Neuro-chronic progressive spinal cord disfunction Flashcards
What are 8 disorders that cause chronic progressive spinal cord disfunction?
- neoplasia
- degenerative myelopathy
- type 2 disk protrusion
- cauda equina syndrome
- cervical spondylomyelopathy (wobbler)
- intraspinal articular cysts
- arachnoid cysts
- syringomyelia/hydromelia
What animals are most often affected by spinal tumors?
large breed dogs
middle age to oldder dogs (5-6 years)
What are two spinal tumors that don’t necessarily affect older dogs?
lymphoma (any age)
neuroepitheliuma T10-L1 in young dogs
Spinal lymphoma is most common in what cats?
young (4yr) adult FeLV positive cats
What are clinical features of spinal tumors?
- related to location
- pain may be prominent with nerve root tumors, tumors involving meninges, aggressive tumors involving bone
NOT tumors of spinal cord usually
How is neoplasia diagnosed?
signalment, history, physical exam, screening blood tests, plain radiographs
What does definitive diagnosis of neoplasia usually require?
CSF analysis
diagnostic imaging
histopathologic evaluation
Whenever a neoplasm is considered as a ddx, what should be done?
a complete physical examination and systemic evaluation to look for sites of primary tumor
- fundic exam
- palpate lymph nodes
- rectal
- thoracic and abdominal radiographs
- U/S of spleen, liver, heart
- maybe lymph node aspiration, cbc, bone marrow smears
What are further diagnostics of the spinal region that may help with diagnosis of neoplasia?
- survey radiographs of affected region
- CSF analysis—tumors rarely exfoliate though
- myelography–can characterize location
- advanced imaging for more precise localization
How are spinal tumors treated?
1.surgical decompression attempts at complete tumor excision in well encapsulated tumors
feline meningiomas have good prognosis, intramedullary tumors have poor prognosis
2. chemotherapy, radiation therapy
3. corticoteroids–temporary improvement
What is degenerative myelopathy?
a degenerative disorder of the spinal cord white mater characterized by widespread myelin and axon loss
Who does degenerative myelopathy occur most frequently in?
aging
German shepherd
cardigan and pembroke welge corgies
5-14yrs
What regions are most severely affected by degenerative myelopathy?
thoracic and thoracolumbar spinal cord
What is the etiology of degenerative myelopathy?
inheritance of a genetic mutation similar to Lou Gehrigs
Why is testing for the genetic mutation involved with degenerative myelopathy not sufficient to diagnose degenerative myelopathy?
because the animal may have the mutation without having the dhsease
What are the clinical signs of degenerative myelopathy?
- slowly progressive (mo-yr)
- UMN paraparesis and ataxia of rear limbs
localization to T3-L3
How is degenerative myelopathy diagnosed?
- signalment
- slowly progressive spinal ataxia, UMN weakness in rear limbs
- systemically normal
- no spinal pain
What are differential diagnoses for degenerative myelopathy?
- neoplasia
- type II disk dz
- enlarged articular facets compressing spinal cord
- musculoskeletal dz affecting rear legs (careful neuro exam)
=diagnosis of exclusion!!
What are the results of radiography, CSF analysis, myelography/advanced imaging with degenerative myelopathy?
- normal spinal radiographs
- cytologically normal CSF
- normal myelogram or MRI
What is the treatment for degenerative myelopathy?
no treatment
exercise may be helpful
aminocaproic acid EACA
What is type II intervertebral disk disease
Fibroid degeneration of intervertebral disk, partial rupture of disk annulus and prolapse of a small amount of disk nucleus into annulus firosus
In what does is type II intervertebral disk disease seen most often?
large breed dogs German Shepherd Lab Doberman (occasionally small)
what are clinical features of type II intervertebral disk disease?
Depends on location
Thoracic: UMN rear limbs
Cervical: UMN all limbs, pelvic limbs more, maybe pain
lumbosacral: cauda equina syndrome
How is type II intervertebral disk disease diagnosed?
- slow progressive signs of spinal cord disfunction
- radiographs–may be normal, not good at localizing site
- CT/MRI important
What are radiographic signs of type II intervertebral disk disease?
- disk space narrowing
- osteophyte prouction
- end plate sclerosis
What is treatment for type II intervertebral disk disease?
- low doses of corticosteroids (short neuro improvement, not a cure)
Surgical: - ventral decompression/hemilaminactomy
What is the goal of therapy for type II intervertebral disk dz?
to stabilize the animals neurogic status (unlikely to see full recovery!)
What are intraspinal synovial cysts?
Cysts arising from the joint capsule of spinal facetal joints affected by degenerative change
Can compress spinal cord or nere roots