confusing neuro case!!

Re: confusing neuro case!!

ilanit — Thu, 08 Aug 2013 15:58:48 GMT

[quote user="Mark Lowrie"]Therefore, there was nothing more you could have done. Even if this dog was myasthenic, the rapid progression of signs would have made it near impossible to manage.[/quote]

Thanks for that!! It makes me feel a bit better. I was feeling really bad for not having tried the MG testing before with possibility of saving the dog.

It was certainly a devastating process to witness and left a deep impact. To see this dog being robbed of all its muscle functions one by one but knowing that the dog was fully conscious in all this makes it so awful. Towards the end she could not move any part of her body but you could still tell from the eyes that she was still aware of eveything!!! Truely horrible!

I'm in Malta btw

Thanks again!

Re: confusing neuro case!!

Mark Lowrie — Thu, 08 Aug 2013 12:58:44 GMT

I know this is a bit late but I agree that a neuromuscular localisation is most likely from your description – and I probably not going to say anything more than what others have already said. If this dog was in the UK then I think idiopathic polyradiculoneuritis would be the most likely cause – and I don’t know where you are based but I would still consider this the most likely possibility. Having said this, an acute fulminating myasthenia cannot be completely excluded nor can botulism. And other causes remain possible though far less likely.

Given the severe progression of signs I don’t think there was anything more you could have done. Idiopathic polyradiculoneuritis has no specific treatment and care is simply supportive. There is a spectrum of disease from mildly affected dogs to those juts like this case where all nerves are affected ultimately resulting in hypoventilation and hypoxia. By this stage I would always recommend euthanasia, some would ventilate but I feel the prognosis is so poor at this time that it is not worth considering.

Therefore, there was nothing more you could have done. Even if this dog was myasthenic, the rapid progression of signs would have made it near impossible to manage.

Post-mortem is unlikely to tell you much as all these diseases leave little in the way of obvious pathology.

Re: confusing neuro case!!

Braden Collins — Thu, 08 Aug 2013 01:04:17 GMT

Polyradiculoneuritis? That would be my guess.

Re: confusing neuro case!!

ilanit — Wed, 07 Aug 2013 22:16:35 GMT

[quote user="Linda Filshie"]What a shame. Are you likely to PM?

[/quote]

No, I didn't suggest it to owner. They are coming over tomorrow to see her

Re: confusing neuro case!!

Linda Filshie — Wed, 07 Aug 2013 22:02:09 GMT

What a shame. Are you likely to PM?

Re: confusing neuro case!!

ilanit — Wed, 07 Aug 2013 22:01:19 GMT

The dog died just when I arrived at hospital with the Neostigmine. It's so sad, she was only two years.

I wish I had tried it earlier, maybe I could have saved her...

Thanks anyway for your input.

For whatever it's worth, I learned from it.

Re: confusing neuro case!!

ilanit — Wed, 07 Aug 2013 19:31:36 GMT

Thanks all! Dog is getting worse and now struggling to breath

Edrophonium is not available but running to hopital now to get neostimine.

Nothing to lose at this point! I think it's already too late

Re: confusing neuro case!!

David Mills — Wed, 07 Aug 2013 18:21:26 GMT

I'd go with the suggestions above though would definitely trial tx for MG 1st with edrophonium if you can get it. 0.1-0.2mg/kg IV and you you expect a rapid improvement in gait/muscle function over 1-2 minutes. Pre-treat with atropine 0.02mg/kg IV. MG can present as a fulminating, progressive condition like you describe.

If organophosphate poisoning (animals often have a garlic-like smell to them), I would expect sl different clinical signs incl diarrhoea, urination, miosis, vomiting, excess lacrimation and salivation. There are some things to try if this is likely - but they may be difficult to get hold of.

If botulism, can take 2-3w to recover and respiratory muscle failure may occur before this is possible.

I'm unsure about preds in these situations - the dog is likely to die from pneumonia, respiratory muscle arrest or bradycardia and I don't think pumping in preds is likely to help any of these, especially if the dog is clinically worsening.

Re: confusing neuro case!!

John Flynn — Wed, 07 Aug 2013 17:59:32 GMT

Doesn't sound good...

I don't see anything you're missing...

Could be muscle, nerve or neuromuscular junction. If mentation good etc and no CN deficitis, then I'd be thinking either generalised peripheral neuropathy or myopathy or neuromuscular defect as you are.

I think CK/AST could be helpful to rule out a generalised myopathy.

Acute phase proteins such as CRP could help detect an inflammatory process, which is probably not going to be that much help though might be of some use...

I certainly wouldn't rule out myaesthenia gravis (see http://vetneuromuscular.ucsd.edu/cases/2010/Feb10.html, can do antibody test for $75 with results in a week if dog lasts that long...); I'd risk a "tensilon" response test if I could get my hands on some edrophonium, but last time I had a case like this rapidly deteriorating with no diagnosis the best I could manage was an attempt at oral "mestinon" just in case was MG and treatable - the dog was aggressive and, while weak obviously got stressed - I shoved the tablets down its throat and it went blue and died...)

You could probably continue the prednisolone at eg 0.25mg/kg without too much risk of exacerbating/causing aspiration pneumonia, but will it actually help at that dose? Is the bradycardia atropine-responsive?

I think you have few options:

1) Try to get a diagonsis (sounds like probably not possible, certainly if patient deteriorating rapidly)

2) Treat with steroids in case steroid responsive (I wouldn't go over 1mg/kg pred q12hrs)

3) "Try" treatment for myasthenia gravis 'just in case'

4) Nurse the patient and hope it spontaneously recovers (eg organophosphate poisoning)

Re: confusing neuro case!!

Anthony Dennison — Wed, 07 Aug 2013 17:55:50 GMT

Is Botulism a problem where you are? Has the dog eaten a chicken carcass recently?