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CHAPTER 1 Signalment and History: The First Considerations

Curtis W. Dewey & Ronaldo C. da Costa

Introduction dysfunction in adult patients (e.g. Chiari-like malformation (CLM)) and some neoplasms are typically encountered in When presented with a patient that is suspected of having a neu- young patients (e.g. nephroblastoma of the spinal cord). rologicdisorder,thesignalment(i.e.breed,age,andsex)andhis- There are very few neurologic disorders with sex predilec- tory are often helpful in guiding the clinician toward the most tions.OneexamplewouldbemusculardystrophyinGolden likely diagnosis. It is important to recognize, however, that this Retrievers, an X-linked heritable disease. information is adjunctive totheneurologicexamination.Prop- erly weighting the importance of signalment and history will help avoid “tunnel vision” when devising diagnostic plans and History4 implementing treatment strategies. Obtaining a concise and accurate medical history as it pertains to a specific neurologic complaint is often crucial to guiding the Signalment1–3, 5 diagnostic plan. It is important to allow the pet owner to elab- orate on pertinent historical details; it is equally important to The information in Table 1.1 and Table 1.2 provides a sum- dissuade the pet owner from delving into historical details that mary of suspected and confirmed breed predilections for vari- have little or nothing to do with the chief clinical complaint. ous neurologic disorders. Knowledge of breed predilections can For example, an intricate account of events concerning a cra- be very helpful when considering differential diagnoses, espe- nial cruciate ligament repair from 10 yrs ago is unlikely to be cially for uncommon presentations (e.g. neuropathies in juve- of value in a patient that presents for head-pressing and gener- nile patients). The clinician should be aware of the limitations alized seizure activity. Alternatively, pet owners often omit per- of breed predilection tables, however. Newly discovered breed tinent historical details. A pet owner may not necessarily think, predilections or undiscovered breed predilections will not nec- for instance, that a change in the sound of their myasthenic ’s essarily be represented in a table. In other words, breed predilec- bark(dysphonia)isinanywayrelatedtothepelviclimbweak- tion tables tend to increase in size with successive textbook edi- ness that prompted them to seek medical advice. Although defi- tions. Also, breeds other than those reportedly predisposed to a nitely related to the chief complaint, dysphonia may be regarded particulardisordermayoccasionallybeaffectedbythatdisorder. by the owner as an unrelated and clinically unimportant obser- Finally, certain rare disorders may have only one or a few mem- vation. In such instances, it is up to the clinician to ask specific bers of a certain breed reported in the literature. Since some of questions that may help to elucidate the nature of the patient’s these disorders are inherited (e.g. lysosomal storage diseases), it neurologic disorder. maybeassumedthatthebreedisatrisk,despitelownumbersof It is very important to get a specific history that does not actually confirmed cases. COPYRIGHTEDinvolve MATERIALinterpretation of signs by the owner but rather descrip- Certain disease categories tend to be more likely with specific tivefactsrelatedtotheowner’sobservation of signs only. This age groups. In general, neoplasia (e.g. tumor) is more com- is a common mistake in clinical . For example, a client mon in older patients. Congenital disorders (e.g. hydrocephalus) mayobserveadoggettingdisoriented,fallingintolateralrecum- are more commonly encountered in juvenile patients. As with bency, and paddling for a few seconds. This event could either be other aspects of patient signalment, there are no “absolutes” in an acute vestibular episode or a seizure. Owners will likely inter- regard to age for the various neurologic disorders encountered in pret this event as a seizure. If the clinician accepts the owner’s clinical practice. Some congenital disorders tend to cause clinical interpretation of the event as a seizure, he/she could follow an

Practical Guide to Canine and Feline Neurology, Third Edition. Edited by Curtis W. Dewey and Ronaldo C. da Costa. © 2016 John Wiley & Sons, Inc. Published 2016 by John Wiley & Sons, Inc. Companion Website: www.wiley.com/go/dewey/neurology

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2 Practical Guide to Canine and Feline Neurology

Table 1.1 Breed-associated neurologic abnormalities of . Table 1.1 (Continued)

