Ella - 1 Year Old German Shepherd

Arrows outline the esophagus which is usually not visible on plain radiographs

Ella is a one year-old spayed female German Shepherd that was adopted one month prior to presentation at Southeast Veterinary Neurology (SEVN).  For the past week she was reluctant to go on walks.  She would take a few steps then would need to sit down.The other important part of the history is that she would ‘spit up’ food shortly after eating.  After further questioning, the ‘vomiting’ was more consistent with regurgitation.

Radiographs of her chest showed megaesophagus.  Normally the esophagus is not visualized on plain radiographs.  When the esophagus is filled with air, the esophageal walls are visible on radiographs.

Exercise-induced weakness combined with regurgitation is suggestive of a problem in the lower motor neuron, and myasthenia gravis is considered the most likely differential.

The tests that are indicated in cases of suspected myasthenia gravis include a complete blood count (CBC), chemistry panel, thyroid panel, thoracic radiographs, a tensilon (edrophonium) test and an acetylcholine receptor antibody.  A tensilon test was performed.  A positive response is strongly suggestive of myasthenia gravis, however an acetylcholine receptor antibody titer is considered the ‘gold standard’.  See the following video to see her after her tensilon test.

The acetylcholine receptor antibody was positive, which is diagnostic of myasthenia gravis.  Pyridostigmine, a long-acting anticholinesterase medication was prescribed.  Prognosis is guarded in that many dogs get aspiration pneumonia secondary to chronic regurgitation.

Pre-Treatment

Post-Treatment