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3: Neurosurgery > Chapter 30 Medical Conditions of the Vertebral Column and Spinal Cord > Flashcards

Chapter 30 Medical Conditions of the Vertebral Column and Spinal Cord Flashcards

1
Q

List DAMNIT V categories

A

D - Degenerative

A - Anomalous

M - Metabolic

N - Neoplasia, nutritional

I - Inflammatory, infectious

T - Toxic, traumatic

V - Vascular

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2
Q

6 finger rule

A
  1. Singlament
  2. Onset
  3. Progression
  4. Lateralising?
  5. Painful?
  6. Neurolocalisation
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3
Q

List 3 examples of metabolic conditions that may result in signs of SC dysfunction

A

Secondary hyperparathyroidism

Thiamine deficinecy

Hypervitaminosis A (cats)

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4
Q

Name 2 locations fo rCSF collection

A

Lumbar subarachnoid space

Cerebellomedullary cistern

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5
Q

What direction does CSF predominantly flow in

A

Rostro-caudal

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6
Q

How mcuh CSF (vol) can be safely collected

A

1 ml/5kg

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7
Q

At what specific site i slumbar CSF collection performed in dogs?

And in cats?

A

L5-L6 in dogs

L6-L7 in cats

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8
Q

What does xanthochromic CSF suggest

A

Xanthochromic = yellow (in greek)

Suggests previous subarachnoid haemorrhage

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9
Q

What is normal WBC level of CSF

An TP?

A

<5 x 10^6/L

TP at cerebellomedullary cistern <250 mg/L, at lumbar subarachnoid space <450 mg/L

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10
Q

What breed of dog is prone to fungal disco?

A

GSDs

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11
Q

Which type of antibody reflects primary (direct expose) and secondary (repeated/chronic infection) immune responses?

A

IgM = primary

IgG secondary

i.e elevated IgG may just represent previous exposure/vaccination. Do IgG antibody index to help distinguish

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12
Q

What antibody tet and result can be used to help diagnose SRMA ?

A

Serum and CSF IgA

(combined elevation in serum and CSF highly suggestive)

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13
Q

List 5 common mediacl disorders of vertebral column and spinal cord

A
  • FCE
  • HNPE
  • Degenerative myelopathy
  • Discospondylitis
  • Meningomyelitis
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14
Q

What is degenerative myelopathy?

C/s

What is gene mutation responsible

Definitive dx?

A

CDM: Diffuse axonopathy associated with necrosis primarily in lateral and ventral funiculi –> axonal and myelin degeneration

C/s: UMN paresis and ataxia –> incontinence, thoracic limb involvement.

Gene mutation: Superoxide dismutase 1 (SOD1). Mis-sense mutation G-to-A transition (A-to-T in Bernese mountain dogs)

Dx: Histo. Presumtive with exluding other disorders thorugh imaging and CSF analysis, + SOD1 gene mutation analysis

Spinal cord histopathology from a 6-year-old Boxer with degenerative myelopathy.

A, Pallor and myelin degeneration (pale-staining areas of the white matter) are marked in the lateral and ventral funiculi at the level of the fifth thoracic spinal cord segment (Luxol fast blue stain with periodic acid–Schiff counterstain).

B, Myelin loss is seen predominantly in the lateral and ventral funiculi (stars) at the level of the eighth thoracic spinal cord segment (Luxol fast blue stain).

C, Dilated myelin sheaths that contain debris (arrows) are most numerous adjacent to the ventral median fissure (star) (Luxol fast blue stain with periodic acid–Schiff counterstain).

D, Multiple axons are absent or fragmented (arrows) and are surrounded by dilated myelin sheaths (Bielschowsky silver stain).

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15
Q

What is prognosis for dogs once dx CDM?

Any exceptions?

A

6-9 month

Corgis 19 months

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16
Q

Name 4 types of meningomyelitis

A
  1. Viral
  2. Bacterial
  3. Protozoal
  4. Idiopathic (SRMA, GME (or MUA as GME can only be dx on PM)
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17
Q

Which meninges are affected by SRMA

A

Leptimeninges (=arachnoid + pia)

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18
Q

At what age are dos usually affected by SRMA?

