Acute myelopathies Flashcards
1
Q
Pathophysiology of fibrocartilagenous embolic myelopathy
A
- Obstruction of arterial or venous supply to the spinal cord
- Obstructive material is fibrocartilage, likely from the nucleus pulposus
2
Q
Signalment and history for FCE
A
- Disease of non-chondrodystrophic, large/giant breed dogs
- Any age, typically 1-7 years (Irish WOlfhounds at 8-13 weeks of age; Miniature Schnauzeres)
- Cats (DSH, older)
- Peracute onset, usually during physical activity
3
Q
Neuro exam with FCE
A
- may be non-ambulatory para/tetra paretic/plegic
- Most commonly non-painful
- Can lose pain sensation if lesion is severe enough
- Signs can be asymmetrical
4
Q
Most common locations for FCE in dogs
A
- L4-S1, T3-L3
5
Q
Most common locations for FCE in cats
A
- C6-T2
6
Q
Diagnosis of FCe
A
- Tentative diagnosis based on hx, signalment, neuro exam findings
- Radiographs help rule out fractures
- MRI +/- CSF to visualize cord
- If focal, often centered over vertebral body
- Gold standard = histopathology
7
Q
What’s a dfdx for FCE based on MRI findings?
A
- GME
- IVDD too
- Acute non-compressive nucleus pulposus extrusion
8
Q
Treatment for FCE
A
- Time - improvement typically begins within days
- Supportive care
- Nothing you can do otherwise
- Might get worse initially and then better
- REhabilitation
9
Q
What is the advantage of MRI for FCe suspects?
A
- More aggressive rehabilitation
- Otherwise, you’re still worried about IVDD
10
Q
What determines prognosis for FCE?
A
- Lesion size (shorter than the length of two vertebral bodies, or cross sectional area <67% = more favorable prognosis for successful outcome)
- Pain sensation
11
Q
What % of animals recover to a functional capacity with FCE if they still have pain sensation?
A
- 85% will recover
12
Q
Prognosis of FCE in cats
A
- Favorable
13
Q
Pathophysiology of acute non-compressive nucleus pulposus extrusions
A
- Result of increased forces on the intervertebral disc - usually vigorous exercise
- Most commonly a concussive injury but can lacerate meninges and cord
14
Q
Signalment and history for ANNPE
A
- Similar to FCE cases
- Middle aged, large breed dogs, non-chondrodystrophic
- Males appear to be predisposed
- Peracute onset after some form of activity
- Not as much cats
15
Q
Neuro exam findings for ANNPE and most common location
A
- T3-L3 signs most often
- Signs are often lateralized = asymmetrical
- Pain may be more common with this disease
16
Q
Diagnosis of ANNPE
A
- Radiographs to rule out fractures/luxations/pathological bone lesions
- MRI +/- CSF analysis
17
Q
What are the two main ischemic myelopathies?
A
- FCE and ANNPE
18
Q
Treatment for ANNPE?
A
- Similar to FCE but less aggressive with PT
19
Q
Prognosis for ANNPE?
A
- Depends on pain sensation
20
Q
Fracture definition
A
- Cracking or breaking of bone
21
Q
Subluxation definition
A
- Beginning of a dislocation, but some joint contact still remains
22
Q
Luxation definition
A
- No joint contact
23
Q
History with suspected spinal fracture?
A
- Trauma!!
- HBC (most common), playing, animal attack/dog fights, falling from cliff
- Pathologic fracture
- Peracute onset
24
Q
Neuro examination for spinal fracture suspect
A
- ALWAYS assess systemically first
- CV and respiratory systems
- Exam findings depend on the location of the lesion
- May need to immobilize
25
Diagnosis for suspect spinal fracture
- Initial trauma evaluation
- ECG
- FAST scans
- Initial blood work (PCV/TS/Azo, lactate, electrolytes)
- Blood pressure
- Vertebral radiographs
- Ideally CT AND MRI in this case
26
What do radiographs tell you about possible spinal cord fracture?
- Only assess vertebral integrity, not the spinal cord
- Lateral radiographs easier to obtain than VD, for the latter use the horizontal beam
- CT is best for bone evaluation
27
Best modality for bone evaluation?
- CT
28
Best modality for cord evaluation?
- MRI
| - Also can help you determine concussive lesions
29
Advantages of MRI
- Cord and soft tissue visualization
30
Disadvantages of MRI
- Bone
- Longer anesthetic time
- More patient manipulation
31
Treatment for spinal cord fractures
- Medical (cage rest for 6 weeks; external coaptation; pain control)
- Surgical (some form of stabilization if needed)
32
How do you determine if spinal cord stabilization is needed for a fracture?
- Divide it into three parts (ventral compartment, middle compartment, and dorsal compartment)
- If two out of three are damaged, then surgical stabilization is warranted
33
Dorsal compartment
- Looks like it's from the dorsal aspect of the transverse process to the dorsal aspect of the spinous process
34
Middle compartment
- Looks like it's the transverse process?
35
Ventral compartment
- Looks like it's from the ventral aspect of the transverse process to the ventral aspect of the spine
36
Prognosis for spinal fractures
- Good as long as the patient has pain sensation
| - Grave if deep pain negative
