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Clinical Neuro > Myelopathies > Flashcards

Myelopathies Flashcards

1
Q

What 2 vessels are the blood supply to the spinal cord?

A
  • Dorsolateral arteries and ventral spinal arteries
  • connected by an anastomosing network with an arterial ring at each intervertebral foramen
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2
Q

What vessel is responsible for venous return from the spinal cord?

A

The ventral vertebral venous plexus

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3
Q

What is located in the dorsal funiculus of the SC?

A

Ascending tracts for proprioception and nociception

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4
Q

What is located in the lateral funiculus of the SC?

A

UMN tracts facilitory to limb flexors and inhibitory to extensor; some ascending sensory tracts

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5
Q

What is located in the ventral funiculus of the SC?

A

UMN tracts facilitory to extensors and inhibitory to flexors

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6
Q

What is an upper motor neuron?

A
  • Originate in the brain and control motor activity
  • stimulate or inhibit the neurons that innervate the mm
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7
Q

What are UMN signs seen with lesions affecting the descending motor pathways?

A

Paresis, paralysis, postural reaction deficits, ataxia, hypertonus, spasticity (release of inhibition), hyperreflexia

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8
Q

What are lower motor neurons?

A

Those that directly innervate the muscles

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9
Q

What are LMN signs and when would you seen them?

A
  • flaccid paresis/paralysis, hyporeflexia, neurogenic mm atrophy (rapid)
  • Seen with lesions affecting the ventral horn of the SC
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10
Q

What are some important spinal segments to remember?

A
  • Symp fibers @ level of T1-3: Horner’s
  • Phrenic n: C5-7
  • Lateral thoracic nerve: C8-T1 - cutaneous trunci
  • Lower motor neuron areas of clinical importance:
    • Cervical intumescence (C6-T2)
    • Lumbosacral intumescence (L4-S3)
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11
Q

What are clinical signs of spinal cord disease?

A
  • Paresis (weakness) or plegia (complete paralysis) - mono, para, tetra, hemi
  • Proprioceptive deficits (ipsilateral)
  • Proprioceptive ataxia
  • Loss of spinal reflexes depending on location
  • Abnormal panniculus
  • Muscle atrophy
  • Spinal pain- not in all cases
  • Micturition abnormalities
  • Resp difficulty (severe cervical lesions - phrenic n.)
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12
Q

Disease affecting only the spinal cord will NOT cause _____

A
  • Change in mentation/attitude
  • cranial nerve deficit
  • seizures
  • vestibular signs
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13
Q

What is your diagnostic work-up for SC disease?

A
  • Obtaining thorough hx and neuro exam
  • MDB, imaging, +/- spinal radiograph
  • advanced imaging, +/- CSF analysis
  • infectious dz testing
  • electrodiagnostics
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14
Q

What does the DAMNITV scheme stand for?

A

Degenerative

Anomalous

Metabolic

Neoplastic/Nutritional

Idiopathic/Inflammatory/Infectious

Traumatic/Toxic

Vascular

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15
Q

What are your differentials for an immature/juvenile patient?

A

Trauma

Congenital malformation

Infectious

Degenerative

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16
Q

What are your differentials for an mature patient?

A

IVDD

inflammatory

FCE/Vascular

Neoplasia

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17
Q

What are your differentials for an geriatric patient?

A

IVDD

Neoplasia

Degenerative

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18
Q

What are your differentials for an chondodystrophoid patient?

A

IVDD

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19
Q

What is your differential diagnosis for an acute, non-progressive course of disease?

A

Vascular

trauma

IVDD

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20
Q

What is your differential diagnosis for an acute, progressive course of disease?

A

Trauma

IVDD

Neoplasia

Inflammatory

Infectious

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21
Q

What is your differential diagnosis for an chronic, progressive course of disease?

A

Neoplasia

degenerative

IVDD

inflammatory

infectious

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22
Q

What are examples of canine spinal diseases that fit in the DAMNITV scheme?

A

Degenerative: DM, IVDD/ANNPE

Anomoulous: Atlanto-axial instability, congenital vetebral malformations, COMs

Neoplasia: primary or metastatic

Immune/Inflammatory (GME)

Traumatic: Hemorrhage, Fracture, Luxation

Vascular: FCE, True vascular events

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23
Q

What are examples of feline spinal diseases that fit the DAMNITV scheme?

A

Cervical ventroflexion - no nuchal ligament!

