Myoedema with pseudohypertrophic hypothyroid myopathy (Hoffman’s syndrome)

Myoedema is an under-recognised neurological sign that can help the bedside diagnosis of metabolic or endocrine myopathies. Myoedema together with pseudo-hypertrophy make a likely diagnosis of hypothyroid myopathy, and its identification may avoid unnecessary investigations.

Cough as a neurological sign: Does it worth it?

Cough is one of the most common complaints that lead patients to see a doctor. It is not only a basic respiratory sign but also an important neurological sign. There are 3 main types of cough: reflex cough (type I), voluntary cough (type II), and evoked cough (type III). Reflex cough sensitivity may be increased in many neurological disorders, such as space-occupying lesion of the brainstem, medullary lesions secondary to type I Chiari malformations, tics disorders such as Tourette’s syndrome, somatic cough, neurodegenerative disorders of the cerebellum, and chronic vagal neuropathy due to allergic and nonallergic diseases. On the other hand, cough sensitivity decreases in the cerebral hypoxia, cerebral hemispheric stroke with a brainstem shock, dementia due to Lewy body disease, Parkinson’s disease, amyotrophic lateral sclerosis, multiple sclerosis, and peripheral neuropathy such as hereditary sensory and autonomic neuropathy type IV, diabetic neuropathy, vitamin B12, and folate deficiency. The ear-cough reflex of Arnold’s nerve, syncopal cough, cough headache, opioid associated cough and cough-anal reflex are signs that can help in the diagnosis of underlying neurological disorders. The cough reflex test is a quick, easy, and inexpensive test that can be performed during the cranial nerve exam. In this article, we have discussed cough reflex testing and various neurological disorders that increase or decrease cough sensitivity.

Hyperadrenocorticism Induces Demodicosis in Shih Tzu Dog

A 10-year old male intact Shih Tzu, was presented to our clinic with complains of skin and hair problem. The condition had been appeared for 3 months. The antifungal medicated shampoo was given to the patient by the previous veterinarian, but there was no any clinical improvement. The clinical symptoms included alopecia in the dorsal body and trunk, comedones, hyperpigmentation, scales, lichenification, <em>pot bellied</em>, polyuria and polydipsia. Skin scraping and trichogram in the face area and fore limb found <em>Demodex sp</em>. Adult onset generalized demodicosis usually has an underlying cause. Endocrine disorders such as hypothyroidism and hyperadrenocorticism must be ruled out. From the clinical sign and laboratory work suggested for Low Dose Dexamethasone Suppressing Test (LDDST). Cortisol value after 8 hours of low dose dexamethasone injection was greater than basal cortisol, it means dexamethasone failed to suppressing cortisol level due to the high number of cortisol in the body. From LDDST the diagnose of hyperadrenocorticism (Cushing syndrome) has been made. The dog was given trilostane (Vetoryl^®) 3mg/kg SID for the Cushing and imidacloprid and moxidectine spot on (Advocate^® spot on) every 2 weeks for the demodicosis. Scales and lichenification was reduced and the skin got better after 3 weeks. Unfortunately, after 3 months of treatment, the dog had neurological sign including seizure, head tilt and nystagmus. From the neurological sign, we suspected that the dog had macroadenoma type of hyperadrenocorticism. A week after hospitalization, the owner decided to euthanize the dog.