Afghan Hound Acquired (idiopathic) laryngeal paralysis Belgian Shepherd (Tervuren) Idiopathic epilepsy Hereditary myelopathy (leukodystrophy) Muscular dystrophy Narcolepsy/cataplexy Bern Running dog Retinal degeneration Bernese Mountain dog Aggression Airedale Terrier Cerebellar abiotrophy Cerebellar abiotrophy Cerebellar hypoplasia Degenerative myelopathy Congenital myasthenia gravis Epilepsy Degenerative lumbosacral stenosis Hepatocerebellar degeneration Akita Acquired myasthenia gravis Histiocytic sarcoma Congenital deafness Hypomyelination/dysmyelination Congenital vestibular disease (bilateral) (dysmyelinogenesis) Glycogenolysis (type III) Meningitis/meningomyelitis (necrotizing Alaskan Husky Gangliosidosis (GM1) vasculitis) Mitochondrial encephalopathy (Leigh’s Bichon Frise Atlantoaxial instability disease, subacute necrotizing Caudal occipital malformation encephalopathy) syndrome Alaskan Malamute Hereditary polyneuropathy Congenital deafness Myelodysplasia Idiopathic tremor syndrome (steroid Muscular dystrophy responsive) Osteochondromatosis of the vertebrae Blue Tick Hound Globoid cell leukodystrophy American Bulldog Ceroid lipofuscinosis Boerboel Cervical spondylomyelopathy American Eskimo dog Congenital deafness Cerebellar abiotrophy Australian Blue Heeler Congenital deafness Ceroid lipofuscinosis Australian dog Ceroid lipofuscinosis Congenital deafness Congenital deafness Fibrocartilaginous embolic Dermatomyositis myelopathy Mitochondrial encephalomyelopathy Idiopathic epilepsy Myotonia congenita Sensory neuropathy Polioencephalomyelopathy Border Terrier Spongiform leukoencephalopathy Australian Kelpie Cerebellar abiotrophy Borzoi Cervical spondylomyelopathy Australian Shepherd Ceroid lipofuscinosis (CLN 6) Congenital deafness Congenital deafness Boston Terrier Brain tumor (gliomas) Basset Hound Cervical spondylomyelopathy (bony Cerebellar abiotrophy stenosis) Congenital deafness Degenerative disc disease (type I) Congenital hydrocephalus Globoid cell leukodystrophy (Krabbe’s Congenital vertebral malformation disease) (hemivertebrae) Glycoproteinosis (Lafora’s disease) Intracranial arachnoid cyst Bavarian Mountain dog Cerebellar abiotrophy Muscular dystrophy Agenesis vermis Myelodysplasia Congenital deafness Vermian hypoplasia Congenital vestibular disease Bouvier des Flandres Distal sensorimotor polyneuropathy Cerebellar abiotrophy Hereditary laryngeal paralysis Globoid cell leukodystrophy (Krabbe’s Muscular dystrophy disease) Pharyngeal/esophageal myopathy Glycoproteinosis (Lafora’s disease) Boxer dog Autoimmune polymyositis Idiopathic epilepsy (+/– paraneoplastic) Intervertebral disc disease (type I) Congenital deafness Methionine deficiency-related spinal Corticosteroid-responsive (aseptic) myelinopathy meningitis Narcolepsy Degenerative myelopathy Necrotizing vasculitis (steroid meningitis, Disseminated idiopathic skeletal Beagle pain syndrome) hyperostosis (DISH) Beagle mix Gangliosidosis (GM1) Head-bobbing (suspected dyskinesia) Belgian Sheepdog Congenital nystagmus Neuroaxonal dystrophy Muscular dystrophy Neuronal vacuolation Belgian Shepherd Muscular dystrophy Pilonidal (dermoid) sinus (Groenendael) Primary brain tumor (glioma, Belgian Shepherd (Malinois) Degenerative myelopathy meningioma) Degenerative lumbosacral stenosis Progressive axonopathy Leukodystrophy/spongy degeneration Sensory neuropathy (encephalomyelopathy; Belgian Spondylosis deformans Shepherd (Malinois)/Shepherd Briquet Griffon Vendeen´ Spinal muscular atrophy (motor neuron mixed-breed dogs) disease) JWST571-c01 JWST571-Dewey Printer: Yet to Come July 7, 2015 8:48 279mm×216mm