D: IVDD

Neoplasia: LSA, meningioma

Immune mediated/inflammatory/Infectious: Toxo, Crypto

Trauma: Traction injury (tail pull), fracture/luxation

Vascular: hemorrhagic/ischemic infarctions

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24
Q

What spinal diseases do you see with equines?

A
  • Cervical spondylomyelopathy - “wobblers”
  • Infectious causes - EPM, EEE, WEE, VEE, EHV
  • Trauma
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25
Q

What myelopathies do pigs get?

A

IVDD, FCE, trauma

26
Q

What is the difference between the various types of IVDD?

A

Hansen 1: Chondrodystrophic breeds, nucleus propulsus extrusion

Hansen 2: non-chondrodystrophic breeds, annulus fibrosis protrusion

Type 3: high velocity/low volume (traumatic disc)

27
Q

How do you diagnose IVDD?

A

Imaging:

  • MRI - best way to assess the spinal cord
  • CT - adequate for visualizing extruded mineralized disc material
  • Myelogram
28
Q

What is the treatment for IVDD?

A

If minimally affected, okay to try STRICT CRATE REST and medical management, surgical intervention

29
Q

What is myelomalacia and how is it diagnosed and treated?

A

Ascending and descending hemorrhagic necrosis of the SC; only occurs in animal that is plegic with NO deep pain

  • CS: ascending panniculus, loss of PL reflexes, anal tone, TL paresis, loss of ventilatory function
  • Dx: No antemortem confirmatory test, imaging findings are supportive
  • NO treatment > Euthanasia
30
Q

When should you proceed to surgery on a myelopathy?

A

Treatment failure of mildly affected dogs

  • progression in 24-48hrs, progression or lack of response in 1-2 weeks of medical management
  • relapse when comes off meds
  • Cervical pain w/ ANY deficits
  • Recurrent pain, mult episodes
  • LMN deficits
  • Non-ambulatory status
31
Q

T or F: you should wait until pain perception is lost with paraplegia to perform surgery on that patient

A

False; NO reason to wait! Much greater prognosis for return to function with TL IVDD if pain perception is still present

32
Q

Describe feline IVDD

A

Extremely rare!; lumbar (L4-5) most common, mineralized discs on radiographs, very good prognosis with surgery

33
Q

Describe degenerative myelopathy

A
  • Slowly progressive disease (6-12mo)
  • begins as a T3-L3 dz
  • typically starts after the age of 5
  • affects GSD most commonly, also Boxers and Corgis
34
Q

What are clinical signs of degenerative myelopathy?

A
  • Proprioceptive ataxia and paraparesis
  • Proprioceptive deficits in pelvic limbs
  • Urinary/fecal incontinence in later stages
  • Can ultimately affect TLs, however typically animal is euthanized before this occurs
35
Q

How do you diagnose and treat degenerative myelopathy?

A
  • No definitive single dx test!
  • MRI typically normal
  • electrodiagnostics may show denervation
  • SOD-1 gene mutation (blood test) - NOT DIAGNOSTIC, just supportive

Tx: nothing definitive, physical therapy can prolong functional time a bit

36
Q

Describe cervical spondylomyelopathy (CSM) or “wobblers”

A
  • Disc-associated
    • protrusion causing cord compression, may have dynamic component
    • In Dobies, Weimeraners
  • Osseous-associated: vert malformation/malarticulation, ligamentous hypertrophy
    • large/giant breed dogs most commonly affected
    • Two-engine gait
37
Q

What is cervical spondylomyelopathy like in horses?

A

Actually discovered in horses first

  • Vertebral malformation - narrow spinal canal (thoroughbreds)
  • Ataxia, tetraparesis, proprioceptive deficits
38
Q

Describe atlanto-axial instability

A

Typically due to odontoid (dens) hypoplasia/aplasia, abnormal ligamentous support of the dens may also contribute

  • typically young, toy-breed dogs, surgical stabilization usually required
39
Q

Describe vertebral malformations and what species they are commonly found in

A
  • Hemi vert, butterfly, wedge vert, block vert
  • Presenting complaint - progressive ataxia, paresis, often non-painful
  • Often animals are asymptomatic and these are incidental findings, but can be severe enough to cause clinical signs
  • Common in Frenchies, pugs, English bulldogs, Bostons (breeding for “screw tail)
40
Q

What does medical management entail for congenital spinal malformations? Surgical?

A

Med: Strict rest, Pred, pain control PRN

Sx: decompressive sx w/ stabilization, poor prognosis

41
Q

What is the pathology of congenital spinal malformations?

