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SAM Neurology > Bilateral Hind Limb Conditions > Flashcards

Bilateral Hind Limb Conditions Flashcards

1
Q

Cause: Degenerative myelopathy

A

Degeneration of axons and mylein sheaths in thoracolumber spinal cord

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2
Q

Degenerative myelopathy Predisposed breeds

A

Older (>8yr) Large and giant breed dogs

GSDs especially

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3
Q

Signs: Degenerative myelopathy

A

Gradual loss of voluntary motor functions and position sense (knuckling/dragging feet, crossing legs when turning, dysmetria, ataxia), muscle atrophy, asymmetical parsesis

UMN signs in hind limbs (LMN if nerve roots effect later on)

No spinal hyperesthesia or pain, sensation normal

Urinary and fecal continence spared until late in progression

Forelimbs affected late in disease progression.

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4
Q

Dx: Degenerative myelopathy

A

Definitive dx: histopathy- axonal and myelin degeneration with atrogliosis

Clinical dx: appropriate signs and exclusion of other causes, elevation of myelin based protein in CSF from lumbar cistern

Genetic test: SOD1 gene esp small breeds

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5
Q

Tx: Degenerative myelopathy

A

None

Phyiotherapy and good nursing may improve life expectancy

Corticosteroids, NSAIDS, B-vit have no effect

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6
Q

Cause: Lumbosacral instability

A

L7-S1: Hansen type II degeneration, compression of cauda equina, proliferation of interarcuate ligament

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7
Q

Signs: Lumbosacral instability

A

Early: Lumbosacral pain, difficulty rising/negotiating stairs

Advanced: Rear limb paresis, decreased extension of hock, pseudohyperreflexia of pateller reflex (loss of sciatic nerve), flexor withdrawl decreased except hip, urinary and fecal incontinence, tail may be immobile

Pain on deep palpation- tail jack test more specific than lordosis test (lordosis will elicit paint with coxofemoral pathology too)

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8
Q

Signalment: Lumbosacral instability

A

Older (5-8) large breed dogs esp working breeds

Transitional vertebra predisposes (8x more likely)

Rarely cats

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9
Q

Dx: Lumbosacral instability

A

Myelography (extended and flexed views), epidurography, MRI, CT to confirm nerve compression

CSF not helpful

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10
Q

Tx: Lumbosacral instability

A

Cage rest, NSAIDS/gabapentin/muscle relaxers/tramadol/prednisone- signs will recur with exercise

Surgical: lumbosacral dorsal laminectomy and removal of ligaments/bone that are putting pressure on the nerves- will not improve continence

Surgival: dorsolateral foramenotomy- less instability at L7/S1

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11
Q

Ddx: Lumbosacral instability

A

Diskospondylitis, neoplasia, lumbosacral ostyeochrondrosis, degenerative myelopathy, cruciate4 rupture, prostate disease, trauma, coxofemoral arthritis

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12
Q

Hansen type II: Thoracolumbar intervertebral disk disease

A

Replacement of nucleus pulposus with fibrocartilage by 7-8yr

Slow protrusion causing nerve/spinal compression pain by stretching of dorsal longitudinal ligament

Chronic, but may be more serious due to prolonged nerve damage

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13
Q

Hansen type I: Thoracolumbarr intervertebral disk disease

A

Replacement of nucleus pulposus with hyaline cartilage (4-18mo) that often becomes calcified. Chondrodystrophic breeds especially

Explosive protrusion of nucleus pulposus material into spinal cord

Acute, but may be less serious if treated right away

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14
Q

Cats: Thoracolumbarr intervertebral disk disease

A

Calcification is common, often in upper cervical and midlumbar region

Usually subclinical, may result in pain and difficulty walking

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15
Q

Hx: Thoracolumbarr intervertebral disk disease

A

May be acute, subacute, or chronic

CS vary from hyperesthesia with no deficits to paralysis and anesthesia

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16
Q

Signs: Thoracolumbarr intervertebral disk disease

A

UMN signs in hind limbs- most occur in T11-L2

Loss of

  1. Conscious proprioception
  2. Voluntary motor function, control of urination/defecation
  3. Superficial pain
  4. Deep pain- poor prognosis
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17
Q

Dx: Thoracolumbarr intervertebral disk disease

A

Spinal radiography- collapse of disc spaces, calcified disc material in vertebral canal

Myelography- definitely locate lesion

CT/MRI

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18
Q

Grade 1: Thoracolumbarr intervertebral disk disease

A

Spinal hyperesthesia without neurological deficits

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19
Q

Grade 2: Thoracolumbarr intervertebral disk disease

A

Paresis but ambulatory

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20
Q

Grade 3: Thoracolumbarr intervertebral disk disease

A

Paresis, non-ambulatory

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21
Q

Grade 4: Thoracolumbarr intervertebral disk disease

A

Paralysis with deep pain

22
Q

Grade 5: Thoracolumbarr intervertebral disk disease

A

Paralysis without deep pain

23
Q

Tx: Grade 1, 2, and 3 Thoracolumbar intervertebral disk disease

A

Strict cage rest for ~2wks and 2 weeks after resolution of clinical signs, prednisone for pain

1/3 will have recurrence, chronic steroids may worsen prognosis

If no improvement consider surgery

Never give NSAIDS for pain- gastric ulceration

24
Q

Tx: Grade 4 Thoracolumbar intervertebral disk disease

A

May show improvement with cage rest but will relapse- pain control and bladder management (UTI common w/UMN bladder); some dogs may deteriorate with cage rest

Surgical best option: over 90% recovery, operate within 24hrs if possible; Dorsal hemilaminectomy and disc fenestration of surrounding discs

