Wednesday, August 17, 2016

 

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Here’s more fun with feline neurology!



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Missed Part 1? Click here!





 

5 of Zuku’s top 10 feline neuro to know for NAVLE®:

  1. Diabetic polyneuropathy

                    Plantigrade stance is typical of diabetic polyneuropathy

    • Classic case:
      • 7+-year-old, neutered male
      • Lethargy
      • Plantigrade stance
      • Poor patellar reflexes
    • Dx: Serum and urine glucose
    • Rx:
      • Insulin glargine (a long-acting insulin)
      • Restrict dietary carbs to less than 15% metabolizable energy
      • Increase dietary fiber
    • Pearls: Guarded to good prognosis for full return of function
    • Click here for a video of a cat with diabetic neuropathy

  2. Idiopathic vestibular disease

                    Immature 5-lined skink, commonly called "blue-tail lizard", has been implicated with idiopathic vestibular disease, but no proven cause and effect

    • Classic case:
      • Circling and head tilt (toward affected side)
      • Ataxia
      • Horizontal or rotary nystagmus (fast phase away from affected side)
      • NO: loss of conscious proprioception, facial paralysis, Horner syndrome
    • Dx: All of the following are negative: otoscopy, MRI, CT, CSF analysis
    • Rx: Nursing care, sedatives, confine to prevent jumping
    • Pearls:
      • Excellent prognosis
      • In southeastern USA, often history of cat toying with or eating an immature five-lined skink (blue-tail lizard) but no proven cause and effect

  3. Otitis media/interna

                    Left Horner syndrome; Horner syndrome may be seen with otitis media/interna

    • Classic case:
      • Head tilt and circling (toward lesion)
      • Horizontal nystagmus (fast phase away from affected side)
      • Ataxia
      • +/- Ipsilateral facial neuropathy
      • +/- Ipsilateral Horner syndrome
    • Dx:
      • Oropharyngeal examination – look for nasopharyngeal polyp
      • Otoscopy – opaque and bulging membrane if fluid in tympanic bulla
      • Myringotomy (puncture tympanic membrane) and culture
      • CT or MRI
    • Rx:
      • Antibiotics for several weeks
      • Bulla osteotomy
    • Pearls:
      • Nasopharyngeal polyps are a common cause of otitis media/externa in young adult cats
      • The tympanic bulla in cats is divided into two chambers by an osseous septum; the ventral chamber cannot be drained via myringotomy (see Vet Surgery Central for a nice schematic on the anatomy)

  4. Feline hyperesthesia syndrome

                    Cat licking at back, a sign of feline hyperesthesia syndrome

    • Classic case:
      • Hypersensitivity to touch in lumbar and lumbosacral region, biting and licking at back and tail
      • Rippling of skin in thoracolumbar region
      • Running erratically, twitching muscles, swishing tail
    • Dx: All tests are negative – thorough physical exam, bloodwork, urinalysis, spinal radiography (+/- MRI, CSF, epaxial muscle biopsies)
    • Rx:
      • Environmental enrichment and exercise
      • Anticonvulsants
      • Tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs)
    • Pearls: Prognosis is guarded
    • Click here for a video of a cat with feline hyperesthesia syndrome

  5. Toxoplasmosis

                    Toxoplasma-positive immunofluorescence reaction

    • Classic case: Usually a younger cat
      • Acute or chronic onset of focal or multifocal neurologic signs:
        • Seizures
        • Ataxia
        • Nystagmus
        • Cranial neuropathies
        • Generalized weakness
    • Dx:
      • Increased serum CK
      • Ophthalmic exam (may see uveitis, chorioretinitis, keratitis)
      • CSF with titers (IgM or rising IgG)
      • MRI
        • Muscle biopsy if myopathy suspected
    • Rx: Clindamycin
    • Pearls:
      • Prognosis guarded
      • Zoonotic risk

owl    Zuku-certified bodacious websites on feline neurological conditions:



de Lahunta’s video resources for neurologic cases

39 videos of neurologic cases in cats like bilateral otitis media/interna, diabetic neuropathy, and feline hyperesthesia.

Courtesy, Cornell University.

University of Minn feline neurology video-clips

More videos of neurologic cases in cats like vestibular syndrome and diabetic neuropathy.

Courtesy, University of Minnesota.


Neuropetvet

Quizzes, “What’s your neurologic diagnosis?” and terminology.

Courtesy, Dr. Mark Troxel.

NeuroWebVet

Original articles and reviews.

Check out tips on obtaining history and neurologic examination videos.


Simon’s Cat

For fun, Simon’s cat in Muddy Paws.

“The smallest feline is a masterpiece.”

- Leonardo da Vinci

 

Example of NAVLE®-format feline neurology question:

A 1-year-old male neutered cat is presented with a 2-day history of being off balance.

He has a right head tilt and horizontal nystagmus, fast phase to the left, and is circling to the right. The rest of the neurologic exam is normal.

Which one of the following conditions is the most likely underlying cause of his right vestibular system deficits?

   A. Granulomatous meningoencephalitis

   B. Cerebral tumor

   C. Myasthenia gravis

   D. Nasopharyngeal polyp

   E. Virulent systemic calicivirus (VS-FCV)

Click here for the answer and explanatory text…

 

zukureview

 

Images courtesy of Dr. Shirley Scott (diabetic neuropathy), Kris Kelley (skink), Vet Surgery Central, Inc. (Horner syndrome), Andou (cat licking back), CDC Public Health Image Library (Toxoplasma), and greyloch (cat and squirrel).

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