Age: 1 year
Sex: Female spayed
"Sadie" in ICU on the day of presentation
Sadie has been healthy up until about one week prior to admission (PTA) at OSU. The owners first noticed she seemed �congested� 7 days PTA and she coughed up some mucus two days later. They also noticed increased salivation and she �threw up� her food the evening before and the morning of OSU admission.
During this same time period, Sadie began walking more slowly. The owners described her gait as a �bunny-hopping� up the stairs. By Friday, her legs gave out on the stairs and she could only hobble outside and then lay down. She can move her front legs but not her back legs.
Sadie was taken to the RDVM 2 days PTA. He performed radiographs of the pelvis and spine (not available) and interpreted them as normal. He dispensed Prednisone 20 mg tabs: 1/2 tab BID for 7 days, then 1/2 tab SID for 7 days and Cephalexin 500 mg caps: 1 cap BID for 10 days. She returned for a recheck 2 days later and had not improved. Sadie was immediately referred to OSU.
Physical Examination -
Temperature: 101.8 �F
Respiratory rate: Panting
Weight: 84 lbs
On neurologic examination, Sadie had normal mentation. She was tetraparetic (graded 2 on a scale of 1-5). Cranial nerves were normal except for a decreased palpebral reflex. Conscious proprioception was normal. Pelvic limb reflexes were normal. She had bilateral decreased hemihopping and hemistanding on both thoracic and pelvic limbs. The neuroanatomic localization was diffuse lower motor neuron disease.
1. List 4 differential diagnoses for Sadie�s lower motor neuron disorder.
2. A Tensilon test was performed and Sadie had a positive response (she was able to walk without difficulty). What disease is this suggestive of? Be prepared to discuss how a Tensilon test is performed and the rational behind it.
3. What additional blood test would you like to send off to confirm the diagnosis suggested by the positive Tensilon test? Where in the country is this test performed?
Write you Diagnosis.