Chapter 1: Signalment and History 3

Table 1.1 (Continued) Table 1.1 (Continued)

Brittany Spaniel Cerebellar abiotrophy (late onset) Multisystem neuronal degeneration Muscular dystrophy (red-haired) Sensory ganglioradiculitis Muscular dystrophy Spinal muscular atrophy Myopathy (lipid storage, mitochondrial, Spinocerebellar degeneration phosphofructokinase deficiency) Brussels Griffon Chiari-like malformation (CLM) Myotonia congenita Bull Mastiff Cerebellar abiotrophy Collie (rough-coated) Cerebellar abiotrophy Cervical spondylomyelopathy Dermatomyositis Extradural synovial cyst Optic nerve hypoplasia Leukodystrophy/spongiform Sensory trigeminal neuropathy degeneration Collie (scotch) Congenital deafness Bull Terrier Cerebellar abiotrophy Dermatomyositis Congenital deafness Distal polyneuropathy Hereditary laryngeal paralysis Collie (smooth-coated) Congenital deafness Hyperkinesis Dermatomyositis Tail chasing Neuroaxonal dystrophy Cairn Terrier Globoid cell leukodystrophy Spinal muscular atrophy Hydrocephalus Coton de Tulear´ Cerebellar abiotrophy (two forms) Portosystemic shunt (hepatic Dachshund Cerebellar abiotrophy encephalopathy) Ceroid lipofuscinosis Spinal muscular atrophy (motor neuron Congenital deafness (dappled) disease) Glycoproteinosis Cardigan Welsh Corgi Congenital deafness Idiopathic epilepsy Sensory ganglioradiculitis Intervertebral disc disease (type I) Catahoula Leopard dog Congenital deafness Mucopolysaccharidosis (type III; Cavalier King Charles Spaniel Chiari-like malformation (CLM) wire-haired) Cerebellar infarct Myasthenia gravis (congenital, acquired) Congenital deafness Narcolepsy/cataplexy Dorsolateral vertebral canal stenosis and Neuronal glycoproteinosis (Lafora’s compression at C2–C3 disease) Episodic muscle hypertonicity (“falling Sensory neuropathy (long-haired) cavaliers”—probable dyskinesia) Dalmatian Ceroid lipofuscinosis Femoral thromboembolism Cervical spondylomyelopathy Fly chasing behavior Congenital deafness Idiopathic epilepsy Episodic muscle hypertonicity (“cramp”) Primary secretory otitis media Hypomyelination/dysmyelination Chihuahua Atlantoaxial instability (dysmyelinogenesis) Ceroid lipofuscinosis Laryngeal paralysis/polyneuropathy Congenital deafness complex Congenital hydrocephalus Leukodystrophy/spongy degeneration Muscular dystrophy Doberman Pinscher Cervical spondylomyelopathy Necrotizing meningoencephalitis Congenital deafness Neuroaxonal dystrophy Congenital vestibular disease (uni or Chinese Crested Cerebellar abiotrophy bilateral) Chow Chow Cerebellar hypoplasia Dancing Doberman disease Congenital deafness Idiopathic head tremor Hypomyelination/dysmyelination Idiopathic self-mutilation (sensory (dysmyelinogenesis) neuropathy) Myotonia congenita Immune mediated myositis Clumber Spaniel Cerebellar abiotrophy Narcolepsy/Cataplexy Mitochondrial myopathy Dogo Argentino Congenital deafness Cocker Spaniel Cerebellar abiotrophy Laryngeal paralysis/polyneuropathy Ceroid lipofuscinosis complex Congenital deafness Dogue de Bordeaux Cranial thoracic stenosis Congenital vestibular disease English Bulldog Cerebellar abiotrophy (English) Congenital deafness Cryptococcosis (American) Congenital vertebral malformation Hydrocephalus (Hemivertebra) Idiopathic facial nerve paralysis Hydrocephalus Intervertebral disc disease (type I) Idiopathic head tremor Juvenile epilepsy Sacrococcygeal malformation Leukodystrophy/spongiform Spina bifida degeneration (continued) JWST571-c01 JWST571-Dewey Printer: Yet to Come July 7, 2015 8:48 279mm×216mm

4 Practical Guide to Canine and Feline Neurology

Table 1.1 (Continued) Table 1.1 (Continued)

