Neuro Flashcards
Clinical signs of kissing spines
- Pain on palpation
- Poor muscling
- Abnormal dynamic response
- Resentment of ridden exercise
- Poor canter
Signs of dorsal spinous process impingement on Xray
Kissing spins
Withers have narrow/no spaces in between them
Override==> coalesce and bony remodelling too
DSPs management
- Local injection of corticosteroids + rehabilitation programme (strengthen core, water treadmill, equiband)
- Interspinous ligament desmotomy (can be back in work quickly (good for young TBs who can’t afford to have time off)
- Subtotal (cranial wedge) ostectomy. Invasive but better outcomes
what other structure might be involved in DSP? and how to manage
Articular joint processes (only in cervical region)
Manage: Corticosteroid injections
signs of sacroiliac disease
- Can buck under saddle
- Becomes disunited at canter
- Has poor hind limb engagement
- Occasionally has overt lameness
how to block scare iliac joint
- Inject local into the sacroiliac joint bilaterally
- Observe the horse ridden before and after blocking
Risks:
- SIJ close to important structures
- Inadvertent block of the cranial gluteal nerve recumbent for 3-4 hours
tx for sacro iliac disease
Regional medications
The joint: About the size of a 50p with ~3ml of synovial fluid = tiny
Injection technique:
- Needles are 12-20cm long
- Injectate is 10-20mls on each side… very rarely injecting the actual joint, more the region
how does Nuclear Scintigraphy (Bone scan) work
- Technetium-99 bonded to methylene diphosphate
- MDP binds to hydroxyapatite crystals during osteoblastic activity in bones
- TC emits radiation as it decays
o The of uptake determined by bone turnover
o Damage areas of the skeleton or areas trying to heal will take up more MDP and emit more radiation
what To do to a horse before and after bone scan
delivered in led tube by special courier just before
Exercised + rugged just prior = vasodilation MDP goes to extremities.
Secreted in urine so cover legs to prevent splashing
isolate for 36-48 hours as excreted in urine
4 examination steps for poor performance
Observe ridden
Palpation: of neck and epaxial muscles and sacroiliac region
- Assess muscle mass, tone, symmetry and look for pain
- Pressure either side of tail base = should be no response
Baited stretches
Sternal lift (sustained pressure = should see dorsal flexion)
why can poor performance localise to the tarsal region be a bother
- Suspensory ligament and tarsometatarsal joint usually cause of lameness here
- Image to differentiate (Suspensory inserts just below tarsus)
3 manifestations of cervical spine disease
- Neck pain/dysfunction
o Reduced range of motion with baited stretches
o Changes in posture
o Reduced muscle mass - Forelimb lameness
o Outside limb lameness when circling. Either
o 1: Muscle dysfunction: loss of muscle I the area involved in forelimb protraction (Brachiocephalicus particularly)
o 2: Radiculopathy: Neuropathic pain causing lameness due to compression of nerve roots (joint narrows to compress intervertebral foramen) - Ataxia – cervical stenotic myelopathy (compression of the whole cord)
signs of the 3 main ataxia presentations
Spinal ataxia: Proprioceptive deficits
- Crossing, abduction, circumduction, knuckling (ascending pathways)
- Foot dragging, stumbling (descending pathways)
Vestibular ataxia: Head tilt, leaning, falling to one side, wide base stance
Cerebellar ataxia:
- Loss of modulatory effect of cerebellum
- Wide base stance
- No proprioceptive deficits
- No weakness
mayhem scale of ataxia grading
- Grade 1 – abnormalities are not consistent, present in only one part of the neurological examination
- Grade 2 – abnormalities are consistent in all parts of the neurological examination but are mild
- Grade 3 – abnormalities are consistent and moderate in all parts of the neurological exam
- Grade 4 – Truncal sway is evident when the horse is stood still, signs at walk are likely severe
- Grade 5 – The horse is recumbent
causes of ataxia with normal mentation
- Spinal ataxia (CVCM, EHV, EPM, vitamin E related)
- Head shaking
- Sleep-deprivation
- Shivers
causes of abnormal mentation
will have cerebral dysfunction and forebrain disease
Viral encephalitides EEE/WEE/VE/WNV/ Borna virus/ RAbies
head trauma
Hepatic encephalaopathy
Leukoencephalomalacia (or however you try pronounce it)
cause and signs of Cervical Vertebral Compressive Myelopathy (CVCM)
= Wobbler’s syndrome
Malformation of spine causing compression on spinal cord
- Developmental condition in well-fed foals and young horses (rapid growth, dietary imbalance, genetic)
Signs:
- Ataxia - Moderate to severe
- Weakness
- Generally symmetrical deficits
- Pelvic limbs more effected
- Truncal sway, crossing and interferences when circling
- Normal cranial nerves
dx and tx of Wobblers
Radiographs show compression of cord
Tx:
Young horses <12months
- NSAIDs ± Steroids (acute phase)
- Diet: Limit overnutrition (protein and/or starch)
Adult horses
- NSAIDs ± Steroids
- Mesotherapy and exercises
- Intra-articular facet joint injection (OA)
- Surgical - Ventral interbody vertebral fusion
patho and signs of EHV1 myeloencephalopathy
- Vasculitis of blood vessels in CNS ==> neuro signs
signs:
- previous respiratory disease
- fever
- symmetrical ataxia and weakness
- Also incontinence, poor anal tone
dx and tx of EHV1
PCR: NP swab or blood
Serology: Paired or complement fixation if unvaccinated
Tx:
- supportive care (anti-inflammatory, IVFT)
- Prevent spread (isolate, movement restrictions)
- Valacyclovir
- steroids to treat brain inflammation
patho and signs of Equine protozoal myeloencephalopathy
- Sarcocystis neurona and Neospora hughesi
- Migration of schizonts and merozoites to CNS = direct neurone damage
- USA and South America
- Ingestion of contaminated feed: concs/hay/ grass
signs:
- Any possible neurological sign
- Asymmetric ataxia with/without cranial nerve deficits (VIII, VII, X)
- Weakness (mostly pelvic limbs) and muscle atrophy (gluteus, biceps femoris, epaxial musculature)
Dx and Tx of Equine protozoal myeloencephalopathy
Challening
clinical signs and area with opossums
Tx:
Pyrimethamine and sulfadiazine - 90 days treatment
Diclazuril/ponazuril - 60 days treatment
What are the two vitamin E related ataxias
Equine degenerative myeloencephalopathy
- inherited in young horses
- insidious onset of symmetrical ataxia and paresis
Equine motor neurone disease
- acquired and progressive. triggered by VE deficiency (need green forage!)
- Generalised weakness, muscle fascinations, sweating, muscle atrophy
Dx and Tx of the vitamin e ones
Low vit E in blood!
Also for motor neurone: confirmatory is tailed muscle biopsy to see atrophy of fibres
Supplementation! especially in dams during pregnancy
