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Dog & Cat Medicine and Surgery > Gaitero - Neurology > Flashcards

Gaitero - Neurology Flashcards

1
Q

Neurological Exam (6 steps)

A
  1. Mental status
  2. Gait / posture
  3. CN exam
  4. Postural reactions: Proprioception/Hopping
  5. Spinal reflexes
    • PL: Patellar / Withdrawal (flexor)
    • TL: Withdrawal
    • Cutaneous trunci, perineal
  6. Palpation (back / neck pain)
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2
Q

3 goals of the neuro exam

A
  1. Identify/confirm presence of a neurological problem
  2. Localize the lesion within the nervous system
  3. Others
     Assess severity/extension lesion  Prognosis
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3
Q

VITAMIN D stands for…

A 
VASCULAR
INFLAMMATORY / INFECTIOUS
TRAUMATIC / TOXIC ANOMALOUS (congenital) METABOLIC
IDIOPATHIC
NEOPLASTIC / NUTRITIONAL
DEGENERATIVE
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4
Q

Spinal Cord Enlargements

A

There are two regional enlargements of the spinal cord for the innervation of the limbs:
· cervical intumescence C6-T2
composed of cord sections C6, C7, C8, T1, (T2)
· lumbosacral intumescence L4 to S3
composed of cord sections L4, L5, L6, L7, S1, S2, S3 (some say L5 to S1)

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5
Q

Intervertebral disc disease

A

Degenerative changes increase with repetitive compression (e.g. heavy lifting in flexion) or trauma (e.g. fall); degenerative changes may be asymptomatic

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6
Q

Where does the spinal cord terminate in large breed/small breed dogs & cats?

A

Large breed - L6
Small breed - L7
Cats - L7/S1

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7
Q

Canine Vertebral Formula

A

C-7, T-13, L-7, S-3

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8
Q

Spinal cord segmentation

A 
Spinal cord divided in segments:
8 cervical
13 thoracic
7 lumbar
3 sacral
>= 2 caudal
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9
Q

3 types of ataxia

A

Proprioceptive
Cerebellar
Vestibular

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10
Q

Where is the LMN Cell body? Axon?

A

Ventral Grey horn
From PNS to muscle
Reflex motor activity

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11
Q

UMN Clinical signs

A

Paresis (weakness)
Decrease of inhibitory LMN reflex so spinal reflexes are increased or normal
Disuse mucle atrophy, increased muscle tone.
Usually proprioceptive ataxia

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12
Q

LMN Clinical signs

A

Paresis/paralysis
Decreased or absent reflex
Loss of muscle tone
Neurogenic muscle atrophy

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13
Q

Functional classification of the spinal cord (segments)

A

C1-C5
C6-T2
T3-L3
L4-S3

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14
Q

Extradural
Intradural-Extramedullary
Intramedullary

A

Outside the dura matter, but pushing pressure on the spinal cord
Inside the dura matter, but not in the actual cord
In the actual spinal cord

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15
Q

Clinical signs of spinal cord compression

A
  1. Back/neck pain
  2. Proprioceptive losses
  3. Loss of motor/paresis
  4. paralysis
  5. loss of nociception (deep pain)
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16
Q

Differentials for acute myelopathies

A

Febrile cartilagonis embolism myleopathy
Spinal trauma
Intervertebral disc (IVD) herniation: extrusion

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17
Q

Annulus fibrosus

A

fibrous ring of intervertebral disk

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18
Q

Intervertebral disc (IVD) herniation: Extrusion vs. protrusion

A

Extrusion of mineralized nucleus pulposus into the vertebral canal (hansen type 1)- usually acute
Protrusion - usually chronic

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19
Q

Chondrodystrophic breeds/ages (w.r.t IVD herniation)

A

Daschunds, beagles, cockers, shih tzu (3-6 years old, rare < 2)

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20
Q

Location for IVD extrusion herniation

A

T11 - L3, cervical (uncommon to be T1-10;inter capital ligament)

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21
Q

IVD Extrusion diagnosis

A

Thoracic rads

Myelogram (CT)

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22
Q

IVD Extrusion treatment (surgical/when to use)

A 
Surgical: 
Thoracic: 
Hemilaminectomy
Pediculectomy
Cervical: Ventral Slot
Use surgical if pain or neurological deficits
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23
Q

Hemilaminectomy

A

Remove part of a lamina of the vertebral arch in order to decompress the corresponding spinal cord and/or spinal nerve root.

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24
Q

pediculectomy

A

surgical removal of portions of vertebral pedicles at the level of the intervertebral foramen.

