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Copyrighted Material JWST571-c01 JWST571-Dewey Printer: Yet to Come July 7, 2015 8:48 279mm×216mm 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 dog’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. brain tumor) is more com- is a common mistake in clinical neurology. 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 1 JWST571-c01 JWST571-Dewey Printer: Yet to Come July 7, 2015 8:48 279mm×216mm 2 Practical Guide to Canine and Feline Neurology Table 1.1 Breed-associated neurologic abnormalities of dogs. 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 Cerebellar degeneration 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 Border Collie Cerebellar abiotrophy Australian Blue Heeler Congenital deafness Ceroid lipofuscinosis Australian Cattle 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 Beagle Agenesis vermis cerebellum 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
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