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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
How should you diagnose a brachial plexus tumour?
Palpable mass Electrodiagnostics MRI
26
How does an ischaemi court myelopathy present?
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
How can you diagnose and treat ischaemic myelopathy?
Dx: MRI Tx: resolves with time, give physio and hydrotherapy Time to ambulatory - 10 days Maximal recovery 3-4 months
28
How some steroid responsive meningitis arteritis present?
6-18mo dogs Pain, Pyrexia and lethargy Occ neurological deficits Boxer and beagle
29
How can you diagnoses and treat SRMA?
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
How does discospondylitis present?
= infection of the intervertebral disc Large entire male, adult dogs Most commonly at L7-S1 Causative agent - staphylococcus pseudintermedius Spinal pain +++ No deficits
31
How can you diagnose and treat discospondylitis?
``` 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
What is the presentation of a traumatic disc extrusion?
Acute, non-painful, non-progressive Only affecting the back legs and usually lateralised Non-chondrodystrophic breeds (disk not mineralised)
33
How can you diagnose and treat a traumatic disc extrusion?
Dx: Radiographs to rule out fracture Myelography MRI Tx: supportive care and physiotherapy Median time to ambulatory = 2 weeks
34
How should you approach a spinal fracture patient?
``` 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
What is the presentation of Atlanta axial instability?
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
How can you diagnose and treat Atlanta axial instability?
Radiography Flexed or extended lateral neck and ventrodorsal CT or MRI Tx: Conservative splint for 6-12 weeks Surgical
37
How does chairi like malformation present?
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
How can chairi like malformation be treated?
``` Robenacoxib Amantadine Tramadol Gabapentin Furosemide Corticosteroids Omeprazole ``` Surgical decompression of the caudal fossa High mortality high morbidity
39
What should you consider in an older patient with a chronic, progressive and painful spinal lesion?
Spinal neoplasia
40
What are the two types of presentation with IVDD?
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
What are the two types of disc extrusion?
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
What is the clinical presentation with a type 1 extrusion?
Peracute, progressive, painful extrusion 3-6 year old, chondrodystrophic breeds 6-8 yo non-chondrodystrophic breeds
43
How can you diagnose a type 1 disc extrusion?
Radiography Narrowed disc space Mineralised disc MRI
44
How can a type 1 extrusion be treated?
Strict rest and analgesia for 6-8 weeks - not usually successful Surgical treatment is indicated if there is neurological deficits and pain
45
How does a type 2 disc protrusion commonly present?
Middle aged non-chondrodystrophic breeds | Slowly progressive, chronic onset spinal pain
46
How can you diagnose and treat a type 2 disc protrusion?
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
How does cervical spondylomyelopathy usually present?
Large breed dogs Short stilted gait in the thoracic limbs Muscle atrophy in TLs Progressive ataxia Tetraparesis
48
How can you diagnose and treat cervical spondylomyelopathy?
Dx: MRI Tx: rest and analgesia
49
How does degenerative lumbosacral stenosis present?
``` 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
How can you diagnose and treat lumbosacral stenosis?
MRI Radiography Clinical signs Tx: conservative Or dorsal hemilaminectomy
51
What is the clinical presentation of degenerative myelopathy?
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
How can you diagnose degenerative myelopathy? What is the prognosis ?
Genetic testing and excluding other differentials Poor px - can try physio to slow deteriation
53
What are the most causes of acute onset spinal disease?
IVDD Ischaemic myelopathies Traumatic disc extrusion Trauma
54
What are the most common causes of a chronic onset spinal disease?
``` Type 2 IVDD and protrusion Neoplasia Inflammatory / infectious Cervical spondylomyelopathy Degenerative myelopathy ```

Small Animal Neurology (9 decks)

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