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25
Q

IVD Extrusion emergency

A

Loss of deep pain
Quick onset
Non-ambulatory (thoracic)
Tetraplegia (cervical)

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26
Q

IVD Extrusion treatment (conservative)

A 
Strict cage confinement for 3-4 weeks
Pain killers (NSAIDs Opioids) +/-
First episode of pain without deficits (50% get better)
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27
Q

IVD Extrusion treatment (what not to use)

A

Never use NSAIDs + steroids
Never use anti-inflammatories without cage rest
Steroid use at all is controversial

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28
Q

IVD Extrusion - prognosis

A

Deep pain present? Yes: 90%

No? < 50%

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29
Q

Fibrocartilaginous embolic myelopathy (FCEM) - what is it?

A

Detachment of the IVD substance (nucleus pulposus) and lodging into a blood vessel - acute. Causes spinal cord ischemia due to the embolism in a spinal cord vessel
(thoracolumbar/cervical)

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30
Q

Fibrocartilaginous embolic myelopathy (FCEM) - breeds

A

Non-chondrodystrophic large breed dogs

Miniature schnauzers

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31
Q

Fibrocartilaginous embolic myelopathy (FCEM) - clinical signs

A

Acute / hyper acute onset
Non-progressive
Asymmetrical CS
Non-painful

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32
Q

Spinal cord arterial supply

A

10 pm, 2pm = upper spinal cord

6 pm = lower spinal cord

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33
Q

Fibrocartilaginous embolic myelopathy (FCEM) - diagnosis

A

History/clinical signs
Rule out others
MRI - Intramedullary, focal, asymmetrical

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34
Q

Fibrocartilaginous embolic myelopathy (FCEM) - treatment & recovery

A 
Treatment = supportive
Recovery = may do well if still have deep pain & start to get some recovery within the first 2 weeks
35
Q

Spinal trauma types

A

Endogenous (e.g. IVD Extrusion)
Exogenous (e.g. HBC)
(spinal cord contusion, vertebral fracture/luxation, traumatic IVD extrusion, hemorrhage)

36
Q

How do you deal with a life-threatening trauma injury

A
  1. Airway/Breathing/Circulation
  2. Minimal manipulation
    Physical/Orthopaedic exam
    Brief neurological exam (latera recumbency, localize severity, deep pain)
37
Q

Treatment for primary vs. secondary injury

A

primary: decompression/stabilization
secondary: maintenance spinal cord perfustion (BP, PO2), steroids?

38
Q

Acute, progressive, T3-L3 myelopathy

A
  1. IVD herniation/extrusion
  2. Inflammatory/Infectious (GME, infectious, spinal empyema
  3. Neoplasia
  4. Less likely: Spinal trauma, FCEM, others
39
Q

Differentials for hemiparesis, delayed proprioception on the same side, and decreased flexor reflex in the same side thoracic limb?

A
  1. FCEM (Fibrocartilaginous embolic myelopathy)
  2. IVD herniation (extrusion)
  3. Others
40
Q

Myelopathies - chronic (5)

A

IVD herniation - protrusion
Atlantoaxial subluxation
Degenerative myelopathy (Genetic degeneration of the spinal cord white matter mainly from T3-L3)
Caudal cervical spondylomyelopathy (wobbler’s)
Degenerative lumbosacral stenosis

41
Q

IVD herniation - protrusion: what is it?

A

A fibroid degeneration of the intact disc (hansen type II degenration); part of the normal aging process.
Progressive thickening on the dorsal annulus. A chronic, slow, compressive myelopathy

42
Q

IVD herniation - protrusion: Signalment & Clinical signs

A 
Chronic, progressive (weeks, years) 
Non-chondrodystrophic large dogs (or any)
Age > 5 years old (5-12 years)
Cervical/thoracolumbar
Spinal pain is mild/moderate vs. none
43
Q

IVD herniation - protrusion: Diagnosis

A

Spinal radiographys/myelogram
CT-myelogram
MRI

44
Q

IVD herniation - protrusion: Treatment

A

Restrict activity
Anti-inflammatory drugs
Steroids (useful for chronic spinal cord injury e.g. predinsone
Many can be controlled for a long time

45
Q

IVD herniation - protrusion: Surgical treatment - success rate, reasons

A

Less successful than IVD herniation - extrusion
Deterioration after surgery (temp or permanent), reperfusion injury
Lack of spinal cord functional reserve capacity: chronic compression, irreversible damage
(assume: Thoracic:
Hemilaminectomy
Pediculectomy
Cervical: Ventral Slot
Use surgical if pain or neurological deficits)

46
Q

Atlantoaxial subluxation - what is it?

