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Neurology > Lecture: Myelopathies > Flashcards

Lecture: Myelopathies Flashcards

1
Q

Number of Vertebrae

A
  • 7 cervical
  • 13 thoracic
  • 7 lumbar
  • 3 sacral
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2
Q

Spinal Cord Segments

A
  • 8 cervical
  • 13 thoracic
  • 7 lumbar
  • 3 sacral
  • 5 caudal
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3
Q

Anatomy

Dorsal funiculus (DF)

A

Ascending tracts for proprioception and nociception

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4
Q

Anatomy

Lateral funiculus

A

Upper motor nuron tracts facilitory to limb flexors and inhibitory to extensors.

Some ascending sensory tracts.

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5
Q

Anatomy

Ventral funiculus

A

Upper motor neuron tracts facilitory to extensors.

Inhibitory to flexors.

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6
Q

Upper Motor Neurons

A
  • Originate in brain and control motor activity
  • Stimulate or inhibit neurons that innevate muscles
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7
Q

UMN signs when lesions affect descending motor pathways

A
  • Paresis, paralysis, postural reaction deficits, ataxia
  • Hypertonus, spasticity (lack of inhibition)
  • Hyperreflexia
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8
Q

Lower Motor Neurons

A

Directly innervate the muscles

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9
Q

LMN signs when lesions affect ventral horn of spinal cord

A
  • Flaccid paresis/paralysis
  • Hyporeflexia
  • Neurogenic muscle atrophy (rapid)
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10
Q

Important segments

Horner’s syndrome

A
  • Sympathetic fibers at level of T1-T3
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11
Q

Important segments

Phrenic nerve

A
  • C5-C7
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12
Q

Important Segments

Cutaneous trunci (Panniculus)

A

Lateral thoracic nerve: C8-T1

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13
Q

Lower motor neuron areas of clinical importance

A
  • Cervical intumescence (C6-T2)
  • Lumbosacral Intumescence (L4-S3)
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14
Q

Clinical Signs of Spinal Cord Disease

A
  1. Paresis/plegia
  2. Proprioceptive deficits (ipsilateral)
  3. Proprioceptive ataxia
  4. Loss of spinal refexes depending on location
  5. Abnormal panniculus depending on location
  6. Muscle atrophy
  7. +/- spinal pain
  8. Micturation abnormalities
  9. Respirator difficulty in severe lesions
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15
Q

Dz affectly spinal cord only won’t cause

A
  1. Change in mentation/attitude
  2. Cranial nerve deficits
  3. Seizures
  4. Vestibular signs
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16
Q

Specific DX work up for Spinal cord disease

A
  • +/- spinal rads
  • Advanced imaging (Myelogram, MRI, CT)
  • +/- CSF analysis
  • Infectious dz testing
  • Electrodiagnostics (EMG, nerve conduction)
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17
Q

Degenerative neuropathies

A
  1. IVDD
  2. Degenerative Myelopathy
  3. Cervical Spondylomyelopathy (CSM)
18
Q

IVDD Types

A
  • Hansen Type 1: Nucleus propulsion extrusion
    • Chondrodystrophic breeds
  • Hansen Type 2: Annulus fibrosis protrusion
    • Non-chondrodystrophic breeds
  • Hansen Type 3: Traumatic disc
19
Q

IVDD imaging

MRI

CT

A
  • MRI: best way to assess spinal cord
  • CT adequate for visualizing extruded mineralized disc material
    • may need myelogram
20
Q

Degenerative Myelopathy

A
  • Slowly progressive (6-12 months)
    • typically starts after 5 years of age
  • Begins as T3-L3 disease
  • GSD posterchild
21
Q

Degenerative Myelopathy

CS

A
  • Proprioceptive ataxia and paraparesis
  • Proprioceptive deficits in pelvic limbs
  • Urinary/fecal incontinence in late stages
  • Can affect thoracic limbs, animal often euthanized before this
22
Q

DM

DX

A
  • RULE OUT DX
    • MRI rules out compressive dz
    • Electrodiagnosis may show denervation
    • SOD-1 gene mutation (Blood test) ONLY SUPPORTIVE
23
Q

