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Medicine 1 VCS860 > Lesion Localization > Flashcards

Lesion Localization Flashcards

1
Q

Localization Syndromes

A

Localizing a neurological lesion is critically important

Consider appropriate differential diagnoses, select appropriate diagnostic tests

A simple method is the creation of “localization syndrome” or distinct areas of the nervous system

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2
Q

Localization syndromes (sites)

A

myopathies

neuropathic

Spinal Cord: lumbosacral, thoracolumbar, Cervicothoracic, Cervical

Pontomedullary

Midbrain

Cerebral

Cerebellar

Hypothalamic

Vestibular

Multifocal

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3
Q

Myopathic Syndro

A

Generalized weakness

exercise intolerance

Stif, stilted gait

Muscle atrophy or hypertrophy

Muscle pain

Limited join movement late in the disease

Reflexes are preserved

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4
Q

Diagnostic Approach to myopathies

A

CBC, Chemistry, UA, T4,

Clinical characteristics and reported disease

Disease specific testing

EMG

Muscle Biopsy

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5
Q

Myopathies

Immune Mediated Polymyositis

A

Immune-mediated, inflammatory

Middle-aged, large breed dogs

weakness worse with excercise

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6
Q

Myopathies

Immune-mediated Polymositis

CK value

A

Usually elevated

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7
Q

Myopathies

Immune-mediated Polymositis

Diagnosis

A

EMG

Biopsy

ANA

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8
Q

Myopathies

Immune-mediated Polymyositis

Treatment

A

Immunosuppression

Prednisone

Azathioprine, cyclosporine

Leflunomide, Mycophenolate

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9
Q

Immune-mediate Polymyositis

General Practive Guidelines

A

This is not a common disease, but when these dogs are presented the vague nature of the exercise intolerance can be misleading

Common differential: Myasthenia Gravis

Will not respond to pyridostigmine, will respond rapidly to pred

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10
Q

Myopathies

Maticatory Myositis

A

The most common myopathy of dogs

Immune-mediated myositis

Large Breed Dogs

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11
Q

Myopathies

Masticatory Myositis

Early

A

Hypertrophy, pain of masticaotry muscles

Pain on opening mouth

Ocular signs

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12
Q

Myopathies

Masticatory Myositis

Late

A

Atrophy of muscles

Fibrosis

Inability to open mouth (trismus)

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13
Q

Myopathies

Masitcatory Myositis

Diagnosis

A

CBC, Chemistry, UA: Normal

EMG: Myopathic potentials

Histopathology: Rarely done anymore

Serum anti-2M antibodies*

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14
Q

Myopathies

Masticatory Myositis

Differentials (early/painful)

A

retrobulbar Abscess

TMJ disease

Otitis Externa / media

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15
Q

Myopathies

Masticatory Myositis

Therapy

A

Prednisone: 2mg/kg/day for 4-6 weeks, gradual reduction - may be sufficient therapy for many of them

Cyclosporine, Leflunomide, Azathioprine, Mycophenolate: Used when side effects of prednisone are intolerable or corticosteroid use is contraindicated, Used when patients relapse on reduction of pred. Commit to minimum of 12 month use

Supportive

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16
Q

Myopathies

Exercise-Induced Collapse

A

Common in Labrador Retrievers: Mutation in DNM1 gene, Defect in nerve communication during exercise, Autosomal Recessive

Clinical Signs: Onset 5 months - 3 years; fit, muscular, excitable; Weakness and collapse after 5-20 minutes of strenous exercise; high rectal temp (>107)

17
Q

Myopathies

Exercise-Induced Collapse

Diangosis

A

Genetic testing at U of Minnesota

18
Q

Myopathies

Exercise-Induced Collapse

Therapy

A

Avoidance of trigger activity

19
Q

Steriod Myopathy

A

Cushing’s disease, iatrogenic

Also Pu/PD, pendulous andomen, alopecia

Generalized muscle atrophy

20
Q

Steroid Myopathy

Diagnosis

A

Increased CK, Increased SAP:EMG

21
Q

Steroid Myopathy

Treatment

A

Discontinue steroid, treat cushings

22
Q

Hypothyroid Myopathy

A

Other signs present: Alopecia, weight gain, inactivity

Hypercholesterolemia, mild anemia

Myxedema

Muscle Atrophy

23
Q

Hypothyroid Myopathy

Diagnsosis

A

Measure Total T4

24
Q

Hypothyroid Myopathy

Treatment

A

Supplement hormone replacement

25
Q

Myopathic Disorders

A

Musclular Dystrophy

Labrador Myopathy

Distal Myopathy or Rottweilers

Canine Stress Syndrome

Myotonia congenita

Fibrotic Myopathy

Nemaline Myopathy

Inclusion Myopathy

Episodic Muscle Hypertonicity

Lipid storage, Glycogen storage

Ischemic Myopathy

26
Q

Feline Hypokalemic Polymyopathy

Clinical Signs

A

Ventroflexion of the neck

Muscle weakness

27
Q

Feline Hypekalemic Polymyopathy

Differential Diagnosis

A

Thiamine deficiency

Feline Idiopathic polymyositis

Usually have chronic renal failure

Primary hyperaldosteronism is important cause

28
Q

Myasthenia Gravis

A

N-M Junction disease

Congenital: absence of ACh receptors

Acquired: Antibodies against the receptor; idiopathic, secondary to thymoma

Generalized weakness

Normal spinal reflexes

Focal MG: megaesophagus, pharyngeal dysfunction

29
Q

Myasthenia Gravis

Diagnosis

A

Detect ACh receptor antibodies

Tensilon Test

Nerve Stimulation

30
Q

Myasthenia Gravis

Therapy

Pyridostigmine Bromide

A

Oral anticholinesterase

Start low dose, gradually increase

Does not improve esophageal motility

31
Q

Myasthenia Gravis

Therapy

Immunosuppression

A

Corticosteroids: generally not recommended as they may worsen weakness or aggravate pneumonia
Limited to pyridostigmine-resistant MG

Azathioprine, Cyclosporine, Mycophenolate, Leflunomide: Limited evidence for the efficacy of any of these drugs to convert the patient to a negative status and cost/side effects may be significant
Spontaneous resolution of disease may happen with no therapy given

Medicine 1 VCS860 (13 decks)

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