Neuro - neuromuscular diseases

Question 1

What is the name for the connection between the nerve and the muscle?

Answer 1

Neuromuscular endplate

Question 2

What is the acronym for assessing motor units?

Answer 2

RAT
Reflex arc decreased/absent
Atrophy of the muscle
Tone of muscles decreased

Question 3

How do you test for muscle activity? What is abnormal?

Answer 3

Electrodiagnostic assessment - needle into leg, record muscle activity
Spontaneous electrical activity - myopathy/axonopathy

Question 4

What can cause generalised acute loss of reflexes followed my muscle atrophy?

Answer 4

Polyradiculoneuritis
Botulism
Metabolic diseases

Question 5

What can cause focal acute loss of reflexes followed my muscle atrophy?

Answer 5

Brachial plexus avulsion

Question 6

What is polyradiculoneuritis?

Answer 6

Immune mediated disease attacking motor nerve axons of dogs
Causes acute flaccid tetraparesis

Question 7

What is a differential for polyradiculoneuritis which is characterised by generalised neuromuscular neurolocalisation + megaoesophagus?

Answer 7

Myasthenia gravis

Question 8

What is the treatment/prognosis for polyradiculoneuritis?

Answer 8

Physiotherapy
NO STEROIDS
Very good prognosis but takes 1-3 months

Question 9

What is brachial plexus avulsion?

Answer 9

Focal neuromuscular disorder from trauma/scratch/wound disrupting reflexes of thoracic limbs
Often in cats

Question 10

What is the main differential for brachial plexus avulsion?

Answer 10

Thromboembolism

Question 11

What diseases can cause predominantly loss of muscle mass?

Answer 11

Polymyositis
Congenital myopathy
Nerve sheath tumour (focal)

Question 12

What can cause polymyositis?

Answer 12

Immune mediated
Infectious
Paraneoplastic

Question 13

What is a differential of a deteriorating lameness with marked pain and muscle atrophy?

Answer 13

Brachial plexus tumour

Question 14

What is the treatment and prognosis of a brachial plexus tumour?

Answer 14

Surgery - tumour removal +/- amputation
Guarded prognosis - months to years

Question 15

What diseases cause insidious onset fatigue with possible loss of reflexes and muscle mass?

Answer 15

Myasthenia gravis
Degenerative polyneuropathy
(CV and metabolic diseases)

Question 16

What is myasthenia gravis?

Answer 16

Disease of the neuromuscular endplate
Immune system destroys acetyl choline receptors
Not enough acetyl choline to muscles, preventing them from initiating muscle contraction

Question 17

How do you diagnose myasthenia gravis?

Answer 17

Regurgitation clinical sign - radiograph for megaoesophagus
Tensilon test - detect antibodies for the acetyl choline receptors

Question 18

What is the treatment for myasthenia gravis?

Answer 18

Pyridostigmine - acetylcholinesterase inhibitor
Postural feeding for megaoesophagus

Question 19

What is the prognosis for myasthenia gravis?

Answer 19

Guarded - aspiration pneumonia common complication

Question 20

What is degenerative polyneuropathy? Where does it affect first?

Answer 20

Disease of peripheral nerves affecting larynx first then spreading to pelvic then thoracic limbs
Causes symmetrical non painful weakness and reluctance to walk, stirtor

Question 21

How do you diagnose degenerative polyneuropathy?

Answer 21

Rule out metabolic differentials
Electrodiagnostics
Genetic testing

Question 22

What is an early sign of degenerative polyneuropathy?

Answer 22

Laryngeal paralysis
Stirtor - difficulty breathing

Question 23

What is the treatment/prognosis for degenerative polyneuropathy?

Answer 23

No cure - supportive treatment
Guarded prognosis

Question 24

What are cranial neuropathies?

Answer 24

Conditions affecting the cranial nerves

Question 25

What are some examples of acute cranial neuropathies?

Answer 25

Idiopathic facial nerve paralysis Idiopathic peripheral vestibular syndrome

Question 26

What are the signs of idiopathic facial nerve paralysis?

Answer 26

Peracute asymmetrical non painful Facial asymmetry Eye changes Drooping face on one side

Question 27

How do you test for idiopathic facial nerve paralysis?

Answer 27

Schirmer tear test Corneal ulcer

Question 28

What is the most common differential for peripheral vestibular disease?

Answer 28

Idiopathic peripheral vestibular syndrome

Question 29

What is idiopathic peripheral vestibular syndrome?

Answer 29

Sudden onset vestibular signs - ataxia, circling, head tilt, nystagmus Non painful

Question 30

What is the prognosis of idiopathic peripheral vestibular syndrome?

Answer 30

Very good - dont euthanise! Marked improvement over first 72 hours

Question 31

What is a differential for idiopathic peripheral vestibular syndrome?

Answer 31

Otitis media/interna - check dogs ears

Question 32

What are the clinical signs of a tail pull injury?

Answer 32

Flaccid tail Flaccid anus Urinary incontinence Sciatic nerve deficits

Question 33

What is the treatment/prognosis for tail pull injuries?

Answer 33

Bladder management - lifelong Fair to guarded prognosis depending on severity - if no improvement after 6 weeks then unlikely to regain function

Question 34

What is the localisation of a tail pull injury?

Answer 34

S1-S3