C09973653 / invoice 10000

Reason: Very LethargicDeb has been overseas and just home yesterday.Mopey and staying in her crate yesterday.Eating normally.Has been on cerenia.  No vomiting since initially began.Is drinking pretty normally for her.A little better today (more active).Seen at AEC a bit over a week ago, sounds like right sided facial paralysis and vestibular disease.  Dispensed anti-nausea meds.Then seen here 2 days later (a week ago), and given more maropitant.Walking in here with a right sided head tilt but no ataxia.Jumped up onto the lower lever of the treatment room table with no difficulty.Chest NAD.Abdo NAD.Right lip mildly droopy, reduced right sided facial sensation, right 3rd eyelid flicks across with palpebral reaction, but the upper and lower lids don't move.  Possible muscle atrophy developing in right side of face.Ears fine.Took liver treats with no trouble (not dropping them).Combined vestibular disease and facial nerve paralysis.Vestibular signs improving, though head tilt remains (and may never fully resolve).  No nausea signs.Right sided facial nerve paralysis.  Usually idiopathic and can happen concurrently with vestibular disease, though would need MRI to rule out anything more sinister.  May take 6 months to improve and in the meantime applying artificial tears to the right eye would be useful to prevent drying out.To reassess if any new clinical signs.Wouldn't be surprised it significant muscle atrophy developed on the right side of the head.    Vital Signs    Weight: 18.7;       

Reason: Recheck From AECAppointment Notes: Special payment terms existSee attached Hx, presented to AEC on 21/2 for sudden onset droopiness of right lip, vomiting, and 'flicking' of the eyes which was confirmed by physical exam. Tx'd as outpatient with maropitant and ondansetron. According to Deb's mother, is still eating (albeit less so), drinking is posibly depressed, although generally improved demeanour.Examine:Vitals WNLAmbulating without lameness or head tiltNystagmus resolvedEars clear, no evidence of FB, or other inner ear diseaseRight lower lip does appear to be droopedNo other CN or peripheral neuro deficits appreciatedAssessment:Tyga is stable on presentation, and clinical signs are largely resolving. Spoke to O's mother - as noted, many differentials remain including intracranial disease, eg. Space-occupying mass, cerebrovascular accident, inner ear disease. Doesn't appear to be acquired cause. Extending anti-emesis treatment until Deb returns. If wishing to chat to vet, can do so on Monday. Treatment:Cerenia 60mg PO Q24hrPlan:Restart ondansetron (O quit as thought made Tyga sleepy)Cerenia and restConsider referral to VRH neurology    Vital Signs