A

Instability between C1-C2
Dorsal displacement of C2 (causes spinal cord compression)
Congenital & acquired forms

47
Q

Atlantoaxial subluxation - Clinical signs

A

C1-C5 myelopathy (can be chronic or acute)

progressive, severe neck pain, dyspnea

48
Q

Atlantoaxial subluxation - Congenital form

A

Small toy canine breeds (yorkshire terrier, chihuahua, miniature schnauzer)
< 1 year old
Failure of ligament support or failure of C2 dens development (hypoplasia/absence/dorsal angulation)

49
Q

Atlantoaxial subluxation - Acquired form

A

Traum -> acute; any dog/cat

50
Q

Atlantoaxial subluxation - Diagnosis

A

Spinal radiographs (usually diagnostic)
Increased space dorsal lamina atlas - dorsal spinous process axis (C2)
Extreme care manipulation - better if awake patient
Myelogram, CT, MRI

51
Q

Atlantoaxial subluxation - treatment

A

Stabilization +/- dens removal
High morbidity/mortality
Risk of respiratory arrest & death

52
Q

Atlantoaxial subluxation - conservative treatment

A

Young animals with mild signs
External splint >= 6 weeks
Risk or recurrences

53
Q

Degenerative myelopathy

A

Degeneration of the spinal cord white matter mainly from T3-L3 (genetic –> form of amyotrophic lateral sclerosis (ALS); genetic marker identified)
Pelvic limb ataxia, abnormal placement of the hind limbs, crossing over, reflexes are normal

54
Q

Degenerative myelopathy - signalment

A 
Large breed (german shepherd **, boxer, pembrokeshire welsh corgi, others
Age: > 5 years old (mean of 9)
55
Q

Degenerative myelopathy - clinical signs

A

Chronic & progressive
T3 - L3 (severe pelvic limb proprioceptive ataxia, paraparesis/paraplegia, sometimes decreased patellar reflexes)
No spinal pain

56
Q

Degenerative myelopathy - diagnosis

A

Rule-out other chronic T3-L3 myelopathies (IVD protrusion, neoplasia; normal spinal imagine)
Genetic marker present (DNA)
For a definitive diagnosis -> histopathology

57
Q

Degenerative myelopathy - treatment & prognosis

A

Supportive/physical therapy
Vitamins/aminocaproic acid, steroids? (not proven)

Prognosis: poor -> euthanasia in 6-12 months (can progress to thoracic limbs if kept alive)

58
Q

Caudal cervical spondylomyelopathy (CCSM)

A

Wobbler’s syndrome (cervical stenotic myelopathy; cervical malformation/malarticulation)
Vertebral malformations/malarticulations affeting caudal cervical vertebrae & acssociated structures (liagments/facets/discs)
Deficits in the thoracic limbs may be less (at least initially) than the pelvic limbs

59
Q

Caudal cervical spondylomyelopathy (CCSM) - pathogenesis

A
  1. Malformation/malarticulation
  2. Degenerative changes in the spine
    - hypertrophic ligaments
    - IVD protrusions (C5-C6, C6-C7)
    - stenosis vertebral canal
    - articular facets: DJD, cysts, hypertrophy
  3. Spinal cord compression
60
Q

Caudal cervical spondylomyelopathy (CCSM) - name the 2 forms

A
  1. disc associated CCSM: large breed, middle aged 3-9 (IVD protrusion)
  2. Osseous-associated CCSM. Giant breed (great dane) < 3 years old, articular facets DJD, canal stensosis
61
Q

Caudal cervical spondylomyelopathy (CCSM) - clinical signs

A

Chronic, progressive
C6-T2 more likely than C1-C5
Tetraparesis (pelvic limbs much worse -> severe ataia & paresis); thoracic limbs (short, stilted, choppy gait -> hypometria)
Neck pain in 50% of cases

62
Q

Caudal cervical spondylomyelopathy (CCSM) - diagnosis

A

Spinal radiographs
Myelogram
CT-myelogram
MRI (identifies intramedullary lesions)

63
Q

Caudal cervical spondylomyelopathy (CCSM) - treatment -> conservative

A

Surgical treatment is usually recommended
Conservative therapy:
Restricted exercise; physical therapy;anti-inflammatories (steroids are beneficial in chronic spinal cord compression)

64
Q

Caudal cervical spondylomyelopathy (CCSM) - treatment -> Surgical

A

None are very successful

  1. Ventral approach: ventral slot; distration/stabilization; disc associated CCSM
  2. Dorsal approach: dorsal laminectomy; osseous-associated CCSM; multiple ventral compressions (will deteriorate later)
65
Q

Caudal cervical spondylomyelopathy (CCSM) - treatment -> Surgical prognosis

A

Surgical treatment - good 70-90% success
Recurrence rate >= 30%
can have domino-effect after surgical stabilization & long recovery period

66
Q

Degenerative lumbosacral stenosis

(DLSS) - what is it?

A

Compression cauda equine nerve roots due to degenerative changes at L7-S1
(Cauda equine syndrome/lumbosacral malarticulation, lumbosacral instability/lumbosacral spondylopathy)

67
Q

Degenerative lumbosacral stenosis

(DLSS) - pathogenesis?

