Neurology 3 - Conditions Involving all Four Limbs

Question 1

What is cervical spondylomyelopathy?

Answer 1

Canine Wobblers, type II disc degeneration at C6/C7 in Dobes and Rotties

Question 2

Two types of cervical disc disease

Answer 2

type I - hyaline degeneration, disc explodes into cervical SC
type II - canine wobblers/cervical spondylomyelopathy

Question 3

Most prominent sign of cervical disc disease?
A) tetraparesis
B) pain
C) incontinence
D) paralysis

Answer 3

B - pain
the cervical spinal column has more space so a protruding disk doesn’t affect neural function as much as a prolapsed disc in the thoracolumbar region

Question 4

How would you diagnose type I cervical disk disease?

Answer 4

inject contrast into cisterna magna, should see prolapsed disk and narrowing of spinal column

Question 5

How would you treat type I cervical disk disease?

Answer 5

cage rest, physio to maintain muscle mass, NSAIDs with prednisone intermittently, can do Sx: modified slanted slot

Question 6

T/F: there is more spinal cord compression in Wobblers compared to type I cervical disc disease

Answer 6

True because with Wobblers there is bone tipping and the craniodorsal ridge causes a stenosis (whereas in type 1 this is not seen) as well as osteophyte formation into the column

Question 7

Signalment of Wobblers

Answer 7

Great Danes 3-18m, Dobes 5-8y

Question 8

Clinical signs of Wobbler’s disease

Answer 8

head guarding, neck pain, pelvic signs (wobbling, paresis), mild CP deficit and stiff gait in forelimbs, atrophy of supra and infra spinatus

Question 9

An owner brings his Doberman in because the dog is showing signs of severe neck pain. There are no other clinical signs. Is it possible this dog has Wobbler’s?

Answer 9

yes, 15% of cases only sign is neck pain

Question 10

How can you diagnose Wobbler’s disease?

Answer 10

traction radiographs - tipping, stenosis, rounding, decreased disc spaces, degeneration in articular facets.
dynamic MRI is better

Question 11

how would you treat Wobblers

Answer 11

each case different
palliative, disease is progressive
can do Sx for decompression, stabilization

Question 12

How would you treat an upper motor neurone bladder

Answer 12

phenoxybenzamine
prazosin
tamsulosin

Question 13

What is Atlanto-axial subluxation?

Answer 13

spinal cord decompression due to dorsal displacement of the axis

Question 14

Signalment of Atlanto-axial subluxation

Answer 14

small breed dogs
dens doesnt develop = instability between C1 and C2
also large breeds exposed to trauma

Question 15

How would you diagnose atlanto-axial subluxation?

Answer 15

radiographs - don’t manipulate neck

Question 16

Signs of atlantoaxial subluxation

Answer 16

neck pain to tetraplegia, respiratory paralysis

Question 17

T/F: hemilaminectomy + wiring/screwing works well on small bones and is 100% effective at treating atlanto-axial subluxation

Answer 17

false

Question 18

Another name for caudal occipital malformation syndrome

Answer 18

chiari 1 malformation syndrome

Question 19

What is the main brain lesion seen in caudal occipital malformation syndrome?

Answer 19

cerebellum slips through the foramen magnum, see dilation of central canal caudal to area, pressure damage to spinal cord

Question 20

Caudal Occipital malformation syndrome seen in 50% of
A) Dobermans
B) Cavalier King Charles Spaniels
C) Yorkies
D) Labs

Answer 20

B - CKCS

Question 21

Treatment for caudal occipital malformation syndrome

Answer 21

Gabapentin, prednisone, FMD (foramen magnum decompression)

Question 22

Causes of infectious myopathies

Answer 22

toxoplasma
neosporum
Lyme
Hepatozoan

Question 23

What is canine idiopathic polymyositis

Answer 23

immune mediated disease of large mature dogs
weakness, stiffness, rapid fatigue, atrophy
can see pyrexia, pain, regorge,bark, dysphagia, ventroflexion of head
Tx: immunosuppressants

Question 24

T/F: can give azathioprine for sparing of prednisone dose (decrease steroid levels) in dogs

Answer 24

True

Question 25

T/F: cats must receive azathioprine when being treated with prednisone

Answer 25

false, cats are less susceptible to effects of long term prednisone use

Question 26

Masticatory muscle myositis

Answer 26

large breeds <4y waxing and waning phases of painful swollen muscles, pseudotrismus fever Tx with prednisone + azathioprine for steroid sparing effects

Question 27

Extraocular myositis

Answer 27

autoimmunity to component of extra ocular muscles golden retrievers and large breeds, 6-18m bilateral exophthalmos PO corticosteroids, may need chronic prednisone

