Neurology Case of the Month: Tremoring Min PinWritten on March 10, 2012 by Mark Troxel, DVM, DACVIM (Neurology) Hospital: Massachusetts Veterinary Referral Hospital

Signalment: 2yr F Miniature pinscher

History: Acute onset of whole body tremors.  The tremors are only noticed with activity and stop with rest or sleep.

Case Video:

Neurological exam:

Mental status: BAR
Gait/posture:
Whole body small amplitude/high frequency tremors; intermittent hypermetria FLs; wide based hind limb gait; mild ataxia x 4
Cranial nerves:
WNL
Postural reactions:
Normal CP/hopping x 4
Spinal reflexes:
WNL x 4
Spinal pain:
None
Muscle tone:
Normal x 4
Muscle atrophy:
None
Pain sensation:
Normal x 4
Cutaneous trunci:
Normal bilaterally

What is your neurolocalization?  What are the top differential diagnoses? (SCROLL DOWN TO SEE ANSWERS)


 

 

 

 

 

 

Neurolocalization = Diffuse brain

 

Differential diagnoses

  • Steroid-responsive Tremor Syndrome (“Little White Shaker”)
  • Tremorgenic toxins
    • Moldy food containing mycotoxins (Penitrem A & roquefortine)
    • Organophosphates
    • Pyrethrins
    • Metaldehyde (snail & slug poison)
    • Lead
    • Bromethalin
    • 5-fluorouracil (chemotherapy agent)
    • Macadamia nut ingestion
    • Theobromine (chocolate)
    • Strychnine
    • Rare congenital/enzyme disorders

 

Diagnostics
Pre-anesthetic CBC/biochemical profile and U/A were unremarkable.   Since there was no history of toxin ingestion, an MRI and spinal tap were performed.   The MRI was within normal limits.  CSF analysis showed a mildly increased WBC count (12 cells/μL; normal < 5), but a normal protein level.  Differential cytology demonstrated a lymphocytic pleocytosis.  Infectious disease tests were all negative.

 

Diagnosis
Steroid-responsive Tremor Syndrome

 

Treatment
The patient was started on prednisone (1 mg/kg PO BID x 2 weeks) and diazepam (0.5mg/kg PO TID x 1 week).   The tremors resolved within a few days and she was normal at recheck exam 2 weeks later.  The prednisone was tapered slowly and we were able to completely stop the prednisone at 8 months.

 

Prognosis
The prognosis for SRTS is very good to excellent if treated early & aggressively.  Recurrence is uncommon  for SRTS, but can occur in dogs with toxicity if exposed to the same toxin again.

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