Feline Medicine Q&A 14

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This 10-year-old neutered female DSH cat has a history of polydipsia/polyuria, weight loss, and intermittent vomiting.

Question	Answer		Article
What is the most obvious feature this cat is displaying?	This cat is showing ventroflexion of the neck, a classic sign of neuromuscular weakness.		Link to Article
What differential diagnoses should be considered?	This is not a specific clinical sign and can be caused by numerous myopathies, neuropathies, or ‘junctionopathies’. Neuropathies: chronic organophosphate poisoning, thiamine deficiency, chronic relapsing polyradiculoneuropathy, toxoplasmosis, paraneoplastic disease, botulism. Polymyopathies: inflammatory/infectious (toxoplasmosis, immune-mediated, possibly retrovirus-associated), metabolic (hypokalaemia, hypernatraemia), paraneoplastic, hyperthyroid-associated, HAC. Junctionopathies: myasthenia gravis (congenital, acquired, paraneoplastic), organophosphate intoxication. Hypokalaemia is probably the single most common cause of this type of presentation. In this cat, the accompanying clinical signs (polydipsia, polyuria, weight loss, and intermittent vomiting) would be strongly suggestive of hypokalaemia secondary to CRF. However, hyperthyroidism would also be an important differential, as would paraneoplastic disease (e.g. with hypercalcaemia causing polyuria and polydipsia).		Link to Article
What are the priorities for further investigation?	Priorities for further investigation would be a thorough history, physical and neurological examination. A neurological examination should aim to detect any specific deficits, and distinguish muscle weakness from neurological disease (e.g. by careful assessment of proprioceptive responses). Initial screening blood tests should include serum biochemistry (including CK, urea, creatinine, calcium, phosphate, sodium, potassium, thyroxine) and urinalysis.		Link to Article