gait
44
Q

Feline: Toxoplasma gondii

A

Brain and systemic infection

45
Q

Rattlesnake Envenomation

(pit vipers)

A
  • Mentation, paresis/plegia, rigidity, CP deficits
46
Q

Southern Pacific, Timber, Western Diamondback envenomation

A
  • Myokymia
    • Ca interference on nerve membrane
    • looks like a moving nerve under skin I think
47
Q

Mojave rattlesnake envenomation

A
  • Neurotoxins
    • inhibits Ach release at presynaptic terminal of NMJ leading to complete neuromuscular blockade
48
Q

Coral Snake envenomation

(Elapid snake)

A
  • Venom has many components
    • postsynaptic alpha-neurotoxins
    • neuromuscular blockade
  • Generalized LMN weakness
    • respiratory paralysis
49
Q

Congenital myopathies

A
  • Muscular dystrophy: golden retrievers
  • Myotonia congenita
  • Hyperkalemic periodic paralysis
50
Q

Exercise Induced Collapse

A
  • labrador retrievers
  • collapse, hyperthermia, loss patellar reflexes
  • DNM1 mutation
51
Q

Myoclonus

A
  • Sudden contraction-relaxation of muscles
  • LMN abnormality
  • Distemper

Neurology (9 decks)

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