Neuro - Tetraparesis/tetraplegia Flashcards by Corinne Perra

What list of differentials can result in both conditions of hindlimb paresis/ paralysis or tetraparesis/paralysis ??

Diskospondylitis
Neoplasia
Fracture/luxation
fibrocartiaginous emboli

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Cervical disc disease occurs in what breeds most commonly?

Chondrodystrophic and poodles

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8yr old Dashunds
Acute onset of severe neck pain, holding neck low, doesn’t want to turn head

Tetraparesis that is worse in the rear limbs

What is your top DDX?
What would by your next diagnostic step?

Cervical disc disease

Radiographs and myelogram

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What is the best treatment for cervical disc disease in a patient that has paresis and in nonabulatory ?

This is grade 3
-> cage rest with pred for pain
These dog are usually continent

If no improvement -> surgery

PHYSIO

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Giving steroids like dexamethasone before surgery has been shown to protect the spinal cord from trauma. Would you do this when doing surgery for cervical disc disease?

Some do, but you should avoid this if possible and do surgery so your not causing trauma to spinal cord

Avoid this if possible due to side effects of steroids
-GI ulceration/perforations -> peritonitis with no stress resposne
-UTIs common
Ect ect .

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What is cervical spondylomyelopathy?

AKA chaining wobblers

Stenosis/osteophyte formation/ Hansen type II disc degeneration —> compression of spinal cords (esp at C5/C6)

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What is the cause of cervical spondylomyelopathy ??

Genetic component

congenital stenosis and lig laxity
rapid over growth and over nutrition

abnormal stresses on joints
calcinonin

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What is the signalment of cervical spondylomyelopathy ?

Great Danes - 3-18months

Dobermans -5-8yrs

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Young Great Dane
Presents with head guarding

Paresis, ataxia, wobbling, and scuffing of hind limbs

Dysmetria and mild CP deficits in forelimb
Atrophy of infra and Supra-spinatus
Neck pain

What is your top dx?

Cervical spondylomyelopathy AKA canine wobblers

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What might you see on a radiograph of a dog with cervical spondylomyelopathy ?

Tipping of vertebrate 
Stenosis 
Rounding 
Decreased disc spaces 
Degeneration in articular facets

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Is extension and flexion the best way to determine if a canine wobblers syndrome dog has a dynamic component ?

No -> may cause more compression and damage to spinal cord if you are flexing and extending

Do a traction radiograph where you pull the head cranially to stretch the vertebral spaces —> if compression is reduced with traction then there is a dynamic component

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What is the best therapy for canine wobblers?

Palliative (40-60% recover). Involves exercise restriction to minimize dynamic compression

Pred to reduced inflammation

Surgical decompression -> otters best long term benefits but not without its own limitations (medical therapy should be the first initial therapy)

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What is the prognosis for dogs with cervical spondylomyelopathy ?

Disc slip > good

Tetraplegic > poor

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What do you call a condition where compression of the spinal cord is caused by dorsal displacement of the axis?

Atlanta-axial subluxation

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What are the three mechanisms causing an Atlanta-axial subluxation ?

Absence or hypoplasia of the odontoid process/dens (most common)

Odontoid fracture at ossification center between dens and C2

Rupture of the ligamentous supports

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Toy poodle 10months

Progressive onset of severe neck pain and tetraplegia

What is your top DDX and what would be your next diagnostic step?

Atlanta-axial subluxation
->due to absence/hypoplasia of dens

Too young for cervical disc disease -> avg age 8yrs

Radiograph in ventrodorsal view

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What is the treatment for Atlanta-axial subluxation?

Hemilaminectomy to relieve compression

Subluxation immobilized by wiring/screwing two vertebrae together

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What is syringomyelia?

Fluid filled cavities in the parenchyma of the spinal cord -> due to abnormal CSF flow

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Syringomyelia is common in what breed

King Charles cocker spaniel

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King Charles spaniels and other small breed dogs develop syringomyelia as a result of???

Caudal occipital malformation syndrome —> impaction into foramen magnum/herniation

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What are signs of Atlanta-axial subluxation?

Neuropathic pain -pressure on dorsal horns

Shoulder scratching, head/neck pain, focalization, vestibular signs, and tetraparesis, with LMN signs to a front limb

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What drugs are used to control syringomyelia?

Diuretics

omeprazole-> proton pump inhibitor
cimetidine-> H2 antagonist

Prednisone
gabapentin -> neuropathic pain management

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What are general signs indicating a myopathy?

Weakness
Stilted stiff gait

Normal CP and reflexes

Sometimes - pain and elevated CPK

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What are possible etiologies of infectious myopathies in dogs?

Toxoplasma 
Neosporisis 
Borrelia burgdorferi 
Hepatozoonoiss 
Leptospirosis

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What are possible etiologies for infectious myopathies in cats?

Toxoplasma FeLV FIV

What is the most common inflammatory myopathy in dogs?