Question 28

Exertional myopathy

Answer 28

``` post exercise, increased serum CK, renal failure grey hounds and working dogs painful muscles and rigidity Tx with fluid, bicarbonate, rest animals tend to die from renal failure ```

Question 29

Hypokalemia

Answer 29

cats with K deficient diets, acidic diet, hyperaldosteronism, hyperthyroidism CS: persistent ventroflexion of the neck, stiff gait, resistance to move, no neuro deficits serum CK elevated, K decreased Tx with oral supplementation

Question 30

Feline Idiopathic Inflammatory Myopathy

Answer 30

sudden onset of weakness, cervical ventroflexion, inability to jump, muscles may be painful Tx: prednisone

Question 31

Limber Tail

Answer 31

pointer sand labs flaccid tail becomes painful Tx with NSAIDs and rest

Question 32

Dystrophic myopathies

Answer 32

young animals inherited deformities of the skeleton stunting, weakness, gait abnormalities, trismus, muscle atrophy with fibrosis

Question 33

Non-dystrophic myopathies

Answer 33

Central Core Like - Danes Nemaline rod - cats, blue merle border collie Congenital degenerative myopathies - labs, retrievers, chows, bouviers muscle wasting, weakness, can't hold head up

Question 34

Metabolic myopathies

Answer 34

hypo and hyperthyroidism hyperadrenocorticism enzyme deficiencies (glycogen storage disease, phosphofructokinase deficiency) exercise induced collapse (EIC) in labs

Question 35

Myotonia

Answer 35

chows, westies, danes, cats fainting goats sustained depolarization of muscle fibers dimbling of muscle, stiff gait, slow CP, clonic reflexes

Question 36

Dermatomyositis

Answer 36

skin lesions 2-6m then weakness, megaesophagus resolves, chronic waxing and waning collies tx: pentoxifylline

Question 37

Feline hyperesthesia syndrome

Answer 37

5-8y pure breeds intermittent, twitching, grooming, agitation, vocalization, running, aggression allergies, SC lesions, myositis, behaviour changes, seizures including body myopathy poor prognosis

Question 38

Two types of Myasthenia gravis

Answer 38

Congenital (born without Ach receptors) and Acquired (autoantibodies to Ach receptors)

Question 39

Classical presentation of myasthenia gravis

Answer 39

weakness following exercise

Question 40

Describe acute. vs chronic myasthenia gravis

Answer 40

Acute - sudden development of flaccid paralysis, hypotonicity, severe regurgitation (predisposes to inhalation pneumonia), weakness, resp failure Chronic - exercise intolerance, megaesophagus

Question 41

Diagnosis of myasthenia gravis?

Answer 41

Tension test - inject edrophonium and look for improvement | Best test - AchR antibody test/immune complex

Question 42

Treatment of myasthenia gravis?

Answer 42

Pyridostigmine increases Ach concentration in the synapse | Congenital and acute cases have poor prognosis

Question 43

MoA of Botulism?

Answer 43

Botulin toxin blocks Ach presynaptically

Question 44

CS of botulism

Answer 44

tetraparesis, flaccid paralysis, CN signs, difficulty breathing

Question 45

Dx of botulism

Answer 45

presence of toxin in faces

Question 46

Best tx of botulism

Answer 46

supportive care

Question 47

2 ticks that can cause tick paralysis

Answer 47

dermacentors, ixodes

Question 48

MoA of tick paralysis

Answer 48

block nerve conduction or decrease Ach

Question 49

Tx of tick paralysis

Answer 49

remove ticks

Question 50

Signs of tick paralysis

Answer 50

tetraparesis, LMN signs | cranial nerves, sensation and continence spared

Question 51

MoA of tetanus

Answer 51

C. tetani neurotoxin enters puncture wound and travels to spinal cord and blocks inhibitory neurons

Question 52

Signs of tetanus

Answer 52

sardonic facial expression, | whole animal is stiff (cats usually just one limb)

Question 53

Tx of tetanus

Answer 53

supportive care, Ace to relax muscles, penicillin to kill bacteria, feeding tubes

Question 54

Acute canine polradiculoneuritis/Coonhound paralysis

Answer 54

inflammation and demyelination of ventral roots saliva from racoons ascending LMN paralysis and tetraplegia cranial nerves, sensation and continence spared recovery after weeks/months

Question 55

Protozoal polyradiculoneurititis

Answer 55

toxoplasma or neospoa canine many dogs subclinical carriers, others show progressive posterior paresis Dx - send 2 samples a while apart to look for increasing concentration Tx - trimethoprim or clindamycin