four limbs ) [ 3 ] . Patients are often seen with varying degrees of dysphonia ( difficulty vocalising , such as barking ) and sometimes also develop facial paralysis ( Figure 2 [ 4 ] ). However , they otherwise retain autonomic functions , remain bright and alert , and have voluntary control of their bladder and bowels [ 3 ] . Physiotherapy is the main treatment for these cases . the clinical signs , Ruby had undergone an uneventful general anaesthetic and dental procedure . Before this , Ruby had been a healthy dog with no other notable issues . She was up to date with her vaccinations and flea and worming treatments , and she was fed a raw diet .
Admission and assessment
On initial examination , Ruby was subdued but alert and responsive , and had a body condition score of 6 / 9 . Cardiopulmonary assessment was unremarkable , with good-quality and synchronous peripheral pulses . Ruby ' s mucous membranes were tacky but pink , with a capillary refill time of 2 seconds . Abdominal palpation was unremarkable . Peripheral lymph nodes were normal , and her rectal temperature was 38.0 ° C .
On ophthalmic examination , Ruby had a bilateral mucoid discharge . With the use of fluorescein staining , small superficial corneal ulcers could be seen in each eye ( Figure 3 [ 5 ] ).
Figure 2 . A dog ( not the case study patient ) with left-sided facial paralysis [ 4 ] .
Learning outcomes
• Identify the clinical signs of polyradiculoneuritis
• Understand the nursing care considerations specific to these cases
• Evaluate the VN ' s vital role in patient care
Patient signalment
Species Breed Age Sex Weight
Dog
Presentation
Cocker spaniel 8 years 9 months Female 12 kg
Ruby was presented to the veterinary hospital with a 2-day history , which her owner reported had begun with Ruby seeming wobbly and experiencing an episode of sickness . This was followed by acute-onset , rapidly progressive ( 2 hours ), symmetrical , non-painful , nonambulatory tetraparesis . Two days before the onset of
Figure 3 . A superficial corneal ulcer ( not the eye of the case study patient ), showing as bright green with fluorescein staining [ 5 ] .
On neurological examination , Ruby was subdued and non-ambulatory , with minimal movement in all four limbs . Her postural reactions were absent in her hindlimbs , meaning she was not able to return her limbs to a normal position when they were turned the wrong way , likely due to lack of motor function . However , she did attempt to correct the position of her thoracic limbs .
Ruby ' s spinal reflexes were appropriately tested ; this included assessing the percussion reflex on both stifles and elbows using a reflex hammer , and checking anal tone by gently pinching around the anus and carrying out a rectal examination . Reflexes were absent in all four limbs but anal tone remained intact .
A complete cutaneous trunci reflex was tested by pinching the skin along the back , either side of the spine , caudally to cranially , while observing for skin twitching [ 1 ] . Ruby ' s cutaneous trunci cut-off was at the
46 Veterinary Nursing Journal