English Foxhound Methionine deficiency-related spinal Congenital myotonia myelinopathy (Hound ) Disseminated idiopathic skeletal English Cerebellar abiotrophy hyperostosis (DISH) Sensory neuropathy (automutilation) Distal symmetric polyneuropathy Spinal muscular atrophy Extradural synovial cyst English Setter Ceroid lipofuscinosis Fibrocartilaginous embolic myelopathy Congenital deafness (FCE) Fila Brasileiro Intervertebral disc disease (type II) Myasthenia gravis Fox Terrier Congenital deafness Nemaline myopathy Myasthenia gravis (congenital) Primary orthostatic tremor Spinocerebellar degeneration Spinal muscular atrophy (Great Dane French Bulldog Arachnoid diverticulum crosses) Congenital deafness Great Pyrenees (Pyrenean Congenital deafness Congenital vertebral malformation Mountain dog) Laryngeal paralysis/polyneuropathy (Hemivertebrae) complex Idiopathic head tremor Optic nerve hypoplasia Gammel Dansk Congenital myasthenic syndrome Greyhound Cervical disc disease Honsehund (presynaptic) Congenital deafness German Shepherd dog Acquired myasthenia gravis Congenital megaesophagus Autoimmune polymyositis Corticosteroid (aseptic) responsive Cervical spondylomyelopathy meningitis Congenital deafness Degenerative lumbosacral stenosis Congenital megaesophagus Exertional myopathy Congenital vestibular disease Fibrocartilaginous embolic myelopathy Cranial thoracic disc disease (protrusion) Thalamic infarct Degenerative lumbosacral stenosis Harrier Cerebellar abiotrophy (Finnish) Degenerative myelopathy Methionine deficiency-related spinal Fibrotic myopathy myelinopathy Giant axonal neuropathy Hound Methionine deficiency-related spinal Hereditary laryngeal paralysis (white coat) myelinopathy Idiopathic epilepsy Polyradiculoneuritis Intervertebral disc disease (type II) Hovawart Degenerative myelopathy Masticatory myositis Ibizan Hound Axonopathy (central and peripheral) Mitochondrial myopathy Congenital deafness Mucopolysaccharidosis Irish Setter Acquired (idiopathic) laryngeal paralysis Nephroblastoma Cerebellar abiotrophy Neuroaxonal dystrophy Ceroid lipofuscinosis Spinal muscular atrophy (motor neuron Congenital megaesophagus disease) Hereditary quadriplegia and amblyopia German Shorthaired Coccygeal muscle injury Idiopathic epilepsy Pointer Gangliosidosis (GM2) Laryngeal paralysis (acquired idiopathic) Hemivertebra Lissencephaly Pyogranulomatous Irish Terrier Muscular dystrophy meningoencephalomyelitis Irish Wolfhound Cervical spondylomyelopathy Sensory neuropathy Fibrocartilaginous embolic myelopathy Golden Retriever Acquired myasthenia gravis (juvenile) Eosinophilic meningoencephalitis Spinal epidural empyema Extraocular myositis Italian Greyhound Cervical intervertebral disc disease Horner’s syndrome Congenital deafness Hypomyelinating polyneuropathy Italian Spinone Cerebellar abiotrophy Idiopathic epilepsy Jack Russell Terrier Congenital deafness Multiple cartilaginous exostoses Congenital myasthenia gravis Multisystem axonopathy and Hereditary ataxia neuronopathy Intracranial arachnoid cyst Muscular dystrophy Mitochondrial encephalopathy Myasthenia gravis Myokymia/neuromyotonia Primary brain tumor (meningioma) Myotonia congenita Sensory neuropathy Neuroaxonal dystrophy Cerebellar abiotrophy Sensory neuropathy Great Dane Cervical spondylomyelopathy Japanese Chin Atlantoaxial instability Inherited (noninflammatory/central core) Japanese Spaniel Gangliosidosis (GM2) myopathy Japanese Spitz Muscular dystrophy Congenital deafness Keeshond Idiopathic epilepsy JWST571-c01 JWST571-Dewey Printer: Yet to Come July 7, 2015 8:48 279mm×216mm

Chapter 1: Signalment and History 5

Table 1.1 (Continued) Table 1.1 (Continued)