A
  1. Chronic instability
  2. IVD protrusion between L7-S1
  3. hypertrophy of the ligaments (interarcuaate-flavum) & articular facets (DJD, synovial cysts)
  4. Subluxation of L7-S1
68
Q

Degenerative lumbosacral stenosis

(DLSS) - signalment?

A
  • large-breed dogs (german shepherds)
  • middle aged to older
  • males more likely than females (?)
    LMN lesion caudal to L7 (Sciatic, pudendal, coccygeal)
69
Q

Degenerative lumbosacral stenosis

(DLSS) - clinical signs

A

MAIN: Lumbosacral pain (reluctance to rise, sit, jump; lameness; PLs tucked under abdomen; low tail carriage)
Other clinical signs often not present

70
Q

Degenerative lumbosacral stenosis

(DLSS) - what is it?

A

TBD

71
Q

How do you detect lumbo-sacral pain?

A

Dorsal palpation of the LS joint, hyperextension PLs, raising up of tail, rectal palpation of the lumbosacral joint

72
Q

What neurologic signs do you expect with a lower motor lesion caudal to L7?

A

Paraparesis (short-stride gait, not ataxia or mild)
Mild proprioceptive deficits (pelvic limbs)
Tail paralysis (low tail carriage)
Pelvic limb muscle atrophy (sciatic innervated)
Decreased withdrawal reflexes (hock)

73
Q

Degenerative lumbosacral stenosis

(DLSS) - diagnosis?

A 
Spinal radiographs
Myelogram (but spinal cord ends at L6 in large dogs)
Epidurogrpahy, discography
CT
MRI
74
Q

Degenerative lumbosacral stenosis

(DLSS) - treatment?

A

Conservative: (if first episode & intermittent pain) -> restricted exercise, anti-inflammatory with success 70%

75
Q

Degenerative lumbosacral stenosis

(DLSS) - prognosis?

A

Surgery requires >= 12 weeks of confinement
Recurrences are more likely in active working dogs.
If only pain - good to excellent
If motor deficits - good to guarded
If incontinence - guarded to poor

76
Q

Spinal pain sources

A
  1. Meninges
  2. Nerve roots
  3. Vertebrae & associated structures (periosteum, ligaments, joints, muscles)
77
Q

Differentials for low head carriage, reluctance to walk, severe neck pain, pyrexic, lethargic, praying posture

A
  1. Inflammatory / Infectious
78
Q

Dyskospondylitis

A

Infectious disease in the spine & intervertibral disk & adjacent vertebrae.
Tends to be caused by bacteria more likely than fungal
Causes neck pain, systemic issues (fever, anorexia) and uncommonly neurological deficits
Can be diagnosed on spinal rads (CT/MRI)
Treatment is antibiotics (anti fungal, analgesics)

79
Q

Steroid-responsive meningitis-

arteritis (SRMA) - what is it? signalment? diagnosis? treatment? prognosis?

A

A non-infectious, immune-mediated disease causing neutrophylic pleocytosis in the CSF, neck pain, pyrexia, lethargy, anorexia that can be diagnosed on CSF and treated with corticosteroids with a good outcome. 8-18 month-olds, boxer, beagles, bernese mountain dogs, german pointers.

80
Q

3 types of peripheral nervous system or neuromuscular diseases

A
  1. Peripheral nerve
  2. Neuromuscular junction
  3. skeletal muscle
81
Q

How do you tell if there is peripheral nerve disease?

A
  1. Reflexes are decreased or absent
  2. Reduced or absent muscle tone
  3. Neurogenic muscle atropic
    Note: CNs can be affected
82
Q

How do you tell if there is neuromuscular junction disease?

A
  1. Reflectes are normal to decreased to absent
  2. There is a diffuse clinical signs or focal
  3. There can be exercise induced weakness (MG)
    Note: CNs can be affected
    (examples are myasthenia gravis, botulism)
83
Q

How do you tell if there is muscle disease (myopathy)?

A
  1. Reflexes are usually normal
  2. Can be focal or diffuse (exercise intolerance)
  3. Severe muscle atrophy
  4. Muscle pain is possible
    Note: CNS are usually normal (masticatory muscle atrophy)
    (examples are polymyositis, masticatory muscle myositis)
84
Q

Name some types of mononeuropathies

A
  1. Traumatic (brachial plexus avulsion, radial nerve, sciatic nerve damage)
  2. Neoplastic (peripheral nerve sheath tumour (PNST))
  3. Others (Ischemic, neuromyopathy, foraminal IVDD, inflammatory - abscess, brachial plexus neuritis)

Dog & Cat Medicine and Surgery (24 decks)

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