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VPK3611
DISEASES OF THE NERVOUS SYSTEM

PERIPHERAL NERVE AND MUSCLE

Intan Shafie
 Peripheral Nerve Disease
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 Paresis/plegia are commonest signs recognised by

owners
 Single nerves/plexus MONPARESIS/PLEGIA
 Generalised disease TETRAPARESIS/PLEGIA
 Localisation initially from spinal cord segments to
muscle (neuromuscular unit)
 Refine by clinical examination
 Imaging

 Electrophysiology
 Compression of Nerve Roots/Peripheral Nerves
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 Aetiology
 Trauma

 Discdisease
 Foraminal
compression
 Mass compressing
nerve
 Tumour
 Calf
 Obstetric Paralysis
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 Prolonged or excessive pressure on

pelvic nerve
 Prolonged, lower pressure worse
 Compression

 Ischaemic degeneration
 Severed

 Obturator  adduction failure

 Sciatic  weakness
 Tibial  recumbency
 Obstetric Paralysis
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 Diagnosis
 History: breed, age, assistance

 Clinical: vaginal contusion, unable to rise, weak in 1 limb or

abnormal gait in affected leg
 Exclusion: absence of other explanatory signs such as milk
fever or mastitis
 Treatment
 Antiinflammatories: flunixin, ketoprofen

 Nursing

 Prognosis
 not always bright. Can progress to downer cow syndrome and
increased risk of further injury due ataxia.
 Conditions Affecting Peripheral Nerves
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 NMU
 Can be affected specifically
 Botulism
is a toxin affecting release of neurotransmitter at
neuromuscular junction
 Can be affected as part of generalised condition
 E.g. diabetic neuropathy
 Can be affected as specific condition of PNS
 E.g.
distal denervating disease
 Immunomediated disease myasthenia gravis
 Botulism in dogs
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 Uncommon  Treatment
 Not in cats
 No specific therapy
 Aetiology  Nursing support
 Same as cattle  Turning in kennel
 History of scavenging  Aspiration of pharynx
 Diagnosis  Consider gastric tube
 History  Oxygen if muscles of respiration
 Clinical signs involved
 Tetraparesis/plegia
 Facial paralysis
 Dysponia
 Difficulty in swallowing
 Meagoesphagous

 Definitive diagnosis difficult to

confirm
 Botulism in dogs
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 Outcome
 Good with quality nursing for
dogs WITHOUT respiratory
involvement
 Aspiration pneumonia poor
prognosis
 Involvement of respiratory
muscles poor prognosis
 Myasthenia Gravis
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 Epidemiology
 Disease primarily of dogs

 GSD, Retrievers and Labradors over represented

 Uncommonly cats

 Rarely large animal species

 Aetiology
 Lack of muscle receptors for the acetylcholine neurotransmitter at the
neuromuscular junction
 Two forms

 Congenital
 Reduced receptor development
 Acquired
 Autoimmune complexes bind to and inactivate receptor
 Thymoma more common cats (26%) vs dogs (3.4%)
 Myasthenia Gravis
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 Generalised MG  Fulminating MG
 Clinical signs  Acuteand rapidly
 Exercise intolerance progressive form
with collapse progressing to
tetraparesis and
 Recovery after short
megaoesophagus
rest
 Normal out with
 Focal MG
collapse episode  Megaoesophagus and
 Megaoesophagus in
associated
majority (~60%) dogs regurgitation
 Myasthenia Gravis
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 Examination of generalised MG
during collapsed phase
 Normal sensation

 Intact patellar reflex

 Decreased withdrawals

 Abnormal proprioception

 Patients with MG tire easily

 Repetitive stimulation of palpebral
reflex may cause it to diminish
 Myasthenia Gravis
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 Diagnosis
p
r  Edrophonium test (NOT
e
s AVAILABLE IN MALAYSIA)
u
m  0.1mg/kg (max 5mg total)
p
ti dogs
v
e  0.2-1.0mg total cats
I
v  Reverses weakness
e
 Lasts ~30 mins
c
o  Antibody titre
n
f  Anti receptor antibodies
i
r
m
 98% of dogs
a Typical gait changes
t  NOT congenital!
o
Progressively shortening of gait
r Choppy and stiff
y
Sternal recumbency
 Myasthenia Gravis
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 Treatment
 Anticholinesterase
 Pyridostigmine bromide 0.5 – 3.0mg/kg BID to TID
 Start low and build up to avoid cholinergic crisis
 Bradycardia
 Profuse salivation
 Diarrhoea
 Miosis
 Limb tremors
 Steroid
 Controversial use
 Immunosuppressive dose (risk of exacerbating muscle weakness
and contraindicated if inhalation pneumonia
 Myasthenia Gravis
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 Outcome
 Prognosis is the potential for remission over a period of months