A

Compression or stenosis of the canal, microinstability due to forces applied to abnormally (wedge) shaped vertebrae

42
Q

What is the novel surgical approach for congenital spinal malformations?

A
  • In-situ biological fusion
  • “strip” or irritate the periosteum and apply bone graft
  • do NOT open the canal/use implants
  • good prognosis, the younger the better > regain ambulatory ability
43
Q

What is syringomyelia?

A

Fluid dilatation within the spinal cord outside the central canal that may or may not communicate with the central canal

  • often secondary to caudal occipital malformation syndrome (COMS) > Cavies over-represented
44
Q

What are the clinical signs and treatments for syringomyelia?

A

CS: phantom scratching, pain, lameness

Tx: Gabapentin, Omeprazole, NSAID vs. Pred, Surgery (foramen magnum decompression)

45
Q

What types of tumor can affect the spinal cord?

A

Meningiomas, gliomas, lymphomas, nerve sheath tumors; may also be vertebral - osteosarcoma, chondrosarcoma, fibrosarcoma, myeloma

46
Q

What is the growth pattern of a meningioma?

A

Intra-mural, extra-medullary

47
Q

What is the growth pattern of a primary glioma?

A

Intra-medullary

48
Q

How do you diagnose and treat spinal neoplasia?

A
  • Definitive diagnosis often difficult due to danger in obtaining samples
  • Treatment options include palliative care, surgical debulking (all but intramedullary), and radiation therapy
  • Guarded to poor prognosis for all tumor types
49
Q

What types of spinal neoplasia do felines get?

A
  • Spinal cord tumors: LSA (thoracic and LS), glial (cervical), and fibrosarcoma (thoracic)
  • Vertebral column neoplasia (OSA)
  • Meninges neoplasia
  • Non-vertebral extramural neoplasia - plasma cell tumors
50
Q

Describe steroid-responsive meningitis/arthritis (SRMA)

A

A common aseptic inflammatory dz

  • Fibrinoid necrosis of vascular arterioles, commonly seen in young (6-18mo) Boxers, Beagles
  • SEVERE cervical pain
  • neutrophilic pleocytosis is hallmark
  • +/- leukocytosis and fever
  • Easy to treat! - steroids for 4-6 mo
51
Q

Describe non-infectious myelitis/meningomyelitis

A

Suspect auto-immune basis, require immune-suppressive medications; young to middle aged terriers and small breed dogs (Yorkies, Poms, Pugs)

52
Q

Describe diskospondylitis

A

Infection of the IVD and adjacent vert endplates

  • Staph, strep, E. Coil, brucella
  • Can get a presumptive diagnosis w/ plain film rads
  • Tx w/ cephalosporins, sulfas
  • Good prognosis
  • LONG term tx
53
Q

Describe infectious myelitis/meninomyelitis and most common causes

A

Typically very sick, painful patient

  • rapidly progressive
  • Bacterial- rare!
  • Viral (distempter, coronavirus- FIP)
  • Fungal (cryptococcus)
  • Protozoa (Neospora, Toxo)
  • Rickettsial (Ehrlichia, RMSF) - rare
54
Q

What are differentials for feline spinal infections?

A

FIP <2 YO

  • Bacterial myelitis
  • Crypto
  • Toxo
  • Idiopathic
  • Inflammatory
55
Q

What is your prognosis for any spinal injury contingent on?

A

Your findings in a thorough neurological exam

56
Q

What are common sources of spinal trauma?

A

Vert fractures, brachial plexus avulsion, penetrating wounds

57
Q

What type of toxin gives you spinal cord disease?

A

Tetanospasmin toxin from Clostridium tetani > inhibits release of GABA by Renshaw cells (inhibitory interneurons of spinal cords)

58
Q

Describe fibrocartilagenous emboli myelopathy (FCEM)

A
  • Embolism of small piece of cartilage (likely from an IVD) into a vessel supplying the spinal cord
  • MOA not known
  • typically large/giant breed dogs, but Mini Schnauzers also commonly affected, young to middle age
59
Q

What are the clinical signs, diagnostics, and treatment for FCEM?

A
  • Acute onset of signs (ie paralysis)
  • typically NOT progressive, usually not painful at presentation
  • Spinal infarct may be visualized on MRI
  • FECM is NOT a surgical dz! - no compression, recovery is variable
60
Q

What do you do when you have a down cat?

A
  • PL: check for pulses, then check for Doppler flow, then get paired NOVAs
  • MDB, BP, met check thorax +/- AUS
  • Prove it’s not a saddle thrombus before you send to neuro!

Clinical Neuro (7 decks)

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