Neurology Case of the Month (April 2013): Episodes in a Lab/Pitbull crossWritten on April 01, 2013 by Mark Troxel, DVM, DACVIM (Neurology) Hospital: Massachusetts Veterinary Referral Hospital

Signalment: 6 mos MI Lab / Pitbull cross

History: Patient was referred for evaluation of a sudden onset of possible seizures

Physical Exam: No significant abnormalities

NEUROLOGICAL EXAM

Mental status: BAR
Gait/posture: Normal gait/posture
Cranial nerves: WNL
Postural reactions:
Normal CP/hop x 4
Spinal reflexes: WNL x 4
Withdrawal: WNL x 4
Spinal pain: None
Muscle tone: Normal x 4
Muscle atrophy: None
Pain sensation: Normal x 4
Cutaneous trunci:WNL bilaterally

 

Neurolocalization: Normal neurological exam between episodes

 

Case Video:

 

What is the primary differential diagnosis for this patient? How do you treat this condition?

SCROLL DOWN TO SEE NEURO EXAM DETAILS AND ANSWERS

 

 

 

 

 

 

 

 

 

 

Working diagnosis: Narcolepsy / Cataplexy
The audio has been muted on the video, but, in person, the patient could be heard snoring from several feet away during the attacks.

Diagnostics
A CBC and biochemical profile were performed to rule out other possible metabolic/systemic causes of episodic events. The results were within normal limits.

Treatment
Methylphenidate (Ritalin) 7.5mg PO TID

Prognosis
The prognosis for Narcolepsy / Cataplexy is generally good with treatment. Owners should be instructed to try to avoid the stimuli that trigger episodes.

Outcome
Within 2 weeks of starting treatment, the narcoleptic attacks had reduced in number significantly and were generally only occurring with extreme excitement or when the next dose of medication was delayed.

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