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23 Cards in this Set
- Front
- Back
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What factors influence the likelihood of recovery/regeneration after peripheral nerve injury?
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Continuity of Connective Tissue Structures
~~~ Remaining Around Nerve ~~~ ~~~ 1 – 4 mm/day Growth Proximity of Nerve Injury ~~~ To Innervated Muscle ~~~ Closer is Better Complete Disruption of Nerve ~~~ Poor Prognosis Physical Therapy Speeds Return to Function ~~~ Delays ~~~ ~~~ Muscle Atrophy ~~~~~~ Tendon Contraction Lack of Improvement in Motor Function ~~~ After 1 Month ~~~ ~~~ Choppy Chop Time Note re Self Mutilation ~~~ Sensory Nerve Regeneration Results In ~~~ ~~~ Abnormal Sensation ~~~ ~~~ ~~~ 7 – 10 Days |
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How can you monitor to see if a patient with a peripheral nerve injury is improving?
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Sequential Mapping Of
~~~ Cutaneous Sensation ~~~ Motor Function |
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What differential Diagnoses must be considered in a 3 year old dog with an acute onset of unilateral facial nerve paralysis?
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Idiopathic
Facial Nerve Branch Damage Within Middle Ear ~~~ Inflammation ~~~ Infection ~~~ ~~~ Extension of Bacterial Otitis Externa ~~~ ~~~ ~~~ Especially ~~~ ~~~ ~~~ ~~~ Cocker Spaniels ~~~ ~~~ ~~~ ~~~ German Shepherds ~~~ ~~~ ~~~ ~~~ Setters ~~~ ~~~ Foreign Bodies ~~~ ~~~ ~~~ Grass Awns Malignant Tumors ~~~ Cats ~~~ Dogs Traumatic Injury ~~~ Brainstem ~~~ Peripherally Hypothyroidsim ~~~ Occasionally CATS ONLY ~~~ Benign Nasopharyngeal Polyps |
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If a dog develops facial nerve paralysis due to a middle ear infection (from extension of otitis externa) what other neurological abnormalities might be seen?
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Horner’s Syndrome
~~~ Miosis ~~~ Ptosis ~~~ Enophthalmus ~~~ Prolapsed Nictitans Peripheral Vestibular Signs ~~~ Head Tilt ~~~ Ataxia ~~~ Nystagmus ~~~ ~~~ Horizontal ~~~ ~~~ Rotary |
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What signs will you see with acute bilateral motor paralysis of the trigeminal nerve?
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Inability to Close Jaw
~~~ Sudden Onset Inability to Prehend Food Swallowing ~~~ Usually Normal Sensory Function ~~~ No Obvious Deficits Mastication Muscles ~~~ Severe Rapid Atrophy ~~~ Occurs in Some Cases Dx via Elimination ~~~ Rabies ~~~ Inflammatory CNS ~~~ Trauma ~~~ ~~~ Rarely Bilateral ~~~ Neoplasm ~~~ ~~~ Rarely Bilateral ~~~ ~~~ Can Occur With ~~~ ~~~ ~~~ Multicentric Lymphosarcoma |
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What are the major differential diagnoses you will consider for acute progressive severe flaccid (LMN) paralysis?
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Acute Polyradiculoneuritis
~~~ aka Coonhound Paralysis Tick Paralysis Botulism Protozoal Polyradiculoneuritis ~~~ RARELY ~~~ Neospora Caninum ~~~ Rapidly Progressive |
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What clinical and historical features allow you to differentiate Acute Polyradiculoneuritis from the major differential diagnoses for acute progressive severe flaccid (LMN) paralysis?