25
Q

Tx: Grade 5 Thoracolumbar intervertebral disk disease

A

Typically will not recover regardless of treatment

Surgical approach: dorsal hemilaminectomy and durotomony for more accurate prognosis; If deep pain has not returned 2wks post-op it is unlikely to recover

Successful sx: motor/bladder function returns after ~4wks and will continue to improve, physiotherapy crucial for recovery

26
Q

Grade 4 and 5Thoracolumbarr intervertebral disk disease Physiotherapy

A
  1. flexion and extension of the limbs
  2. massaging the limbs
  3. assisted walking and standing
27
Q

Prevention: Thoracolumbarr intervertebral disk disease

A

No known behavioral risk factor

Percutaneous disc ablation to destroy T10-L4 and prevent extrusions

28
Q

Cause: Diskospondylitis

A

Infection of the cartilaginous endplates with involvement of the intervertebral disc

Vertebral osteomyelitis- S. intermedius, Brucella canis, Streptococcus spp.

29
Q

Signalment: Diskospondylitis

A

Large, middle-aged dogs

Rare in cats

30
Q

Signs: Diskospondylitis

A

Common in C6/7, T4-6, and L7/S1

Hyperesthesia, pyrexia, depression, weight loss

Untreated: Proliferation of fibrous connective tissue and new bone leading to spinal cord compression

Complications: Spinal cord myelitis, pathological vertebral fractures, disc protrusion, vertebral instability

31
Q

Dx: Diskospondylitis

A

Spinal cord signs with concurrent systemic signs of infection, CSF often normal or with mildly elevated proteins

Definitive diagnosis: spinal radiographs (bone lysis, sclereosis, spondylosis), scintigraphy or MRI

32
Q

Tx: Diskospondylitis

A

Minimal neurological involvement: analgesic and parenteral abx

Neurological dysfunction: surgical decompression/stabilization

Prognosis good unless fungal infection

33
Q

Types/Locations of Vertebral/spinal neoplasia

A
  1. Intramedullary- astrocytoma, oligodendroglioma, ependymoma
  2. Metastatic intramedullary- hemangiosarcoma, melanoma, carcinomas
  3. Intradural-extramedullary- meningioma, nephroblastoma, MPNSTs
  4. Extradural- vertebral osteosarcoma, chondrosarcoma, multiple myeloma, hemangiosaroma, fibrosarcoma and mets
34
Q

Most common type of Vertebral/spinal neoplasia in Dogs

A

Spinal cord Meningioma,

2nd Hemangiosarcoma

35
Q

Vertebral/spinal neoplasia are usually found in what portion of the spinal column

A

Thoracolumbar area

36
Q

Signalment: Vertebral/spinal neoplasia

A

Medium to large breed dogs around 6yr (30%

37
Q

Most common type of Vertebral/spinal neoplasia in Cats

A

Extradural lymphosarcoma in the thoracolumbar spinal chord esp cats with FeLV

Cerebral meningiomas

38
Q

Signs: Vertebral/spinal neoplasia

A

Root signs with progressive neurological deficits (depends on nerves effected)

39
Q

Diagnosis: Vertebral/spinal neoplasia

A

Lytic lesions on radiographs, abnormalities in the dye column on myelogram

Intramedullary- thin and divergent columns of dye
Intradural-extramedullary- characteristic “golf-tee” sign
Extradural- deviation of dye towards the lumen

40
Q

Tx: Vertebral/spinal neoplasia

A

Meningiomas- resection

No tx- survival limited to weeks/months

Tx: post-op radiation/chemotherapy can increased life expectancy

41
Q

Cause: Vertebral fractures and luxations

A

Trauma to sacroiliac and thoracolumbar areas especially

Tail tugs resulting a sacrococcygeal luxations/fractures common in cats

42
Q

Signs: Vertebral fractures and luxations

A

History of trauma and evidence of other wounds

Spinal hyperesthesia or anesthesia, decreased/absent voluntary motor activity, misalignment of spine, crepitus, Schiff-Sherrington

LMN signs caudal to lesion if spinal edema that may resolve to UMN signs after 24hrs

43
Q

Diagnosis: Vertebral fractures and luxations

A

Radiography

CT/MRI more precise

44
Q

Tx: Vertebral fractures and luxations

A

Analgesia as needed, correct other life threatening traumas (shock, hypovolemia, etc), steroids (limited efficacy), 20% Mannitol to reduce spinal edema once hypovolemia is corrected

Surgical decompression of spinal cord if unstable lesion

Stabilization works better for smaller patients; larger patients may benefit more from cage rest

45
Q

Bulldogs and boston terriers

A

Hemivertebrae- failure of left and right centers of ossification to fuse

46
Q

Block or fused vertebrae

A

Incomplete segmentation of two or more vertebrae

May not cause neurological signs

47
Q

Spinal dysraphism

A

Bulldogs and bostons- spina bifida, meningiocele, myelomeningocele

Manx cats- sacrococcygeal dys/agenesis

Weimeraners- inherited myelodisplasia

48
Q

Spinal synovial cysts

A

Articulation facets, may cause pain

Tx: surgical decompression and stabilization

49
Q

Spondylosis deformans

A

Common in older dogs, rarely clinical

Formation of bone spurs/ridges at intervertebral spaces

50
Q

Old dog hind limb tremors

A

Old terriers and large breeds predisposed

Mild tremors in hind limbs while standing or at rest that often disappear with movement; may be slowly progressive

Unknown etiology and no tx

51
Q

Dancing dobermans

A

Flexion of pelvic limbs while standing may be slowly progressive over years (CP deficits)

No discomfort, walking unaffected

SAM Neurology (3 decks)

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