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Neurosurgery > Medical conditions > Flashcards

Medical conditions Flashcards

1
Q

What does the DAMNIT-V pneumonic for spinal cord injury stand for?

A

Degenerative
Anomalous
Metabolic
Neoplastic
Inflammatory/infectious
Traumatic
Vascular

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2
Q

Describe different spinal cord disorders present based on their onset, progression and symmetry.

A
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3
Q

What are the two locations for collection of CSF?

A
  1. Cerebellomedullary cistern.
  2. Lumbar subarachnoid space.

No more than 1ml of CSF should be collected per 5 kg of body weight.

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4
Q

In what direction does CSF flow?

A

Rostrocaudal (ideally CSF collection should be caudal to the suspected lesion).

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5
Q

Are CSF abnormalities specific for certain neurologic conditions?

A

No. CSF abnormalities are sensitive for detection of disease, but do not definitively delineate the cause.

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6
Q

What is the location of CSF collection from the cerebellomedullary cistern?

A

Intersection of lines between the external occipital protuberance and spinous process of C2, along the cranial aspect of the wings of the atlas.

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7
Q

What is the site for collection of CSF at the lumbar subarachnoid spacee?

A

L5/L6 in dogs, L6/L7 in cats.

At this location the cord has typically tapered to the conus medullaris and is less likely to be damaged.

Note: the subarachnoid space rarely extends to the lumbosacral articulation in dogs.

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8
Q

What are the normal cell counts and total protein values for CSF of the dog and cat?

A

Cell count: 0-5 x 10^9/L
Protein: <25 mg/dL from the cerebellomedullary cistern, <45 mg/dL from the lumbar cistern.

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9
Q

What additional testing may be beneficial on the CSF (aside from protein and cell count)?

A
  1. Culture.
  2. Serology (can compare serum to CSF IgG levels to determine location of infection).
  3. PCR (may increase the chances of identifying an infectious cause when combined with serology).
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10
Q

Can myelography differentiate between extradural and intradural lesions?

A

Yes, but can be difficulty to differentiate between intradural-extramedullary and intramedullary lesions.

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11
Q

What is degenerative myelopathy?

A

An axonopathy that predominantly affects the lateral and ventral funiculi of the white matter of the spinal cord. The axonopathy is accompanied by demyelination and astrogliosis.

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12
Q

What is the most common neurolocalization of patients with degenerative myelopathy?

A

T3-L3.

Late in the disease may progress to urinary and fecal incontinence, thoracic limb involvement, and rarely LMN of the pelvic limbs.

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13
Q

What is the genetic risk factor for development of degenerative myelopathy?

A

Missense mutation in the SOD1 gene.

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14
Q

How is degenerative myelopathy diagnosed?

A

Exclusion of other disorders by imaging, CSF analysis, and the results of testing for the SOD1 mutation.

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15
Q

What treatments are available for degenerative myelopathy?

A

None. Progression usually results in nonambulatory status by 6-9 months.

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16
Q

What are the types of meningomyelitis?

A
  1. Idiopathic.
    a. Steroid responsive meningitis arteritis.
    b. Granulomatous meningoencephalomyelitis.
  2. Infectious meningomyelitis.
    a. Viral meningomyelitis (Canine distemper, FIP)
    b. Protozoal.
    d. Bacterial.
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17
Q

Are infectious or idiopathic causes of meningomyelitis more common in the cat?

A

Infectious causes more common in the cat.

Idiopathic and immune mediated disease is more common in the dog.

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18
Q

What are the two forms of SRMA?

A
  1. Acute (or classic) form: hyperasthesia, cervical rigidity, stiff gait.
  2. Chronic form: meningeal fibrosis results in secondary hydrocephalus or ischemia.
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19
Q

Does SRMA more commonly affect old or young dogs?

A

Young. Age of onset typically 6-18 months.

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20
Q

How is SRMA diagnosed?

A

CSF, MRI, serum/CSF IgA levels

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21
Q

What can be used to monitor response to therapy when treating SRMA?

A

Protein C levels.

Elevated IgA levels in both CSF and serum are a common finding, but they remain elevated throughout the disease making them less useful in monitoring response to therapy.

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22
Q

What is the etiopathogenesis of SRMA?

A

Unknown.

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23
Q

What is the treatment for SRMA?

A

Prednisone or prednisolone +/- azathioprine. Slowly tapering dose based on clinical signs +/- CSF analysis.

24
Q

How does GME typically present?

A

Acute-onset, progressive, focal-to-multifocal neurologic disease.

Females and toy breeds are overrepresented. Mean age of 55 months.

25
Q

What are the three forms of GME?

A
  1. Disseminated (most common): acute onset of rapidly progressive, multifocal, neurologic signs.
  2. Focal: slowly progressive, can mimic neoplastic disease.
  3. Ocular: presents as blindness.
26
Q

What is the etiopathogenesis of GME?

A

Unknown. Seems to predominantly affect the white matter of the cerebrum, caudal brainstem, cervical spinal cord, and meninges.

27
Q

How is GME diagnosed?

A

CSF and MRI. Often definitive antemortem diagnosis may not be possible (may be diagnosed as meningoencephalomyelitis of unknown origin [MUE]).

