Peripheral Neuropathy

Question 1

Motor unit includes

Answer 1

Lower motor neuron
Neuromuscular junction
Muscle fibers

Question 2

Functional signs of diffuse motor unit disease

Answer 2

Paresis
Weakness
Gait abnormalities
Exercise induced weakness
Reduced reflexes
Postural alterations (cervical ventroflexion)
Dysphonia
Regurgitation
Dysphagia
Dyspnea

Question 3

Megaesophagus

Answer 3

Dilation of esophagus
Common with generalized motor unit disease

Question 4

Development of megaesophagus in cats/dogs

Answer 4

Skeletal muscle distribution in
2/3 in dogs
1/3 in cats

Question 5

Classic sign of weakness in cats

Answer 5

Cervical ventroflexion
Cats don’t have a Nuchal ligament and will sit back on haunches bc they can’t lift their head

Question 6

Testing for diffuse neuromuscular disease

Answer 6

Signalment, History, Physical exam, Neurologic Exam
• CBC, Chemistry (including CK), Urinalysis
• Metabolic/Endocrine and infectious disease testing as appropriate
• Thoracic Radiographs, Abdominal Ultrasound
• ACh antibody titer (will be discussed further)

Question 7

Advanced testing for for NMD

Answer 7

Electro diagnostics
Muscle/nerve biopsy
CT/MRI
CSF sampling

Question 8

Neuropathy

Answer 8

Primary injury to cell body, secondary demyelination

Question 9

Axonopathy

Answer 9

Primary injury to axon, secondary demyelination

Question 10

Demyelination

Answer 10

Primary loss of myelin, no change to axon

Question 11

DAMNITV

Answer 11

Degenerative
Anomalous
Metabolic
Nutritional
Neoplastic
Idiopathic
Inflammatory
Infectious
Trauma
Toxin
Vascular

Question 12

Degenerative polyneuropathy

Answer 12

Laryngeal paralysis
Could be hereditary or acquired

Question 13

Hereditary laryngeal paralysis

Answer 13

Young animals
Huskies, Rottweilers
Varying severity & nerve involvement

Question 14

Acquired laryngeal paralysis

Answer 14

Older dogs
Large breeds, Labrador retrievers**

Question 15

Prognosis and treatment for laryngeal paralysis

Answer 15

Generally poor for both hereditary and aquired
Exercise restrictions, avoid stress & heat
Arytenoid lateralization surgery

Question 16

Diabetic polyneuropathy

Answer 16

Occurs in dogs and cats
Bilateral pelvic limb paresis & abnormal reflexes
Could occur bc the axons are dying or have abnormal Schwann cell function

Question 17

Diagnosis and treatment of diabetic polyneuropathy

Answer 17

Documented/diagnosed diabetes
Rule out other causes for polyneuropathy
No specific treatment - just control the diabetes
Prognosis is guarded

Question 18

Neoplastic polyneuropathy

Answer 18

Lymphoma
Some tumors have a predilection for nerves

Question 19

Paraneoplastic polyneuropathy

Answer 19

Insulinoma
Clinical signs vary and can be severe
Treat underlying neoplasia - will help neuropathy

Question 20

Inflammatory polyneuropathy

Answer 20

Infectious or immune mediated

Question 21

Infectious inflammatory polyneuropathy

Answer 21

Neospora canium, toxoplasma gondii

Question 22

Immune mediated inflammatory polyneuropathy

Answer 22

Immune mediated in cats
Acute polyradiculoneuritis
Trigeminal neuritis

Question 23

Signalment in immune mediated PN in cats

Answer 23

Young, males more than females
Weakness, tetraparesis, reduced withdrawals

Question 24

Acute polyradiculoneuritis

Answer 24

Coonhound paralysis
Most common polyneuropathy in dogs
Progressive paresis with reduced reflexes

Question 25

Diagnosing & treating acute polyradiculoneuritis

Answer 25

Signalment, history, clinical sings, muscle biopsy, CSF eval
Prognosis is good - takes time
Supportive therapy during recovery

Question 26

Differentials for acute flaccid paralysis

Answer 26

Acute polyradiculoneuritis
Botulism
Tick paralysis
Fulminant myasthenia gravis

Question 27

Dysautonomia

Answer 27

Degenerative disease
Common in young dogs and cats
Clinical signs are compatible with autonomic dysfunction