Breeds:

A

6-18 months

Beagle, Bernese, Boxer (BBB)

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19
Q

With SRMA, what other structures may be affected by arteritis

A

Mediastinum, thyroid, heart

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20
Q

What are the two types of SRMA?

Dx:

A

Acute and chronic

Dx:

  • MRI = miningeal enhancement
  • CSF = pleocytosis + elevated TP
  • Serum + CSF IgA!
    • If both high then sens 91% spec 78%. N.B. IgA remains elevated so no use for monitoring

Gross and histopathologic lesions associated with steroid-responsive meningitis-arteritis.

A, Ventral surface of the caudal medulla with a leptomeningeal plaque (arrow).

B, High magnification (40×) views of the prolific arterial inflammation in the cervical spinal cord leptomeninges. Neutrophils are prominent. Note the thrombosis of the arteriole (left) and the fibrinoid degeneration of the blood vessel (right).

C, Transverse section of the cervical spinal cord—low-magnification view of an inflammatory plaque in the ventral leptomeninges (left arrow). In the two insets at higher magnification, note the advanced fibrinoid mural degeneration (right arrow) and the neutrophilic infiltration.

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21
Q

Tx of SRMA

A

Pred +- azathioprine

22
Q

What are various presentations/types of GME?

A

Disseminated

Focal (appears as mass!)

Ocular

23
Q

Sex and breed predilection for GME?

A

Female

Toy/terrier breeds

24
Q

DOes GME predominantly affect white or grey matter?

A

white matter

25
Q

What is most common MRI finding in disseminated GME?

A

Multiple T2W and T2 FLAIR hyperintensities throughout the CNS white matter - typically infiltrative appearance and irregular margins.

Despite the predilection of the granulomatous meningoencephalomyelitis for white matter, MRI lesions often are distributed throughout both gray and white matter.

The lesions have variable intensity on T1-weighted images and have variable degrees of contrast enhancement.

Vasogenic edema in the white matter is commonly present on T2-weighted images and appears hyperintense to the neuroparenchyma. Although meningeal enhancement has been described it is not commonly apparent.

Ddx: Infectious meningoencephalomyelitis, CNS lymphoma, metastatic neoplasms

Magnetic resonance imaging (MRI) and histopathology of granulomatous meningomyelitis in a 6-year-old mixed-breed dog.

A, On the sagittal plane T2-weighted MRI of the lumbar vertebral column, there is a diffuse, intramedullary hyperintensity in the lumbar spinal cord (arrows) Histopathologically this hyperintensity is the result of granulomatous meningoencephalomyelitis.

B, Subgross transverse section of the lumbar spinal cord (taken from a section of spinal cord in the area of hyperintensity dorsal to L5 vertebra) shows intramedullary inflammation within the dorsal, right lateral, and ventral funiculi. Note the rare involvement of the right dorsal and ventral nerve rootlets (arrows).

C, Magnified view (box outline in B) at the level of the central canal depicting numerous perivascular, coalescing, inflammatory infiltrates within the spinal cord parenchyma typical of granulomatous meningoencephalomyelitis (40×; hematoxylin and eosin stain).

26
Q

Tx for GME

A

Pred

+ cytarabine (cytosine arabinoside) (50 mg/m2 sc q12hrs for 2-3 d)

+- cyclosporine

27
Q

What is f=emdian reported survival of dogs with focal GME

and disseminated?

A

Focal 12d

Disseminated 8d

28
Q
  • What c/s do dogs with distemper virus affectign CNS often show?
  • How is it spread?
  • What tissues does it affect?
  • Dx:
A
  • Canine distemper virus myoclonus
  • Spread via respiratory droplets
  • Affects all epithelial tissues + CNS
  • Dx: CSF, PCR, urine or conjunctival scraping, skin IHC
29
Q

What are two types of FIP

A

Effusive (wet)

Non-effusive (dry aka “brain-eye”)

Meningoencephalomyelitis most commonly seen with dry form.

May see ocular signs; irisitis, aqueous flare, retinal haemorrhage and detachment

30
Q

What histo sign is seen with CNS FIP

A

perivascular pyogranulomatous infiltration in leptomeninges, brain, Sc, choroid plexus, ependyma

31
Q

How is FIp definitively diagnosed

A

Histo + IHC for coronavirus

Ofetn see higher than expected TP values in CSF, but not sensitive

32
Q

List two types of protozoal meningomyelitis

What 2 neurologic syndromes can occur with oinfection fo either of these

A
  • Toxoplasa gondii (affects cats and dogs)
  • Neospora caninum (just dogs)
  • Meningoencaphalomyelitis
  • Myositis-polyradiculoneuritis (<6 month old dogs)
33
Q

What is definitive host for t gondii?