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Acute Polyradiculoneuritis
~~~ History ~~~ ~~~ Prior Systemic Illness ~~~ ~~~ ~~~ 7 - 10 Days ~~~ ~~~ Prior Vaccination ~~~ ~~~ ~~~ 7 - 10 Days ~~~ ~~~ ~~~ Especially Rabies ~~~ Clinical ~~~ ~~~ Pain ~~~ ~~~ ~~~ HYPERESTHESIA ~~~ ~~~ ~~~ ~~~ Some Cases ~~~ ~~~ Bark ~~~ ~~~ ~~~ Hoarse ~~~ ~~~ Progression ~~~ ~~~ ~~~ As Little As 12 Hrs ~~~ ~~~ ~~~ Weakness Ascends Rapidly From Pelvic Limbs ~~~ ~~~ Afebrile ~~~ ~~~ Maintain Appetite ~~~ ~~~ Muscles ~~~ ~~~ ~~~ ~~~ Flaccid Symmetric Tetraplegia ~~~ ~~~ ~~~ ~~~ Decreased Tone ~~~ ~~~ ~~~ ~~~ Rapid Atrophy ~~~ ~~~ Neurologic ~~~ ~~~ ~~~ Spinal Reflexes ~~~ ~~~ ~~~ ~~~ Diminished or Absent ~~~ ~~~ ~~~ Perineal Reflex ~~~ ~~~ ~~~ ~~~ Normal ~~~ ~~~ ~~~ Continence ~~~ ~~~ ~~~ ~~~ Bladder and Rectal Sphincters Intact ~~~ ~~~ ~~~ Cranial Nerves ~~~ ~~~ ~~~ ~~~ Usually NOT INVOLVED ~~~ ~~~ ~~~ ~~~ Dysphagia ~~~ ~~~ ~~~ ~~~ ~~~ No ~~~ ~~~ ~~~ Pupillary Reflexes ~~~ ~~~ ~~~ ~~~ Usually Normal ~~~ ~~~ Electromyography ~~~ ~~~ ~~~ Diffuse Denervation After 6 Days ~~~ ~~~ ~~~ Motor Nerve Conduction Velocities Slow |
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What clinical and historical features allow you to differentiate Tick Paralysis from the major differential diagnoses for acute progressive severe flaccid (LMN) paralysis?
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Tick Paralysis
~~~ History ~~~ ~~~ Tick Exposure ~~~ ~~~ ~~~ 5 - 9 Days Before Onset ~~~ Clinical ~~~ ~~~ Pain ~~~ ~~~ ~~~ Normal Pain Perception ~~~ ~~~ Progression ~~~ ~~~ ~~~ 24 to 72 Hrs ~~~ ~~~ ~~~ Pelvic Limb Weakness to Recumbancy ~~~ ~~~ Bark ~~~ ~~~ ~~~ Altered ~~~ ~~~ ~~~ Cough ~~~ ~~~ Muscles ~~~ ~~~ ~~~ Loss of Tone ~~~ ~~~ ~~~ No Significant Atrophy ~~~ ~~~ Neurologic ~~~ ~~~ ~~~ Spinal Reflexes ~~~ ~~~ ~~~ ~~~ Absent ~~~ ~~~ ~~~ Cranial Nerves ~~~ ~~~ ~~~ ~~~ Most Cases Not Significantly Affected ~~~ ~~~ ~~~ ~~~ Mild Jaw Weakness Possible ~~~ ~~~ ~~~ ~~~ Mild Facial Weakness Possible ~~~ ~~~ ~~~ ~~~ Dysphagia ~~~ ~~~ ~~~ ~~~ ~~~ May Occur ~~~ ~~~ Electromyography ~~~ ~~~ ~~~ Absence of Spontaneous Activity ~~~ ~~~ ~~~ Diminished Amplitude |
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What clinical and historical features allow you to differentiate Botulism from the major differential diagnoses for acute progressive severe flaccid (LMN) paralysis?