Autoimmune polymyositis

Autoimmune polymyositis is most commune in what dogs?

Large breed, mature May be acute or chronic

What are signs of autoimmune polymyositis?

Generalized weakness, stiff gait and rapid fatigue Generalized muscle atrophy Some have -pyrexia, pain, regurge, dysphonia, and dysphagia

How can you make a definitive diagnosis for autoimmune polymyositis ?

Muscle biopsy Necrosis, phagocytosis of myocytes, perivascular lymphocyte, plasma cell infiltration, and regeneration

How is autoimmune polymyositis treated?

Prednisone and azathioprine Azathioprine takes 3 weeks to be effective -> taper off pred at this time

What condition appears as .. pseudotrismus Fever Atrophy of masticatory muscles PE: dog will not want to ope mouth

Masticatory muscle myositis (MMM)

What is the cause of masticatory muscle myositis ?

Autoimmune Humoral response against type 2M fibers

Treatment of masticatory muscle myositis??

Pred with azathioprine

What is the best test to determine masticatory muscle myositis?

Serology

Golden retrievers get what condition that causes a bilateral exopthalamos?

Extraocular myositis -> autoimmune myositis causing inflmmation a dilation of ocular muscles -> pressure causes exopthalmia

A racing greyhound presents with painful and rigid muscles. Biochem shows markedly elevated CK What should be your top DDX?

Exertional myopathy

In an exertional myopathy, what is often the cause of death despite treatment with fluids, bicarb, and analgesics?

Renal failure due to myoglobinemia

Cat with ventroflexion of the neck , inability to jump, and remains recumbent What could by some DDX for this cat?

Infectious myopathy -> toxoplasma, FeLV, or FIV Hypokalemic myopathy Feline idiopathic inflammatory myopathy

What conditions can result in a severe hypokalemia in cats?

Chronic renal failure Acid diet Conn’s - hyperaldosterone —> Na reabsorption and K secretion Hyperthyroid - PU/PD

How should a hypokalemic myopathy be treated?

Oral supplementation Potassium gluconate: 2-4 mEq/day mildly affected 5-10 mEq/day severe case

How can your differentiate feline idiopathic inflammatory myopathy from an infectous/hypokalemic myopathy?

Test for FLV/FIV/mycoplasma/toxoplasma K levels in biochem If infectious agents neg and K Normal -> then this disease, be exclusion

What is the best therapy for feline idopathic inflmmatory myopathy?

Prednisone | -> very few side effects in cats

Pointer dog has developed a flaccid tail after being out on a hunting trip with his owner. What could be some DDX and how might you rule them out?

Limber tail AKA coccygeal muscle injury -> recover with a few days of rest and anti-inflammatories Lumbosacral degenerative stenosis -> would have LMN in hindlimbs, pain response on tail jack test

Inherited abnormalities of the cytoskeleton is what type of myopathy?

Dystrophic (degenerative/developmental)

Dystrophic myopathy is seen in what animals and what are the signs?

Puppies - as early as 6weeks of age Stunning, weakness, gait abnormalities, trismus, muscle atrophy with fibrosis and contracture Skeletal deformities like kyphosis and lordosis

What usually causes death in animals with dystrophic myopathies?

Dilated cardiomyopathy w

What breed of dog has a central core like myopathy?

Great Dane

What animals can we see a nemaline rod myopathy?

Family of cats | Border collie

Centronuclear myopathies are seen in what breed of dog?

Labrador retrievers

Myofibriallar myopathy with desmin storage is seen in what breed of dog?

Australian shepherd dog

What are the metabolic diseases causing myopathies?

``` Hypothyroid Hyperthyroid Hyperadrenocorticism Enzyme deficiencies -glycogen storage disease -phosphofructokinase deficiency Exercise intolerance and collapse ```

Labrador retrievers with ataxia and “rocking horse” gait following exercise. Hindlimbs are weak and unable to bear weight What is your DDX?

``` Exercise intolerance and collapse Heart disease Electrolyte/glucose abnormalities Anemia Other muscle disease ```

What is the treatment for exercise intolerance and collapse ?

Dogs usually return to normal after 5-25mins of rest Phenobarbital can prevent signs -> may be by reducing excitement

What is myotonia congenita?

Sustained depolarization of muscle due to Cl- channelopathy Animals are stiff and walk with difficulty

T/F: during Myotonia congenita there can be clonic reflexes because of motor neuron problems

False Clonic reflex because of muscular abnormalities Reflexes also can be slow

Collie 4months Facial dermatitis Waxing and waning of mild weakness and megaesophagus . What is your top DDX?

Dermatomyoitis Inflammatory dz of capillary walls in skin and to a lesser extent muscle

What breeds are predisposed to feline hyperesthesia syndrome?

Abyssinian, Siamese, and Burmese Between 5-8yrs

What signs are associated with feline hyperesthesia syndrome? What other diseases would be on your DDX for theses symptoms ?

