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Neuro > CS: Wobbly Animals > Flashcards

CS: Wobbly Animals Flashcards

1
Q

Ddx for a hyperacute onset, non progressive, strongly lateralised, non painful T3-L3 myelopathy

A
  • non-painful -> in SC
  • Non-progressive ->
    > infarct (FCE) aetiology unknown or
    > HVLD non-compressive nucleus pulposus EXTRUSION (not the same as IVDD)
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2
Q

What is a HVLD ?

A
  • high velocity low volume??
  • acute non-compressive nucleus pulposus extrusion
  • > contusion but not compression
  • sometimes painful
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3
Q

Tx and prog for HVLD?

A

Good, tx not surgical just physio and hydrotherapy

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4
Q

Do infarcts of the SC appear hypo or hyperintense?

A

Hyper

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5
Q

What are the 2 potential stages of pathology wrt IVDD?

A
  • initial contusive injury

+- 2* ompressive injury if material hangs around

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6
Q

Where does a 2 engie gait indicate the lesion to be?

A

C6-T2

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7
Q

What is cervical spondylomyopathy?

A

= wobblers (covers many disease processes!!)
> 2 distinct types
- disk assocaited (multiple sites so hard to dx)
- osseus associated (cranial)

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8
Q

How is a hemivertebra defined?

A

> 25* angle of kyphosis

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9
Q

What is a flare up of a chronic disease termed?

A

Acute on chronic presentation

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10
Q

What may cause acute on chronic presentation of CVM/s?

A

Trauma can exacerbate underlying deformity

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11
Q

Diagnostic techniques for IVDD in the dog?

A

> survey spinal rads (suggestive but not dx)
myelography (cord compression and malacia)
CT (fat v soft tissue, can seee extruded mineralised disk material)
MRI (T2W)
CSF analysis

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12
Q

What an be seen on rads with IVDD?

A
  • narrowed intervertebral space
  • altered shape of intervertebral foramina
  • radiopaque material in the vertebral canal [with chondroid type 1 dz]/superimposed on foramen
  • v size dorsal articular joint space
  • spondylosis deformans
  • sclerosis of end plates
  • do NOT necessarily correlate with clinical significance or spine/n. compression
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13
Q

What can myelography be useful for?

A
  • ID siteo f cord compression

- myelomalacia

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14
Q

What is CT useful for with IVDD?

A
  • fat v soft tissue

- can kind of see extruded dsik material if mineralised

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15
Q

What may be seen on MRI with IVDD?

A

> T2W

  • normal hydrated nucleus pulposus is hyperintense cf. annulus fibrosus
  • becoems iso/hypointense as loses hydration
  • extrusion of degenerate nucleus pulposus appears as hypoinense extradural SC compression
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16
Q

Is degreee of compression of the SC correlated to prognosis?

A

NO - presence of deep pain only prognostic indicator

17
Q

What CSF changes can be seen with IVDD?

A
  • caudal to lesion ^ protein conc

+- pleiocytoisis w/ predominance of LYMPHOCYTES if examined >7d after onset

18
Q

What is spondylosis deformans?

A

LOOK UP

19
Q

MEdical conservative tx of IVDD? When is this indicated? What is the “hope” with medical management?

A

> decision based on severity of clinical signs (milkdly affected = pain alone/mild paresis)
- only suggest if VERY SURE it is IVDD and nothing more sinister!
- disk isease v. rare >10yo so more indepth work up needed for these
hope that compressive material will dissipate and dorsal annulus will heal over and not re-herniate
Tx
- cage confinement min 2 weeks (4-6 better)
- >2 weeks no improvement - consider surgery
- if improvement seen continue cage rest 1-2 weeks after clinical resolution
- gentle physio ad short lead walks
corticosteroids NOT indicated despite advice you might hear.

20
Q

Surgical tx of IVDD? Whaen is this indicated?

A

> indicated if unable to supportt weight
Aim: surgical decompression of SC (if retain deep pain before surgery 90% chance of walking after surgery aim to carry out

21
Q

How long after surgery does a lack of deep pain indicate v poor prognosis?

A

2-4 weeks

22
Q

Pathogenesis of EHV myelopathy?

A
  • endotheliotropic virus
  • vasculitis
  • local areas of BBB break down
  • protein and pigment, then cells leak into CSF (pleiocytosis)
23
Q

Which diagnostic tests are useful for dx of CVM/S?

A

> neuro exam
- sway test for paresis (@walk)
- slap test (withers-larynx) crude
radiology
- plain lateral rads (transverse processes must be lined up for a tru lateral!!) @C1-C2, C3-C5, C6-C7
- measure inter/intravertebral ratios
- ski ramping (caudal epiphyseal flare)
- caudal extension of dorsa llamina
- step
- subluxation
contrast myelography to prove compression
- GA and recumbency required so referral only
- neutral, flex and extension radiographs to ID dynamic compression
- always necessary if contemplating surgery
CSF
- normal with CVM/S
- can r/o other dx
experimental endoscopy/myeloscopy of arachnoid space (between dura and pia)

24
Q

Outline hwo to calculate intra- and intervertebral ratios. WHat clinical significance are these?

A 
a= minimum width of vertebral canal
b= minimum distance from physis to preceding dorsal bit of spine
c= ???
A= maximum width of vertebral physis
B= max width of next vertebra along caudally
> Intervertebral = b/B or c/B
> Intravertebral = a/A
- If intRAvertebral ratio
25
Q

How may presence of bog spavin be linked to myelopathies?

A
  • Bog spavin OCD -> 2* OA
  • link between presence of OCD in hocks and other joints
  • so presence of bog spavin -> ^ risk OCD in neck joints
26
Q

Aetiology of CVM/S?

A
  • developmental condition of well fed foals, esp TB colts
  • ? genetic: OCD lesions seen on articular surfces and vertebral body growth plates
  • often biggest, strongest foal - fed more to encourage growth
  • abnormalities of vertebral bodies, dorsal laminae and/or articular processes
  • dynamic and static stenosis of vertebral canal and focal compression of the SC
27
Q

What are the 2 types of CVM/S?

A

> type 1 (dynamic)
- usually C2- C6
- epiphyseal flaring -> narrowing @ cranio/caudal orifices
type 2 (static)
- usually C5-C7
- dmaage ascending [-> ataxia] and descending [-> paresis] tracts

28
Q

Potential anagement/tx of CVM/S?

A

> conservative (more successful for dynamic)
- v growth rate (Pace diet)
- 6mo box rest (prone to accidents)
- adjust Ca/Ph ration
- feedd/waer elevated
- articular process joint mediccation (u/s guidance; not useful for ataxia but good for neck pain)
surgical
- drill out intervertebral space, screw to arthrodese the vertebrae in extension
- success depends on duration of clinical signs, severity and age (young horses tx early = greatest success)
- cervical fusion to immobilise affected vertebral spaces -> regression of enlarged intervertebral joints and decompression

29
Q

Prognosis of CVM/S?

A
  • guarded for return to usfulness (1/2 return to work) have to wait min 6 months post op to evaluate
  • suitable for breeding
  • prog worse for static
30
Q

Safety implications for horses with CVM/S?

A
  • always say ride at your own risk!!
  • Grade 2 or worse ataxia = dont ride
  • Grade 1 ataxia = probably ok, such a subjective scale anyway
    > older horses more guarded prognosis
31
Q

What breeds of dog are pdf IVDD?

A
  • chondrodystrophic breeds
  • butt all dogs can get it !! inc large breed
    > young - middle age commonly, not necessarily ^ risk with age

Neuro (30 decks)

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