Kerry Blue Terrier Cerebellar abiotrophy Pembroke Welsh Corgi Degenerative myelopathy Degenerative myelopathy Dermatomyositis Multisystem degeneration Intervertebral disc disease Kuvasz Congenital deafness (type I) Acquired (idiopathic) laryngeal paralysis Sensory ganglioradiculoneuritis Cerebellar abiotrophy Pit Bull Terrier Congenital deafness Congenital deafness Plott Hound Mucopolysaccharidosis (type 1) Exercise intolerance-collapse syndrome Pointer Congenital deafness Idiopathic epilepsy Spinal muscular atrophy Labrador Retriever (central) axonopathy Pomeranian Atlantoaxial instability Labrador Retriever myopathy Chiari-like malformation (CLM) Leukodystrophy/spongy degeneration Congenital hydrocephalus (encephalomyelopathy) Globoid cell leukodystrophy Lumbosacral stenosis Intracranial arachnoid cyst Myasthenia gravis (acquired) (Miniature) Atlantoaxial instability Myotonia congenital Chiari-like malformation (CLM) Narcolepsy/cataplexy Cerebellar abiotrophy Organic aciduria Degenerative myelopathy Reflex myoclonus Glycoproteinosis dog Cerebellar abiotrophy Intervertebral disc disease (type I) Idiopathic epilepsy Leukodystrophy/spongy degeneration Leonberger dog Laryngeal paralysis/polyneuropathy (brain) complex Narcolepsy/cataplexy Leukoencephalomyelopathy Optic nerve hypoplasia Lhasa Apso Congenital hydrocephalus Sphingomyelinosis Lissencephaly Spinal cord leukodystrophy Lurcher Hound Hypomyelination/dysmyelination Poodle (Standard) Idiopathic epilepsy (dysmyelinogenesis) Organic aciduria (neonatal Malinois Shepherd cross Spongiform degeneration (gray matter) encephalopathy) Maltese Chiari-like malformation (CLM) Polymicrogyria (neuronal migration Congenital deafness disorder) Congenital hydrocephalus Poodle (Toy) Atlantoaxial instability Idiopathic (steroid responsive) tremor Congenital hydrocephalus syndrome Portuguese Water dog Gangliosidosis (GM1) Necrotizing meningoencephalitis Pug dog Arachnoid diverticulum Organic aciduria Chiari-like malformation (CLM) Mastiff Cerebellar abiotrophy Congenital vertebral malformation Cervical spondylomyelopathy (hemivertebra) Extradural synovial cyst Degenerative myelopathy Miniature Pinscher Atlantoaxial subluxation Intracranial arachnoid cyst Congenital deafness Necrotizing meningoencephalitis Idiopathic tremor syndrome Puli Congenital deafness Mucopolysaccharidosis (type 2) Queensland Blue Heeler Ceroid lipofuscinosis Miniature Poodle Congenital deafness Rat Terrier Muscular dystrophy Newfoundland Myasthenia gravis Rhodesian Ridgeback Cerebellar abiotrophy Polymyositis Congenital deafness Norwegian Hound Congenital deafness Degenerative myelopathy (Dunker) Dermoid (pilonidal) sinus Norwich Terrier Episodic muscle hypertonicity Myotonia congenital Nova Scotia Duck Tolling Congenital deafness Rottweiler Cervical spondylomyelopathy Retriever Idiopathic epilepsy Congenital deafness Steroid responsive meningitis arteritis Distal sensorimotor polyneuropathy Cerebellar abiotrophy Laryngeal paralysis-polyneuropathy Congenital deafness complex Mitochondrial myopathy Leukoencephalomyelopathy Muscular dystrophy Myopathy (distal) Papillon Congenital deafness Neuroaxonal dystrophy Neuroaxonal dystrophy Neuronal vacuolation Pekingese Atlantoaxial instability Spinal arachnoid cyst Congenital hydrocephalus Spinal muscular atrophy (motor neuron Intervertebral disc disease (type I) disease) Optic nerve hypoplasia (continued) JWST571-c01 JWST571-Dewey Printer: Yet to Come July 7, 2015 8:48 279mm×216mm

6 Practical Guide to Canine and Feline Neurology

Table 1.1 (Continued) Table 1.1 (Continued)