28
Q

What is the treatment for GME?

A

Corticosteroids +/- cytosine arabinoside and cyclosporine (once results for PCR and serology testing of CSF have returned negative).

Prognosis is often poor without aggressive immunosuppression.

29
Q

What testing should be performed in cases of suspected infectious meningoencephalomyelitis?

A
30
Q

What is the treatment for canine distemper virus?

A

Supportive care and antimicrobials to treat secondary infections. Prognosis is guarded.

31
Q

What form of FIP is most frequently associated with CNS signs?

A

The dry form.

32
Q

What are the two clinical neurologic manifestations of toxoplasma gondii or neospora infection in the dog?

A
  1. Meningoencephalomyelitis.
  2. Myositis-polyradiculoneuritis (dogs less than 6 months).
33
Q

What titer results are indicative of an active infection with toxoplasma or neospora?

A

IgM titer greater than 1:64, four-fold increase in titers on serial testing.

34
Q

What is the treatment for toxoplasma gondii (dog and cat) or neospora (dog) infection?

A

Clindamycin.

35
Q

What is epidural empyema?

A

Accumulation of purulent material within the vertebral canal.

36
Q

What diagnostics should be performed in the work-up of bacterial meningitis?

A

CSF (cytology and culture, PCR), urine and blood culture, MRI.

37
Q

What is the treatment for bacterial meningitis?

A
  1. Antimicrobial therapy (must cross the blood-brain barrier).
  2. Laminectomy may be required for drainage and lavage in some instances.
38
Q

What is discospondylitis?

A

Bacterial or fungal infection of the intervertebral disc and contiguous vertebrae.

39
Q

Does discospondylitis more commonly affect males or females?

A

Males (young to middle-aged adult dogs).

40
Q

What are the main clinical signs associated with discospondylitis?

A

Hyperasthesia. Affected animals may also be depressed, anorexic, febrile, and reluctant to jump.

Proliferation of inflammatory tissues can sometimes result in overt neurologic signs.

41
Q

What is the most likely source of discospondylitis?

A

Hematogenous or lymphatic spread.

UTIs are the most common concurrent condition. Other potential sources of infection include; prostatic abscessation, endocarditis, pyometra, pneumonia, periodontal disease.

42
Q

Why are vertebral end plates thought to be predominantly affected by discospondylitis?

A

Rich vascular supply with dead end capillary loops that may function to trap circulating bacteria.

Infection of adjacent intervertebral discs may be due to microtrauma and associated neovascularization of the intervertebral disc.

43
Q

What organisms are most frequently isolated in dogs with discospondylitis?

A

Staph and E.coli.

German Shepherd dogs (particularly female) seem predisposed to fungal discospondylitis.

44
Q

What diagnostics should be performed in a dog with suspected discospondylitis?

A
  1. Radiographs, CT/MRI (more sensitive).
  2. Percutaneous aspiration of the disc to identify the causative agent (successful in 60% of cases) +/- blood and urine culture (successful in 40%).

Efforts to identify the underlying cause should include:
1) Echocardiography, thoracic radiography, B. canis testing +/- fungal serology or culture).

45
Q

What are common sites for discospondylitis?

A

Caudal cervical, mid thoracic, lumbosacral.

46
Q

What are some DDx for discospondylitis?

A
47
Q

What is the treatment for discospondylitis?

A
  1. Eight weeks of empiric (first generation cephalosporin) or culture guided antimicrobial therapy.
  2. Analgesia (NSAIDs, opioids, tramadol).
  3. Surgical fixation if vertebral instability results.
48
Q

What is the most common cause of acute spinal cord ischemia/infarction?

A

FCE.

Can closely mimic ANNPE and feline ischemic myelopathy both in clinical presentation and on MRI.

49
Q

What is the cause of FCE?

A

Embolization of fibrocartilaginous material within the meningeal, spinal cord or vertebral blood vessels.

Causes peracute to acute spinal cord ischemia/infarction.

50
Q

What is the most common signalment of patients affected by FCE?

A

Young, adult, midsized to large breed dogs.

51
Q

What is the common clinical presentation for patients with FCE?

A

Peracute to acute, little progression, non-painful. Often follows a history of mild trauma or vigorous exercise.

52
Q

What are some mechanisms by which an FCE is thought to gain entry to the spinal cord vasculature?

A

1) Direct penetration from the nucleus pulposus.
2) Remnant vessels within the nucleus pulposus.
3) Penetration of the vertebral bone marrow with subsequent migration to the vasculature.
4) Neovascularization of a degenerative disc.

53
Q

What diagnostics should be performed for work-up of suspected FCE?

A

1) CSF: mild pleocytosis may be present.

2) MRI: hyperintensity on T2W fast spin echo sequences. Although some dogs (21%) may have no changes on MRI.

54
Q

What is the prognosis for FCE?

A

Depends on lesion severity.

Worse prognosis for:
1) Lesions affecting the lumbar or cervical intumescence.
2) Lesion to vertebra length ratios >2 (60% successful outcome, compared to 100% for <2).
3) When no improvement seen in 2 weeks.

Maximum recovery can take 4 months.

55
Q

What are some DDx for FCE?

A
56
Q
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57
Q
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Neurosurgery (11 decks)

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