How is it spread

A

Cats, but any mammal can be intermediate host

Spread via carnivorous ingestion, but also orofaecally and transplacental

34
Q

What may be found on CSF of protozoal meningoencephalomyelitis?

A

Albuminocytologic dissociation (i.e. increased protein without accompanying WBC increase)

35
Q

HOw can t gonii and neospora be diagosed?

A

Antibody titres, CSF analysis, PCR

IgM titres > 1:64 suggestive, ideally serial increases too

IHC pf muscle/nerve biopsy sometimes successful

PCr

36
Q

How is T gonii/neospora treated?

A

10-25mg/kg clindamycin bid 3-4 weeks

37
Q

What test shoudl be run if suspect bacterial meningitis?

A

CSF analysis + culture, Urine + blood culture, eubacteria PCR

38
Q

Comment on MRI

A

Transverse (A) and sagittal (B) plane T2-weighted magnetic resonance images of lumbar vertebral column in a dog with bacterial meningomyelitis and epidural empyema. Note the hyperintensity present on the sagittal (single arrow) image that is shown on the transverse images (double arrows) as marked hyperintensity in the epidural space. Cerebrospinal fluid analysis and culture disclosed marked neutrophilic pleocytosis and Gram-negative bacilli, respectively. The dog had a complete response to a 3-month course of antibiotics.

39
Q

What breeds are predisposed to discospondylitis

A

Great dane, Lab, Rottie, GSD (fungal), Dobie, Bulldog

40
Q

List 4 common sites for discospondylitis

A
  1. LS junction
  2. TL junction
  3. Mid thoracic
  4. Caudal cervical
41
Q

What is the most common concurrent condition with disco?

What are 2 most common bacteria in discospondylitis

A

UTI

Staph, e.coli

42
Q

What are potential sequalae of disco (5)?

A
  1. Epidural abcessation
  2. Myelitis
  3. Vertebral instability
  4. IVD herniation
  5. Vertebral fracture
43
Q

List 8 sources of disco infection

A
  1. UTI
  2. Prostatic abcess
  3. Grass awn migration
  4. Oral cavity infection
  5. Gi disease
  6. Pyoderma
  7. Endocarditis
  8. Pyometra
44
Q

List 4 rdaiographic changes of disco

A
  1. End plate lysis
  2. IVD space narrowing
  3. Sclerosis
  4. Spondylosis

Radiograph and computed tomography (CT) scan of discospondylitis in a 6-year-old female, spayed Working Kelpie mix.

A, Lateral radiograph shows mild narrowing of the lumbosacral intervertebral disc space. The caudal endplate of the L7 vertebra and the cranial endplate of the sacrum do not appear lytic.

B, Transverse CT image (bone window) disclosing marked lytic changes (white arrows) within the sacrum consistent with discospondylitis. The dog responded completely to a 3-month course of antibiotics.

45
Q

What zoonosis whoudl be checked for in disco cases?

A

Brucella canis (bacteria)

46
Q

What 2 syndromes mimic FCE

A

ANNPE

Feline ischaemic myelopathy

47
Q

Why might T3-L3 FCE mislocalise to L4-S3

A

Spinal shock

should resolve in 12 hours but authrours report can take days

48
Q

Where does FCe orifginate from

A

Nucleus pulposus

unclear how

49
Q

of grey or white matter, whch is more affected by fce and why

A

grey matter as has higher metabolic demand

50
Q

List 5 management steps for FCE

A
  1. Minimise vertebral column movement
  2. Monitor respiration if severe
  3. Recumbency/urine/faeces care
  4. IV fluid to aid perfusion
  5. Physio
51
Q

What is median time for FCE dogs to:

Regain voluntary motor function

Unassisted ambulation

Maximal recovery

A

Regain voluntary motor function 6d

Unassisted ambulation 11d

Maximal recovery 3.75 months

3: Neurosurgery (12 decks)

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