Russian Wolfhound Optic nerve hypoplasia Smooth-coated Fox Terrier Congenital myasthenia gravis Saint Bernard Acquired (idiopathic) laryngeal paralysis Hereditary ataxia Congenital deafness Soft-coated Wheaten Congenital deafness Episodic dyscontrol (rage syndrome) Terrier Degenerative myelopathy Idiopathic epilepsy Dyskinesia (movement disorder) Narcolepsy/cataplexy Springer Spaniel Congenital deafness Saluki Ceroid lipofuscinosis Congenital myasthenia gravis Leukodystrophy Episodic dyscontrol (rage Spinal muscular atrophy (motor neuron syndrome) disease) Hypomyelination/dysmyelination Spongiform degeneration (gray matter) (dysmyelinogenesis) Samoyed Cerebellar abiotrophy Fucosidosis Cerebellar hypoplasia/lissencephaly Staffordshire Terrier Chiari-like malformation (CLM) Congenital myasthenia gravis Cerebellar abiotrophy Hypomyelination/dysmyelination Myotonia congenita (dysmyelinogenesis) Organic aciduria (L-2-hydroxyglutaric Leukodystrophy/spongiform degeneration aciduria) Muscular dystrophy Sussex Spaniel Congenital deafness Myotonia congenital (Samoyed Mitochondrial myopathy cross-breed) Swedish Lapland dog Glycogenosis type II Schnauzer (Giant) Congenital deafness Spinal muscular atrophy (motor neuron Narcolepsy/cataplexy disease) Schnauzer (Miniature) Congenital megaesophagus Sydney Silky Terrier Glucocerebrosidosis Fibrocartilaginous embolic myelopathy Terrier Mix Multiple cartilaginous exostoses Hyperlipidemia (seizures) Tibetan Mastiff Hypertrophic neuropathy Idiopathic adipsia Tibetan Spaniel Congenital deafness Idiopathic epilepsy Tibetan Terrier Ceroid lipofuscinosis Intervertebral disc disease (Type I) Congenital deafness Muscular dystrophy Toy Poodle Congenital deafness Myotonia congenita Walker Hound Congenital deafness Scottish Deerhound Primary orthostatic tremor Mononeuropathy Vertebral articular process (facet) Weimaraner Cerebellar hypoplasia hypertrophy Hypomyelination/dysmyelination Cerebellar abiotrophy (dysmyelinogenesis) Congenital deafness Spinal dysraphism Episodic muscle hypertonicity (Scotty West Highland White Congenital deafness cramp) Terrier Corticosteroid responsive (idiopathic) Leukodystrophy/spongy degeneration tremor syndrome (fibrinoid leukodystrophy/Alexander’s Globoid cell leukodystrophy disease) Organic aciduria (L-2-hydroxyglutaric Sensory ganglioradiculitis aciduria) Sealyham Terrier Congenital deafness Whippet Congenital deafness Shar Pei Congenital megaesophagus Sensory neuropathy Shetland Sheepdog Congenital deafness Wire-haired Fox Terrier Cerebellar abiotrophy Dermatomyositis Congenital deafness Hyperlipidemia (seizures) Congenital megaesophagus Mitochondrial encephalopathy Lissencephaly (Kearnes–Sayre syndrome) Yorkshire Terrier Atlantoaxial instability Spongiform encephalopathy Chiari-like malformation (CLM) Shih Tzu Atlantoaxial instability Congenital deafness Intervertebral disc disease Congenital hydrocephalus Intracranial arachnoid cyst Intervertebral disc disease Shiloh Shepherd dog Vertebral articular process (facet) (type I) hypertrophy Microvascular hepatic dysplasia Shropshire Terrier Congenital deafness Mitochondrial encephalopathy Siberian Husky Congenital deafness Myokymia/neuromyotonia Degenerative myelopathy Necrotizing leukoencephalitis Hereditary laryngeal paralysis Portosystemic shunt (hepatic Sensory ganglioradiculoneuritis encephalopathy) Silky Terrier Leukodystrophy/spongy degeneration Yugoslavian Sheepdog Ceroid lipofuscinosis JWST571-c01 JWST571-Dewey Printer: Yet to Come July 7, 2015 8:48 279mm×216mm

Chapter 1: Signalment and History 7

Table 1.2 Breed-associated neurologic abnormalities of .

