C09992918 / invoice 10000

Reason: WobblyNotes: PRXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXHistory:Beagz is a 10 year 11 month old female spayed Beagle, presenting to ARH Neurology today as a referral from IM due to concern for facial paresis. 20/12/25 Beagz was diagnosed wit IMHA, has subsequently been treated with clopidogrel, cyclosporine, prednisolone and riveroxaban. 2/3/26 Beagz re-presented to IM due to being 'off over the past 4 days, possible salivation and seems slightly lethargic, no V+/D+ reported by O. However not eating all her food. IMHA considered likely in remission with normal RBCs count on CBC.The underlying cause for reduced appetite and slight lethargy is not clear, ddx developing gastroenteritis vs undetected reason on the diagnostics performed today. The elevated liver enzymes today is likely from prednisolone therapy. Rx reduce pred, discontinue clopidogrel, reduce cyclosporine, continue riveroxaban.Beagz also has a history of 2 x hemilaminectomies secondary to IVDE, 2 x stifle sx (TPLO?).3/3/26 Beagz re-presented to ARH due to O observing that there was no improvement overnight. Transferred to ARH Neurology. O reports that 4-5 days ago she seemed to be a bit lethargic, going to unusual parts of the house. Checked gums, they seemed normal. Was eating much less food, drooling, back legs shaky. Dropping food from her mouth. O did touch her neck at one point and she yelped. Eyes looked a bit unusual. Did notice PL tremoring.. NEx revealed, bilateral facial paralysis, NAL CNN VII bilaterally. No other neuro deficits. MRI performed, revealing idiopathic facial neuritis bilateral. CSF WNL. No specific rx.--- 05/03/2026 13:13:14 PRA:O called Didn't eat breakfastUrinated in houseFace planted onto carpetHiding this morningWobbly this morning, much worse than yesterday, shaking in back legsCurrent Medications: Cyclosporine 100mg PO SID Prednisolone 12.5mg PO SID (5mg tabs)Rivaroxaban 20mg PO SID Examination findings: T:  NT                 MM: pink and moistP:  100bpm        CRT: 1 secR:  pantHydration: EuhydratedWeight: 15.7kgBCS: 5/9MCS: 3/3Cardiovascular: No murmur auscultated, sinus rhythm, femoral pulses strong and synchronous Respiratory: Clear bronchovesicular sounds bilaterally, normal respiratory effort.Abdomen: Soft, comfortable on palpation. No mass effect appreciableOral exam: No obvious oral lesionsEars: No erythema or discharge notedIntegument: No lesions noted. Lymph nodes: Symmetrical, NSF Musculoskeletal: Full exam np, no obvious lameness.  Rectal: NP Neurologic exam findings: Mentation/Demeanour - BARGait and posture – No significant findings except intermittent PL tremoringProprioception – PPR, RS and hopping intact in all limbsMotor function:1.Spinal reflexes – Intact pedal, proximal sciatic, patellar, CTR, and perineal reflexes.2.Muscle bulk - Normal3.Muscle tone - NormalCranial nerves - Unable to close palpebral fissure OU, no nares or other facial movement, unable to contract lip commisures, reduced lip tone bilaterally, drooling both sides of mouth. Normal vision, normal facial sensation, CNN otherwise intact. Continence - IntactVertebral hyperpathia – None noted Nociception - IntactOphthalmic exam - NPAdditional findings - noneNeuroanatomical localisation: bilateral facial nervesProblem list:- Bilateral facial paresisPotential causes:1. Infectious/inflammatory; idiopathic facial paresis, MUO, OM/OI2. Neoplastic; PNST, meningioma3. Vascular; CVAAssessment:Beagz's neurological examination today reveals bilateral facial paresis. The primary differential diagnosis at this stage is idiopathic facial paresis, however other differential diagnoses to consider include MUO, otitis, neoplasia, or vascular, however these would be unusual given lack of other neuro deficits and symmetry. This condition is unrelated to previously diagnosed conditions (IMHA, IVDD). It is recommended at this stage to pursue MRI and CSF tap for further diagnosis.    Vital Signs