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Botulism
~~~ History ~~~ ~~~ Ingestion of Spoiled Food or Carrion ~~~ ~~~ ~~~ Hours to 6 Days Before Clinical Signs ~~~ ~~~ Groups of Dogs ~~~ Clinical ~~~ ~~~ Pain ~~~ ~~~ ~~~ Normal Pain Perception ~~~ ~~~ Progression ~~~ ~~~ ~~~ Ascending ~~~ ~~~ Regurgitation ~~~ ~~~ ~~~ Megaesophagus ~~~ ~~~ Muscles ~~~ ~~~ ~~~ Profound Weakness Especially ~~~ ~~~ ~~~ ~~~ Face ~~~ ~~~ ~~~ ~~~ Jaw ~~~ ~~~ ~~~ ~~~ Pharynx ~~~ ~~~ ~~~ Loss of Tone ~~~ ~~~ ~~~ No Atrophy ~~~ ~~~ Neurologic ~~~ ~~~ ~~~ Spinal Reflexes ~~~ ~~~ ~~~ ~~~ Absent ~~~ ~~~ Cranial Nerves ~~~ ~~~ ~~~ Extensive Impairment ~~~ ~~~ ~~~ ~~~ Drool ~~~ ~~~ ~~~ ~~~ Cough ~~~ ~~~ ~~~ ~~~ Dysphagia ~~~ ~~~ ~~~ ~~~ ~~~ Prehension Deficits ~~~ ~~~ ~~~ Pupillary Reflexes ~~~ ~~~ ~~~ ~~~ Mydriasis ~~~ ~~~ ~~~ Palpebral Reflex ~~~ ~~~ ~~~ ~~~ May Be Lost ~~~ ~~~ Electromyography ~~~ ~~~ ~~~ Absence of Spontaneous Activity ~~~ ~~~ ~~~ Diminished Amplitude |
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What clinical and historical features allow you to differentiate Protozoal Polyradiculoneuritis from the major differential diagnoses for acute progressive severe flaccid (LMN) paralysis?
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Protozoal Polyradiculoneuritis
~~~ History ~~~ ~~~ Litters of Puppies ~~~ ~~~ Occasionally Adults ~~~ Clinical ~~~ ~~~ Spinal Reflexes ~~~ ~~~ ~~~ Diminished ~~~ ~~~ Muscles ~~~ ~~~ ~~~ Flaccid Paralysis ~~~ ~~~ Cranial Nerves ~~~ ~~~ ~~~ Dysphagia ~~~ ~~~ Electromyography ~~~ ~~~ ~~~ Ventral Spinal Root Denervation |
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What are the major differential diagnoses you will consider for chronic progressive weakness, muscle atrophy and diminished reflexes in a dog?
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Diabetes Mellitus
~~~ Subtle Dogs ~~~ Dramatic Cats Hypothyroidism Insulinoma ~~~ Parneoplastic Other Parneoplastic Syndromes Systemic Immune Mediated Dz ~~~ SLE (Systemic Lupus Erythematosus) Idiopathic |
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What tests will you do to look for the cause of chronic progressive weakness, muscle atrophy and diminished reflexes in a dog?
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Electromyography
~~~ Tentative Dx Polyneuropathy ~~~ Denervation ~~~ Decreased Conduction Velocity Biopsy ~~~ Confirm Dx Polyneuropathy ~~~ Muscle ~~~ Peripheral Nerves CBC / Chem / UA ~~~ Diabetes Mellitus ~~~ Systemic Immune Mediated Dz Thyroid Hormones ~~~ Hypothyroidism Insulin ~~~ Insulinoma Physical Exam ~~~ Paraneoplastic Tumor Survey Rads and Ultrasound ~~~ Paraneoplastic Tumor Lymphnode Aspirates ~~~ Paraneoplastic Tumor Bone Marrow ~~~ Paraneoplastic Tumor Protein Creatinine Ratio ~~~ Systemic Immune Mediated Dz Antinuclear Anti Body (ANA) Titre ~~~ Skin Biopsy ~~~ Blood |
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What is the pathophysiological mechanism in acquired myasthenia gravis?
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Antibodies Against Nicotinic Acetylcholine Receptors In Skeletal Muscle
Antibodies Bind Nicotinic Acetylcholine Receptors Reduce Sensitivity of Postsynaptic Membrane to Acetylcholine Impairs Neuromuscular Transmission |
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What are the primary clinical abnormalities noted in most patients with MG (myasthenia gravis)?