Intermittent twitching, grooming, agitation, vocalizing, running, and aggression DDX: Behavior disorder, caudal lumbar spinal lesions, and paraspinal myositis

What is the prognosis of feline hyperesthesia syndrome?

Poor

What breeds are predisposed to congenital mysasthenia gravis?

Jack Russell | Foxies

What is the acquired form of mysasthenia gravis?

Autoantibodies to the AchR

Where is focal mysasthenia gravis localized?

Megaesophagus Facial, pharyngeal, laryngeal muscle weakness

What are the two types of generalized mysasthenia gravis?

Acute fulminating Chronic generalized

Dogs with sudden onset of regurgitation. Generalized muscle weakness with recumbency and respiratory distress Dx?

Acute fulminating generalized myasthenia gravis

Dog with muscle weakness induced by exercise and weakness of the facial, pharyngeal, and laryngeal muscles. Some regurgitation due to megaesophagus. DX?

Chronic generalized myasthenia gravis

What is the BEST diagnostic choice for myasthenia gravis?

AchR antibodies or immune complexes at the motor end plate

In what cases would a Tensilon test give false negative results for MG??

Only gives postive results in dogs that have generalized weakness following exercise —> not effective in focal or acute fulminating MG

Myasthenia gravis in cats is usually associated with???

Thymoma Rare generalized

What is the treatment for myasthenia gravis?

Pyridostigmine PO 1-3mg/kg, 8-12hrs +/- prednisolone (aza/cycle)

What are signs that your dose of pyridostigmine may be too high?

PSNS signs GI Bradycardia Bronchoconstriction Depolarizing blockade with respiratory arrest

What is the purpose of prednisolone or azathioprine as part of treatment for MG?

Acquired MG is an autoimmune rxn with AB production against ACh receptors —> anti-inflammatory effect

What is the prognosis for myasthenia gravis cases ?

Poor in congenital and fulminant Clinical and immunological cases generally resolve in about 6 months with treatment of pyridostigmine

What is the MOA of botulism toxin?

Blocks ACh release from presynaptic membrane and somatic and automobile neuromuscular junctions

What are signs of botulism toxin?

Hypotonia, hypo-/areflexia Decreased PSNS functions - bladder retention - constipation - dilated pupils - tachycardia Respiratory paralysis

What is the treatment for botulism?

Polyvalent antisera Supportive therapy Neostigmine may be helpful

Tick paralysis is caused by what species of tick?

Dermacentor andersoni (Rocky mountain wood tick) Dermacentor variabilis (American dog tick) Ixodes -occasionally

What is the MOA of tick paralysis?

Blocking conduction of impulses along distal portions of motor nerves or inhibiting presynaptic release of ACh at motor end plate

What are the signs of tick paralysis ?

Rapidly developing paresis - tetrapeligia LMN signs - hypo-tones/reflexia Cranial nerves, sensation, and continence are usually spared

Dog with ... Wrinkling of skin between ears, frowning appearance Enopthalamos Increased extensor tone -> saw horse stance What would your top dx be?

Tetanus

What is the treatment for tetanus??

Tetanus antitoxin -> only binds circulating toxin, prevents progression but doesn’t reverse If hyperthermic -> reduce temp Penicillin/metronidazole Acepromazine —> dopamine, serotonin, and histamine antagonist —> tranquialer/sed/antispasmodic effect

What is coonhound paralysis (acute idiopathic polyradiculoneuritis)?

Raccoon bite saliva -> change antigenicity that results in inflammation, degeneration, and demyelination of the ventral nerve root and peripheral nerves

What is the treatment for coonhound paralysis?

Supportive therapy - prevent decubitus ulcers, UTA and muscle atrophy Clinical signs usually resolve in weeks to months

What is the most common etiology of protozoal polyradiculoneuritis in dogs ??

Neospora caninum

Neospora infections are usually acquired how?

Transplacenally

Puppy 2months old Progressive posterior paralysis Extensor rigidity of pelvic limbs Dermatitis Dx?

Protozoal polyradiculoneuritis

How does neospora cause the signs seen in protozoal polyradiculoneuritis ??

Scar formation in the muscles from LMN damage and infection of the muscle

What is the treatment for protozoal polyradiculoneuritis ?

Trimethoprim-sulfadiazine (potentiated sulfonamide) Pyrimethamine (folic acid inhibitor) -> impairs production of protein and nucleic acid

What is the most common etiology of protozoal polyradiculoneuritis in cats ??

Toxoplasma

A dropped hock in a cat is a neuropathy associated with??

Diabetes mellitus

What type of neuropathies are associated with hypothyroidism??

Cranial (vestibular, laryngeal ) Generalized peripheral neuropathy

What is idiopathic facial nerve paralysis?

Degeneration of myelinated fibers in the facial nerve - usually unilateral with drooping years and lips - deviation of nose