 Major risk is inhalation pneumonia

 Often fatal
 Related to regurgitation due to megaoesphagous
 Some studies suggest 40-50% mortality

 Outcome heavily influenced by early recognition

 Polyradiculoneuritis
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 Inflammation of peripheral nerve and nerve roots

 Acute progressive
 Clinical signs similar to botulism and mysthenia
gravis but megaesophagus is rare
 Immune mediated/idiopathic
 Treatment centered at supportive care and
rehabilitation
 Tetanus
 Epidemiology
 All species susceptible
 Difference in
susceptibility
 Horses most susceptible
 Cattle least susceptible
 Dogs more susceptible
cats
 low susceptibility
 Aetiology
 Toxin produced by
Clostridium tetani
 Toxin affecting release
of neurotransmitters at
synapses
 Disease represents the
loss of inhibition of γ
motor neurons
 Lossof inhibitory
neurotransmitters
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 Tetanus
 Clinical signs
 Rigid muscles
 Muscle spasm with
stimulation
 Stiff gait
 Raised tail
 Facial expression
 Risus sardonicus
 Increased palpebral fissure
 Wrinkled forehead (dogs)
 Salivation
 Difficulty in swallowing
 Difficulty in breathing
 Recumbency 17
 Tetanus
 Course of disease
 5-10 days horses and
cattle
 3-4 days sheep
 5-7 days dogs
 Diagnosis
 Based on clinical signs
 History of recent wound
 Confirmation requires
specialist techniques
 Treatment
 Antibiotics
 Metronidazole
 Penicillin G
 Antitoxin
 Risk of anaphylaxis
 Slow i/v
 Test dose first SC
 100-500IU/kg
 Nursing support
 Gastrotomy tube
 Bladder catheterisation
 Debride wound if
necessary 18
 Tetanus
 Outcome  Prevention
 Fatality around 40-50%  Horses are the only
 Death due to respiratory animals routinely
paralysis vaccinated
 More marked the clinical
 Very susceptible
signs the poorer the
prognosis
 Recovery
 Can take months for
muscle tone to reduce
 Issue in dogs with
urniation related to high
sphincter tone 19
 Muscle disease

 Can be a difficult
diagnosis
 Signs very variable
 Poor muscle development
 Muscle loss
 Exercise intolerance
 Myalgia
 Systemic illness

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 Muscle disease

 Labrador centronuclear myopathy

 Present many countries
 Congenital disease
 Poor development
 Stabilises at around a year of
age
 Retrievers
 Dystrophin deficiency
 congenital disease
 Great dane inherited myopathy
 “core myopathy”
 Variation in clinical signs

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 Muscle Disease

 Diagnosis of muscle
disease
 Clinical suspicion
 Enzymology (CK, AST, (ALT))
 EMG
 biopsy

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 Peripheral Neuropathies
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 Breed related
 Rare – specific breed strong clue
 E.g polyneuropathy of
Leonbugers
 Acquired
 Coon Hound paralysis
 Botulism
 Tick paralysis
 Endocrine disease
 Peripheral Neuropathies
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 Diagnosis
 Clinical suspicion

 Electrophysiology

 EMG and conduction

 Biopsy

 Nerve and muscle

 Often part of a broader investiation

 Take home messages
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 Involvement of neuromuscular unit requires further

refinement to spinal cord, nerve root, peripheral
nerve, neuromuscular junction muscle
 Neuromuscular unit can be affected by specific
conditions and also affected by generalised
conditions such as diabetes
 Course take home messages
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 DON’T PANIC
 Core skill is clinical examination and interpretation (localisation)
 Clinical signs are an excellent clue to where but not why
 Localisation is the key to every thing else
 Localisation is not always easy and may need further investigative tools
 Nervous system is affected by specific diseases but also commonly affected
by generalised conditions