Appendicular |
Muscle Weakness
~~~ Worsens ~~~ ~~~ With Exercise ~~~ Improves ~~~ ~~~ With Rest Pytalism Regurgitation ~~~ Megaesophagus ~~~ ~~~ 90% of Dogs with Aquired MG ~~~ ~~~ Inconsistent Cats Dysphagia Hoarseness ~~~ Bark ~~~ Meow Mydriasis ~~~ Persistent Facial Muscle Weakness |
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What do you expect to find in a complete nervous system examination of a dog with myasthenia gravis?
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Mentation
~~~ Normal Proprioception ~~~ Normal Reflexes ~~~ Normal Mydriasis ~~~ Possible Facial Muscle Weakness ~~~ Possible |
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If you suspect MG (myasthenia gravis) in a dog what is the most definitive test to confirm that diagnosis?
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Serum Titre
~~~ Circulating Antibody Against ~~~ ~~~ Acetylcholine Receptors Interim Dx ~~~ Positive Response to Edroponium Chloride (Tensilon) ~~~ ~~~ Acetylcholinesterase Activity |
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What is the Signalment of masticatory myositis?
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~~~ Mainly Large Breed Dogs
~~~ ~~~ Especially ~~~ ~~~ ~~~ German Shepherd ~~~ ~~~ ~~~ Retrievers ~~~ ~~~ ~~~ Doberman Pinscher ~~~ Age ~~~ ~~~ Mainly Young to Middle Age ~~~ Gender ~~~ ~~~ No Predilection ~~~ Cats ~~~ ~~~ Not Documented |
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What are the clinical signs of acute masticatory myositis in dog?
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Swelling
~~~ Masticatory Muscles ~~~ ~~~ Temporalis ~~~ ~~~ Masseter ~~~ Recurrent ~~~ Painful ~~~ Resistance to Opening Mouth Exophthalmus Pyrexia Lymphadenopathy ~~~ Submandibular ~~~ Prescapular Anorexia Pytalism Depression |
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What are the main clinical signs associated with the chronic form of masticatory myositis?
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Progressive Severe Atrophy
~~~ Temporalis ~~~ Masseter ~~~ Skull Appearance Enophthalmus Difficulty Opening Mouth ~~~ tf Difficulty Eating BAR Systemically ~~~ Normal |
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How will you diagnose masticatory muscle myositis?
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Clinical Signs
~~~ Preliminary Dx CBC / Chem / UA ~~~ Acute ~~~ ~~~ Neutrophilia ~~~ ~~~ Eosinophilia ~~~ ~~~ CK ~~~ ~~~ AST ~~~ ~~~ Globulin ~~~ ~~~ Proteinuria Serum Titre ~~~ Type 2M Muscle Fibre Antibodies ~~~ 80% of Dogs Electromyography ~~~ Normal In Some Chronic Dogs ~~~ ~~~ Fibrous Connective Tissue Replacement of Muscle Tissue Histochem ~~~ 2M Muscle Fiber - Antibody Complexes ImmunoHistochem ~~~ 2M Muscle Fiber - Antibody Complexes Histopath Muscle Biopsy ~~~ Definitive Dx |
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How will you treat masticatory muscle myositis?
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Corticosteroids
~~~ Initially Immunosuppresive Dose ~~~ Decrease After 3 Weeks ~~~ Gradually Taper Over 3 - 4 Months ~~~ ~~~ Lowest EOD Dose Azathioprine ~~~ Dogs Refractory to Corticosteroids ~~~ Relapse DO NOT PRY MOUTH OPEN |
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How will you monitor response to therapy for masticatory muscle myositis?
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Jaw Mobility
Jaw Discomfort Serum CK |
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How can you differentiate polymyositis and polymyopathy from polyneuropathy?
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Biopsy
~~~ Muscle ~~~ Nerve Electromyography ~~~ Decreased Conduction Velocity ~~~ Denervation Serum Titres ~~~ Muscle vs Neural Antibodies Neurologic Exam ~~~ UMN Signs ~~~ ~~~ Proprioceptive Deficits ~~~ Cranial Nerve Deficits Blood Chemistry ~~~ CK |
