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Small Animal Neurology > Neuromuscular Disorders > Flashcards

Neuromuscular Disorders Flashcards

1
Q

What are the 3 clinical signs that you will always see with a neuromuscular disorder?

A

Reduced to absent reflexes
Muscle atrophy
Reduced muscle tone

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2
Q

What are some other clinical signs of neuromuscular disease?

A 
Tetraparesis
Stiff stilted gait and bunny hopping
Exercise intolerance and collapse
Proprioceptive deficits
Muscle atrophy and tremors 
Ventroflexion of the head and neck
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3
Q

How can a neuropathy be distinguished?

A

Generalised or focal
Neurogenic atrophy
Severe flaccid paralysis
Sensory deficits and motor deficits

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4
Q

How can a junctionopathy be distinguished?

A

Always generalised
Exercise intolerance with fatigue
Normal sensory function
Intact reflexes

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5
Q

How can you distinguish a myopathy?

A 
Generalised, symmetrical or focal
Myotonia 
Contractures 
Myalgia 
Reduced or absent reflexes
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6
Q

What is the presentation of polyradiculoneuritis?

A

Inflammation of the nerve roots - idiopathic / rabies vaccine
Bengal cat

Acute onset, rapidly progressive pure motor deficits
Non-ambulatory tetraparesis

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7
Q

How can you diagnoses polyradiculoneuritis?

A

History and clinical signs
F waves
CSF analysis - increased protein

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8
Q

What is the prognosis and how can this disease be managed?

A

Fair
Supportive care
Turn q 4-6 h
Physiotherapy

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9
Q

What is the most common form of myasthenia gravis in dogs and how can it present?

A
  1. Generalised - most common
  2. Fulminant - acute onset and rapidly progressive
  3. Focal - megaoesophagus

Akitas, GSD, German shorthaired pointers, chihuahua

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10
Q

What are the common presentations of myasthenia gravis in the cat?

A
  1. Generalised
  2. Secondary to a thymoma

Abyssinian cats

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11
Q

How can you diagnose myasthenia gravis?

A

Anti-nicotinic acetyl choline receptor antibodies

Positive edrophonium test

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12
Q

How can you treat myasthenia gravis and what is the prognosis?

A

Anticholinesterases

  • pyridostigmine PO
  • neostigmine IM

Immunosuppression using corticosteroids at a later stage - worsens px if aspiration pneumonia develops

Thymectomy if due to a thymoma

Megaoesophagus management - postural feeding, PEG tube

Guarded px - may recover in 6m
Fulminant form difficult to treat

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13
Q

What are the most common causative agents in infectious myositis?

A

Neospora

Toxoplasma

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14
Q

What are the clinical signs of immune mediate polymyositis?

A 
Variable onset
Exercise intolerance and general weakness
Pyrexia 
Very severe myalgia
Muscle atrophy 
Stiffness and reluctance to move 
Non-ambulatory tetraparesis
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15
Q

How can you diagnose immune mediate polymyositis?

A

Inflammatory leukogram
Elevated AST and CK
Muscle biopsies
Rule out infectious cause

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16
Q

How can you treat immune mediated polymyositis?

A

Immunosuppression

Prednisolone etc

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17
Q

What is the clinical presentation of masticatory myositis?

A

CKCS
Swollen and painful masticatory muscles
Exophthalmos
Masticatory muscle atrophy

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18
Q

How should you diagnose masticatory myositis?

A

Anti 2M antibodies
Muscle biopsy
Raised CK

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19
Q

How should you treat masticatory myositis?

A

Prednisolone

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20
Q

How does infectious myositis due to neospora usually present?

A 
Puppies
Polyradiculoneuritis 
Polymyositis
Ascending paralysis of the PLs
Pelvic limb hyperextension
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21
Q

How can you diagnose infectious myositis and how should you treat it?

A

Dx: serology

Tx: Clindamycin, TMPS, pyrimethamine

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22
Q

How do brachial plexus avulsions usually present?

A 
Post RTA or fall
Monoparesis
Ipsilateral cutaneous trunci cut off
Horners syndrome 
Unable to extend limb and weight bear - radial n function required for triceps
23
Q

What is the clinical presentation of a tail pull injury?

A

Traumatic myopathy seen in post-RTA cats

Absent perineal sensation and anal tone
Tail base sensation absent
Tail doesn’t not move
Bladder dysfunction

Tx tail amputation and allow a month to recover

24
Q

What is the clinical presentation of a brachial plexus tumour?

A

Chronic, progressive monoparesis of a FL
Pain
Muscle atrophy

25
Q

How should you diagnose a brachial plexus tumour?

A

Palpable mass
Electrodiagnostics
MRI

26
Q

How does an ischaemi court myelopathy present?

A

Large, non-chondrodystrophic breeds
Miniature schnauzer
Cat - secondary to hypertension

Peracute, non-painful, lateralised paresis/paralysis
Usually occurs at exercise
Due to a fibrocartilagenous embolism

27
Q

How can you diagnose and treat ischaemic myelopathy?

A

Dx: MRI

Tx: resolves with time, give physio and hydrotherapy
Time to ambulatory - 10 days
Maximal recovery 3-4 months

28
Q

How some steroid responsive meningitis arteritis present?

A

6-18mo dogs
Pain, Pyrexia and lethargy
Occ neurological deficits

Boxer and beagle

29
Q

How can you diagnoses and treat SRMA?

A

Dx: leukocytosis with neutrophillia
CSF analysis - neutrophillic pleocytosis, increased protein and increased IgA in the CSF and serum

Tx: immunosuppression
Prednisolone +/- azathioprine

Very good px - potential for relapse

30
Q

How does discospondylitis present?