DM

TX

A
  • None
  • Physical therapy may prolong function
24
Q

Cervical Spondylomyelopathy (CSM)

WOBBLERS

A
  • Disc-Associated
    • disc protrusion compresses spinal cord
    • Dobermans, Weimeraner
  • Osseous-Associated
    • Vertebral malformation/malarticulation, ligamentous hypertropy
    • Large and giant breed dogs, horses

*two engine gate

*medical vs surgical management

25
Q

Anomalous myelopathies

A
  1. Atlanto-axial instability
  2. Vertebral Malformations
  3. Syringomyelia
26
Q

Atlanto-axial instability

A
  • odontoid (dens) hypoplasia/aplasia
  • abnormal ligamentous support of dens
  • young, toy-breed dogs
  • sx stabilization usually required
27
Q

Vertebral malformations

A
  • FRENCH BULLDOGS, scretail
  • hemi, butterfly, wedge, block vertebrae
  • +/- clinical signs
  • often incidental findings
28
Q

Syringomyelia

About

A
  • Fluid dilatation within the spinal cord outside the central canal.
    • May or may not communication with central canal
  • Often secondary to Caudal Occipital Malformation syndrome (COMS)
    • Cavalier King Charles
    • Mechanism unknown
29
Q

Syringomyelia

CS

TX

A
  • CS:
    • cervical myelopathy
    • phantom scratching at neck/ears
    • pain
  • TX
    • reducing CSF production
    • Pain management
30
Q

Neoplasia

Spinal cord tumors

A
  • Meningioma
  • Glioma
  • Lymphoma
  • Nerve sheath tumors
31
Q

Neoplasia

vertebral tumors

A
  • osteosarcoma
  • chondrosarcoma
  • fibrosarcoma
  • myeloma
32
Q

Neoplasia

CS

DX

TX

Prognosis

A
  • CS
    • variable
  • DX
    • difficult (dangerous to sample)
  • TX options
    • palliative care
    • surgical debulking
    • radiation therapy
  • Prognosis: typically guarded
33
Q

Inflammatory

Non-infectious myelitis/meningomyelitis

A
  • Probs auto-immune
  • TX: immuno-suppressive medications
  • Young to middle aged terriers and small breed dogs
34
Q

Inflammatory

Steroid responsive Meningitis/Arteritis

A
  • Common aseptic inflammatory disease
  • SEVERE cervical pain
  • Neutrophilic pleocytosis is hallmark
  • +/- Leukocytosis & fever
  • young (6-18mo) boxers, beagles, large/giant breeds
35
Q

Infectious myelopathies

A
  • Diskospondylitis
  • Infectious myelitis/meningomyelitis
36
Q

Diskospondylitis

About

DX

TX

Prognosis

A
  • Infection of intervertebral disk and adjacent vertebral endplates
    • Staph, Strep, E. Coli, Brucella
  • presumptive dx with plain film rads
  • tx: cephalosporins, sulfas
    • long-term tx
  • good prognosis
37
Q

Infectious myelitis/meningomyelitis

A
  • Very sick, painful patient, rapidly progressive
  • Organisms
    • bacteria rare
      • hematogenous spread via innoculating trauma
    • Viral
      • distemper, coronavirus (FIP)
    • Fungal
      • cryptococcus
    • Protozoa
      • neospora, toxoplasma
    • Rickettsiae (rare)
      • Ehrlichia, RMSF
38
Q

Trauma myelopathy

A
  • Vertebral fractures
  • Brachial plexus avulsion
  • Penetrating wounds
39
Q

Toxin myelopathy

A
  • Tetanospasmin toxin from Clostridium tetani
    • acts at level of spinal cord
    • inhibits release of GABA by Renshaw cells
    • causes skeletal muscle rigidity
40
Q

Vascular myelopathy

A
  • Fibrocartilagenous Embolic Myelopathy (FCEM)
    • embolism of small piece of cartilage into vessel supplying spinal cord
    • Mechanism unknown
    • typically large/giant breed dogs, also mini schnauzers
    • acute onset of signs, not typically progressive
    • spinal infarct may be visualized on MRI
    • Not surgical
    • variable recovery rate

Neurology (9 decks)

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