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SAM Neurology > All Four Limb Conditions > Flashcards

All Four Limb Conditions Flashcards

1
Q

Four general causes of tetraparesis/plegia

A
  1. Spinal cord lesions between C1 and T2
  2. Muscle and end-plate conditions
  3. Neuropathies
  4. Brain Conditions
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2
Q

Causes: Cervical disc disease

A

Hansen type 1: typically at C3/4, C5/6, or C6/7

Hansen type 2: typically at C6/7

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3
Q

Canine wobbler syndrome

A

Hansen type 2 prolapse at C/7

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4
Q

Signs: Cervical disc disease

A

Predominantly severe neck pain- may be acute or slowly progressive (hold neck at a fixed position and yelp following minor movements)

Neurological signs due to spinal compression less common than with thoracolumbar (wider canal)

Signs more severe in hind limbs than front

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5
Q

Dx: Cervical disc disease

A

Radiographs- narrowing of disc spaces, mineralized disc material in spineal canal

Myelography to confirm site

CSF- increased cellularity and protein

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6
Q

Tx: Cervical disc disease

A

Cage rest if no neurological deficits with pred/diazepam/methocarbamol to control pain (2wks past resolution of CS)

If no improvement in 2wks- surgical intervention; ventral fenestration or decompression

Prognosis excellent though second surgery may be required

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7
Q

Common name: Cervical spondylomyelopathy

A

Canine Wobblers

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8
Q

Causes: Cervical spondylomyelopathy

A
  1. Congenital stenosis of vertebral canal (Dobermans and Great Danes)
  2. Hansen type 2 disc protrusion
  3. Hypertrophy of ligamentum flavum and joint capsule
  4. Bony proliferation of articular processes, pedicles, and/or lamina (Great Danes)
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9
Q

Etiology: Cervical spondylomyelopathy

A

Genetics, congenital spinal canal stenosis, over-nutrition, rapid growth, abnormal vertebral growth (bobble head), congenital ligamentous laxity, abnormal stresses/mobility in synovial joints, Hyperplasia of interarcuate ligament, joint capsules, dorsal longitudinal ligament, and dorsal annulus fibrosis, Hypercalcitonin-induced retardation of osteocytic osteolysis, Intervertebral disc degeneration

R/o Trauma

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10
Q

Sings: Cervical spondylomyelopathy

A

Slowly progressive neurological signs over weeks to months
Cervical hyperesthesia and neck guarding

Hind limbs: Paresis (more pronounced), ataxia, wide based gait, scuffing

Forelimbs: paresis, hypometria, LMN signs absent with atrophy in supra/infraspinatus muscles and decreased flexor withdrawl

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11
Q

Dx: Cervical spondylomyelopathy

A

Signalment ang CS highly suggestive, myelography or MRI

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12
Q

Cervical spondylomyelopathy Radiographic findings (5)

A
  1. Tipping of craniodorsal aspect of vertebral bodies
  2. Stenosis of vertebral canal
  3. Rounding of cranioventral aspect of veterbral body
  4. Collapsed disc space
  5. Degeneration of articular facets
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13
Q

Cervical spondylomyelopathy MRI findings (4)

A
  1. Dorsal cord compression from hypertrophied ligamentum flavum
  2. Ventral cord compression from hypertrophied dorsal annulus
  3. Lateral cord compression from articular facet malformation
  4. Compression from a stenotic vertebral canal or vertebral tipping

25% may be clinically normal
Typically one site in dobermans and multiple sites in great danes

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14
Q

Tx: Cervical spondylomyelopathy

A

Medical therapy will not improve condition: exercise, prednisone

Surgery: best option; decompression, dorsal laminectory and stabilization: recovery in about 2.5m

Survival time the same for both options, prognosis good for prolapsed disc patients

Prognosis poor for tetraplegic, recurrence of clinical signs common

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15
Q

Causes: Atlanto-axial subluxation

A
  1. Absence or hypoplasia of odontioid process/dens (most common)
  2. Odontoid gracture at ossification center between dens and C2
  3. Rupture of ligamentous supports (dorsal atlanto-axial ligament and/or transverse ligament)
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16
Q

Signs: Atlanto-axial subluxation

A

Acute traumatic rupture results in pithing and acute death

Very from neck pain to tetraplegia may be acute or slowly progressive

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17
Q

Common COD: Atlanto-axial subluxation

A

Respiratory paralysis

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18
Q

Dx: Atlanto-axial subluxation

A

Clinical signs and radiography

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19
Q

Tx: Atlanto-axial subluxation

A

Hemilaminectomy and immobilization of subluxation

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20
Q

Definition: Syringomyelia

A

Fluid filled cavitities in the spinal cord as a result of abnormal CSF flow

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21
Q

Breed disposition: Syringomyelia

A

Cavalier king charles, poodles, terriers, pugs

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22
Q

Etiology: Syringomyelia

A

Caudal occipital malformation syndrome (Chiari type 1 malformation in humans) and underdeveloped caudal fossa