Abyssinian Acquired myasthenia gravis Balinese Sphingomyelinosis (Niemann–Pick disease, type A) Birman Distal polyneuropathy Leukodystrophy/spongy degeneration Burmese Congenital vestibular disease Hypokalemic myopathy Meningoencephalocele Cornish Rex Congenital deafness (white coat) Devon Rex Congenital deafness (white coat) Muscular dystrophy Domestic Short-haired Acquired (idiopathic) laryngeal paralysis Ceroid lipofuscinosis Globoid cell leukodystrophy Figure 1.1 Sign–time graph of neurologic diseases. This applies to the (Krabbe’s disease) majority of cases but there are exceptions in essentially all categories. (The Gangliosidosis (GM1) Ohio State University. Reproduced with permission.) Gangliosidosis (GM2) Hyperoxaluria Mannosidosis Metachromatic leukodystrophy erroneous diagnostic approach. It is important to ask the client Mucolipidosis II (I-cell disease) to simply state the signs he/she observed, without interpreta- Mucopolysaccharidosis (type I) tive connotations, leaving the interpretation of all signs to the (Hurler’s syndrome) clinician. Mucopolysaccharidosis (type VI) (Maroteaux–Lamy syndrome) For any episodic event or signs seen only intermittently, it is Muscular dystrophy very helpful to have a video recording of the event. In this day, Neuroaxonal dystrophy video recording is easily available, and in cases where the history Sphingomyelinosis (Niemann–Pick is unclear and the neurologic signs inconclusive, it is important disease, type C) Spinal muscular atrophy to review videos showing the events/episodes to decide on the Domestic Tri-colored cat Neuroaxonal dystrophy diagnostic approach. Egyptian Mau Leukodystrophy/spongy degeneration The neurologic history should allow the clinician to obtain Exotic Short Hair Congenital deafness (white coat) information regarding the possible etiologies. In general, there Himalayan Esophageal hypomotility Fibrotic myopathy areexpectedtimecoursepatternscharacteristicofcertaincat- Pendular nystagmus (congenital) egories of neurologic disease. Ischemic/vascular and traumatic Korat Gangliosidosis (GM1) disorders tend to have peracute onsets (within minutes to a few Laryngeal paralysis hours)andoftenprogressminimallyornotatallaftertheinitial Lissencephaly 24 hrs of onset of clinical signs. Inflammatory/infectious disor- Manx Congenital deafness (white -coat Manx) ders tend to have acute onsets (hours to days) with fairly rapid Sacrocaudal (sacrococcygeal) progression if not aggressively treated. Neoplastic and degener- dysgenesis ative disorders often display insidious onset of clinical dysfunc- Norwegian Forest cat Glycogenosis (type IV) tion (days to several months) with slower progression of clinical Persian Cerebellar abiotrophy (late onset) Congenital deafness (white coat) signs (Fig. 1.1). Some degenerative disorders (e.g. type II disc Mannosidosis-alpha disease) may progress slowly over several years. Many anoma- Rex Myopathy lous disorders are characterized by static disease courses, that Scottish Fold Congenital deafness (white coat) is the clinical abnormality is recognized at a young age and the Siamese Cerebellar abiotrophy Ceroid lipofuscinosis disease is nonprogressive. Finally, there are some neurologic dis- Congenital vestibular disease orders that are typically episodic in nature, such as idiopathic Gangliosidosis (GM1) epilepsy. As with signalment information, the nature of disease Hypomyelination/dysmyelination onset and progression is often helpful in ranking differential (dysmyelinogenesis) diagnoses in terms of likelihood for a specific patient, but should Mucopolysaccharidosis Muscular dystrophy be considered as a rough guideline only. There are numerous and Myasthenia gravis notable exceptions to the expectations outlined above. For exam- Pendular nystagmus (congenital) ple, spinal lymphoma in cats is characterized by acute onset of Sphingomyelinosis clinical signs. Somali Acquired myasthenia gravis Sphynx Muscular dystrophy The history can also provide therapeutic and prognostic infor- Turkish Angora Congenital deafness (white coat) mation. For example, a large-breed dog with progressive pro- prioceptive ataxia and paraparesis that received treatment with JWST571-c01 JWST571-Dewey Printer: Yet to Come July 7, 2015 8:48 279mm×216mm

