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86 Ataxia

• If respiratory distress is a manifestation of airway inflammation; chronic airway inflam- • Minimize stress and avoid inhaled irritants
(e.g., cat litter, aerosols) in asthmatic cats.
disease, sudden death can occur before mation leads to structural changes and • Oxygen supplementation and bronchodila-
VetBooks.ir trained to administer injections of a • Novel drug therapies evaluated have not been tors are necessary during episodes of respira-
veterinary intervention. Owners can be
permanent damage.
tory distress.
shown to be more effective at reducing airway
bronchodilator or MDI albuterol until
veterinary intervention.
• For cats presenting with cough but not eosinophilia and bronchoconstriction than Client Education
traditional therapy.
distress and if inflammation is controlled • Allergen-specific immunotherapy (ASIT; • Keeping a record of when clinical signs occur
with glucocorticoids and environmental allergy shots) modulates the immune can help establish the seasonality to allergen
modulation, prognosis is good to excellent. response to induce tolerance to allergen exposure.
• If inflammation is not well controlled, lung or alter the immune response so that it is • Teach owner how to administer emergency
damage can occur and lead to airflow limita- less damaging. ASIT reduced inflamma- bronchodilator at home.
tion, in which case the prognosis is guarded tion and altered immune responses in an
to fair. experimental model of feline asthma and SUGGESTED READING
may one day prove to be a useful therapeutic Trzil JE, et al: Update on feline asthma. Vet Clin
PEARLS & CONSIDERATIONS strategy. North Am Small Anim Pract 44:91-105, 2014.
Comments Technician Tips AUTHOR: Laura A. Nafe, DVM, MS, DACVIM
• Bronchodilators should not be given as • Monitor respiratory rate and effort for early EDITOR: Megan Grobman, DVM, MS, DACVIM
monotherapy because they do not suppress detection of an asthmatic crisis.

Ataxia Client Education
Sheet

BASIC INFORMATION HISTORY, CHIEF COMPLAINT • Ipsilateral positional ventral strabismus
• Onset: peracute to chronic/insidious, depend- (ventral deviation of the globe when the
Definition ing on cause examiner lifts the head)
Failure of muscular coordination; a sign of • Hyperesthesia may be associated with pro- • Ipsilateral limb flexion and contralateral limb
sensory dysfunction in the nervous system seen prioceptive ataxia. extension may be noted.
commonly in animals with neurologic disease • “Walking as if intoxicated” may be reported. • Paresis and proprioceptive deficits are not a
• Owners of animals with acute onset of component of peripheral vestibular disease
Epidemiology vestibular ataxia often think their animal is but may be seen with central vestibular
SPECIES, AGE, SEX seizuring. disease.
Depends on the underlying cause • History of otitis externa (vestibular ataxia) • With peripheral vestibular disease, nystagmus
• Recent therapy with metronidazole or is horizontal or rotary, with the fast phase
GENETICS, BREED PREDISPOSITION aminoglycosides (vestibular ataxia) away from the lesion, and it does not change
Depends on underlying cause: small, chon- with different head positions.
drodystrophic dogs (intervertebral disc disease PHYSICAL EXAM FINDINGS • In central vestibular disease, nystagmus may
[IVDD]); young, large-breed, nonchondro- Some or all findings may be present. be horizontal, rotary, or vertical or may change
dystrophic dogs and miniature schnauzers Proprioceptive ataxia: direction with different head positions.
(fibrocartilaginous embolism); Great Danes • Generally accompanied by paresis • Mentation may be depressed with central
and Doberman pinschers (cervical stenotic • Base-wide stance vestibular disease.
myelopathy); German shepherds and boxers • Circumduction, abduction, and crossing over • Patients should be examined for positional
(degenerative myelopathy) of the limbs nystagmus while rolled on their backs because
• Delayed limb protraction with an elongated resting nystagmus is often absent in chronic
Clinical Presentation stride vestibular conditions.
DISEASE FORMS/SUBTYPES • Mild hypermetria • Postural reactions are usually normal with
• Proprioceptive (sensory) ataxia: dysfunction • Standing on the dorsum of the paw; “knuck- peripheral vestibular disease and delayed with
of the proprioceptive pathways in any or all ling over” central vestibular disease, although with
of the spinal cord, brainstem, or cerebrum. • Ulceration of the dorsal aspect of the paw severe peripheral disease, patients may not
The appearance is that of a patient’s failure and wear of the claws correct a knuckled paw despite normal
to perceive where its limbs are in space. • With cervical lesions, there may be only proprioception.
• Vestibular ataxia: dysfunction of the periph- pelvic limb ataxia, or forelimbs may show • Bilateral peripheral vestibular disease (most
eral vestibular system in the inner ear or the a stiff/short-stride (“two-engine”) gait commonly an idiopathic feline condition)
central vestibular system in the medulla. The Vestibular ataxia: causes a crouched posture with wide head
appearance is that of a patient with loss of • The hallmark of vestibular ataxia is a head excursions bilaterally, absent physiologic
balance/disequilibrium. tilt, with the ventral ear indicating the side nystagmus without the presence of head tilt,
• Cerebellar ataxia: results from diseases affect- of the lesion. Rarely, the head tilt may be resting nystagmus, or postural deficits.
ing the cerebellum. The appearance is that directed away from the lesion in paradoxical Cerebellar ataxia:
of loss of fine motor control despite normal vestibular syndrome. • Broad-based stance
initiation of movements. Patients may have • The trunk may lean, fall, or drift toward the • Dysmetria, hypermetria, spasticity (abnormal,
hypermetria, tremors, and truncal sway but side of the lesion, causing patients to press excessive, stiff movement of the limbs,
are not paretic. against a wall. respectively)

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