23
Q

Signs: Syringomyelia

A

Impaction of foramen magnum= subtle cerebellovestibular signs

Impaction of the syrix on the dorsal horns= neuropathic pain and scratching, head/neck pain, vocalization, vestibular signs, tetraparesis, sometimes LMN signs to a front limb

Usually progressive

24
Q

Tx: Syringomyelia

A

Diuretics, omeprazole/cimetidine, prednisone, gabapentin/pregabalin

Craniocervical decompression- 20% relapse

25
Q

Infectious myopathies

A

Dogs: Neospora, toxoplasma, borrelia, hepatoxoonosis, leptospirosis

Cats: Toxoplasma, FeLV, FIV

26
Q

Most common inflammatory myopathy

A

Autoimmune polymyositis

27
Q

Signs: Autoimmune polymyositis

A

Generalized weakness, stiff gait, rapid fatigue, generalized muscle atrophy

Muscle pain, pyrexia, regurgitation from megaesophagus, dysphonia, dysphagia

28
Q

Dx: Autoimmune polymyositis

A

Muscle biopsies- necrosis, phagocytosis of myocytes, perivascular lymphocyte and plasma cell infiltration, regeneration and fibrosis

Changes in muscle EMG

29
Q

Ddx: Autoimmune polymyositis

A

Infectious myopathies, paraneoplastic polymyositis

30
Q

Tx: Autoimmune polymyositis

A

Responsive to immunosupressive doses of prednisone

Long-term therapy may be required, give with azothioprine

31
Q

Signalment: Masticatory muscle myositis

A

Larger-breed dogs under 4yo

32
Q

Signs: Masticatory muscle myositis

A

Inflammation of the muscle of mastication: swollen, painful esp when opening mouth

May be fever, regional lympadenomegally, pseudotrismus, elevated CK, leukocytosis, eosinophlia

33
Q

Cause: Masticatory muscle myositis

A

Autoimmune humeral response against type 2M muscle fibers

34
Q

Acute: Masticatory muscle myositis

A

Last 1-3wks

35
Q

Chronic: Masticatory muscle myositis

A

Severe atrophy of masticatory muscles; difficulty opening mouth due to fibrosis

Often have no Hx of acute episodes

36
Q

Dx: Masticatory muscle myositis

A

Serology or immunohistohemistry of muscle biopsies

37
Q

Tx: Masticatory muscle myositis

A

Good response to prednisone; may eventually be withdrawn

38
Q

Signalment: Extraocular myositis

A

Golden retrivers esp, other large breed dogs usually 6-18mo

39
Q

Signs: Extraocular myositis

A

Bilateral exopthalmus (can be unilateral)

Masticatory and limb muscles are notmal

40
Q

Tx: Extraocular myositis

A

Corticosteroid therapy for a few weeks

41
Q

Exertional myopathy

A

Typically seen in greyhounds and sled dogs a day or two after a race

CS: distressed with painful rigid muscles, elevated CK

COD: Renal failure

42
Q

Cause: Hypokalemic myopathy

A

Older cats with renal disease, low potassium/acidifying diets, hyperthyroidism

43
Q

Signs: Hypokalemic myopathy

A

Persistant ventroflexion of the neck, stiff, stilted gait, resistance to movement, increased CK

44
Q

Tx: Hypokalemic myopathy

A

Potassium supplementation

45
Q

Feline idiopathic inflammatory myopathy

A

Ddx: Inflammatory and hypokalemic myopathy

Sudden onset of weakness with pronounced cervical ventroflexion

Tx: prednisone

46
Q

Signalment: Limber tail/ coccygeal muscle injury

A

Pointers, labrador retrievers, other working dogs

CS occur after long periods of rest and subsequent hard workouts

47
Q

Signs: Limber tail/ coccygeal muscle injury

A

Flaccid tail which may be painful

Fecal/urinary continence spared

48
Q

Tx: Limber tail/ coccygeal muscle injury

A

None, recovery within a few days

49
Q

Cause: Dystrophic myopathies

A

Inherited abnormaitites of the cytoskeleton-dystrophin

50
Q

Signs: Dystrophic myopathies

A

Progressive condition for ~6mo of age then stabilizes

Stunting, weakness, gait abnormalities, trismus, marked muscle atrophy with fibrosis and contracture

Kyphosis and lordosis, enlargement of tongue base, and pharyngeal/esophageal dysfunction

51
Q

Tx: Dystrophic myopathies

A

None, older animals will die of complications

52
Q

Non-Dystrophic myopathies (5)

A
  1. Central core-like myopathies (Great danes)
  2. Nemaline rod myopathy (family of cats and blue merle border collie)
  3. Centronuclear myopathies (labs)
  4. Myofibrillar myopathy with desmin storage (Aussies)
  5. Congenital degenerative myopathies (labs, bouviers, chows, retreivers)
53
Q

Metabolic myopathies (4)

A
  1. Hypothyroidism
  2. Hyperthyroidism
  3. Hyperadrenocorticism
  4. Various Enzyme deficiencies

SAM Neurology (3 decks)

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