8 Practical Guide to Canine and Feline Neurology

corticosteroids and showed no improvement would have degen- Questions pertinent to seizures and episodic erative myelopathy as a higher diagnostic consideration, as events opposed to one that responded favorably to steroid treatment. When phrasing the questions, be careful to not repeat and rein- Similarly, the duration of clinical signs could provide prognos- force the idea of a specific event like a seizure. Refer to any tic consideration. The prognosis for a deep pain negative (absent episodic event as “episodes” or “events.” nociception) paraplegic dog for 2 wks is significantly worse than r Can you please describe the event that you observed in details a dog that has similar signs for 12 hrs. (describe the entire event, i.e. signs before, during, and after Listed below are examples of questions that are provided to the event)? students at the Ohio State University to guide them in the history r How was the muscle tone during the event (e.g. flaccid/floppy taking of patients with neurologic signs. or rigid/stiff)? r Did you notice anything happening on his/her face (e.g. drool- ing, facial/eyelid twitching)? General questions applicable for r Was the head involved in the episode (e.g. tremors, tilting)? most conditions r Did you observe any evidence of lateralizing signs (one r When did you first observe the signs? eye/limb more affected)? r Did they appear quickly or slowly (acute or chronic)? r Have you seen any drooling, urination, or defecation associ- r Are the signs progressing? ated with the event? r How is the behavior/personality at home? Did you notice any r Washe/sheresponsiveandawareduringtheevent? change? r When was the event first noted? r Have you noticed any mentation changes at home (e.g. quiet, r What is the frequency of these events? dull, somnolent)? r How long do these events last? r Is he/she or was he/she on any medication (try to learn dose r Are they increasing in frequency or duration? and frequency)? r How is your dog after the event (evidence of postictal signs)? r Have you had any tests (blood work, radiographs, etc.) done r Are the events associated with anything (stress, sleeping, feed- for this problem? ing, etc.)? r Have you noticed any other sign? r How is their behavior/personality at home? Did you notice any r Does he/she have, or has he/she had, any other medical prob- change? lems? r Have you noticed any mentation changes at home (e.g. quiet, r Has he/she had any vomiting, diarrhea, coughing, sneezing? dull, somnolent)? r How is he/she eating or drinking? What does he/she eat? r Is he/she on any anticonvulsant, or any other, medication (try r Is he/she updated on vaccines? to learn specific drug, dose, and frequency)? r Is he/she indoors/outdoors? Did you travel with him/ r If on anticonvulsants, ask for results of serum levels. her? r Have you noticed any other signs? r Is he/she indoors/outdoors? Any possible toxin or drug expo- sure? Questions pertinent to spinal problems r Did you travel with him/her? (gait problems) r Anyfamilyhistoryofthesameevent? r What is the problem (present complaint)? r When did you first observe the signs? r Which limb(s) is (are) affected? References r Did the signs appear quickly or slowly (acute or chronic)? r Are the signs progressing? 1BagleyRS.Fundamentals of Veterinary Clinical Neurology.Ames, r Do you think he/she is in pain? If so, where? IA: Blackwell Publishing; 2005. r 2deLahuntaA,GlassE,KentM.Veterinary Neuroanatomy and Clin- If yes, why do you think he/she is in pain? ical Neurology. 4th ed. St. Louis, MO: Elsevier; 2015. r Any possibility of trauma? How? r 3 Lorenz MD, Coates JR, Kent M. Handbook of Veterinary Neurol- Hashe/shehadanysimilarepisodes? ogy. 5th ed. St. Louis, MO: Saunders/Elsevier; 2011. r Are you giving him/her any medicine for this problem? r 4 Oliver JE. Neurologic examinations: Taking the history. Vet Med Have you noticed any response to treatment(s)? Small Anim Clin. 1972;67:433–434. r Have you had any tests (blood work, radiographs, etc.) done 5 Sharp NJH, Wheeler SM. SmallAnimalSpinalDisorders,Diagno- for this problem? sis and Surgery. 2nd ed. Edinburgh, UK: Mosby; 2005.