A

= infection of the intervertebral disc
Large entire male, adult dogs
Most commonly at L7-S1

Causative agent - staphylococcus pseudintermedius

Spinal pain +++
No deficits

31
Q

How can you diagnose and treat discospondylitis?

A 
Dx
Radiography 
- narrowing of the intervertebral disc space
- roughening of the end plates 
- proliferation of adjacent bone

Bacteriology - CSF sample
MRI

Tx: antibiotics based on c&s, NSAIDs

32
Q

What is the presentation of a traumatic disc extrusion?

A

Acute, non-painful, non-progressive
Only affecting the back legs and usually lateralised

Non-chondrodystrophic breeds (disk not mineralised)

33
Q

How can you diagnose and treat a traumatic disc extrusion?

A

Dx:
Radiographs to rule out fracture
Myelography
MRI

Tx: supportive care and physiotherapy
Median time to ambulatory = 2 weeks

34
Q

How should you approach a spinal fracture patient?

A 
Careful neurological exam
Thoracic and abdominal survey radiographs
Surgery radiographs of the spine
Analgesia 
Stabilise the spine 
Refer for surgery

V poor prognosis if no deep pain

35
Q

What is the presentation of Atlanta axial instability?

A

Disarticulation between the atlas and axis
Leads to compression of the spinal cord

Young toy breed dogs - less than 2

Neck pain, ataxia and tetraparesis

36
Q

How can you diagnose and treat Atlanta axial instability?

A

Radiography
Flexed or extended lateral neck and ventrodorsal
CT or MRI

Tx: Conservative splint for 6-12 weeks
Surgical

37
Q

How does chairi like malformation present?

A

CKCS and other toy breeds

Mismatch between caudal fossa volume and its contents, cerebellum herniated and compresses the spinal cord, leading to the development of syringomyelia and hydromelia

Neck scratching
Neck pain
Torticolis and scoliosis
Thoracic limb weakness and atrophy

38
Q

How can chairi like malformation be treated?

A 
Robenacoxib
Amantadine
Tramadol
Gabapentin
Furosemide
Corticosteroids 
Omeprazole

Surgical decompression of the caudal fossa
High mortality high morbidity

39
Q

What should you consider in an older patient with a chronic, progressive and painful spinal lesion?

A

Spinal neoplasia

40
Q

What are the two types of presentation with IVDD?

A
  1. Chondrodystrophic breeds - daschund, shih tzu, FB
    During the first few years of life
    Chondroid metaplasia
  2. Non-chondrodystrophic breeds - GSD, Labrador
    Middle aged
    Fibroid metamorphosis
41
Q

What are the two types of disc extrusion?

A

Hansen type 1 - ruptures through the annular fibres
- nuclear material is extruded into the spinal canal

Hansen type 2 - annular protrusion, annular fibres intact

42
Q

What is the clinical presentation with a type 1 extrusion?

A

Peracute, progressive, painful extrusion

3-6 year old, chondrodystrophic breeds
6-8 yo non-chondrodystrophic breeds

43
Q

How can you diagnose a type 1 disc extrusion?

A

Radiography
Narrowed disc space
Mineralised disc

MRI

44
Q

How can a type 1 extrusion be treated?

A

Strict rest and analgesia for 6-8 weeks - not usually successful

Surgical treatment is indicated if there is neurological deficits and pain

45
Q

How does a type 2 disc protrusion commonly present?

A

Middle aged non-chondrodystrophic breeds

Slowly progressive, chronic onset spinal pain

46
Q

How can you diagnose and treat a type 2 disc protrusion?

A

Radiography
Narrowed intervertebral disc space
Spondylitis

MRI

Tx: strict rest for 4-6w, analgesia
Surgery is indicated if the is no response to rest and analgesia

47
Q

How does cervical spondylomyelopathy usually present?

A

Large breed dogs

Short stilted gait in the thoracic limbs
Muscle atrophy in TLs
Progressive ataxia
Tetraparesis

48
Q

How can you diagnose and treat cervical spondylomyelopathy?

A

Dx: MRI

Tx: rest and analgesia

49
Q

How does degenerative lumbosacral stenosis present?

A 
Monoparesis / paraparesis
Urinary and faecal incontinence 
PL muscle atrophy 
Proprioceptive deficits
Reduced withdrawal reflexes
Lumbosacral pain

Secondary to type II IVDD and narrowing of the spinal canal at the lumbosacral junction

50
Q

How can you diagnose and treat lumbosacral stenosis?

A

MRI
Radiography
Clinical signs

Tx: conservative
Or dorsal hemilaminectomy

51
Q

What is the clinical presentation of degenerative myelopathy?

A

Boxer, GSD, corgi

Insidious, slowly progressive paresis of the pelvic limbs
Starts between 5-9yo and progresses over 6-18m
T3-L3 myelopathy
Non painful

52
Q

How can you diagnose degenerative myelopathy? What is the prognosis ?

A

Genetic testing and excluding other differentials

Poor px - can try physio to slow deteriation

53
Q

What are the most causes of acute onset spinal disease?

A

IVDD
Ischaemic myelopathies
Traumatic disc extrusion
Trauma

54
Q

What are the most common causes of a chronic onset spinal disease?

A 
Type 2 IVDD and protrusion 
Neoplasia 
Inflammatory / infectious
Cervical spondylomyelopathy 
Degenerative myelopathy

Small Animal Neurology (9 decks)

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