Neuro - Pelvic Limb Conditons Flashcards by Corinne Perra

What disease occurs due to degeneration of axons and their myelin sheaths in the thoracolumbar spinal cord?

Degenerative myelopathy

How well did you know this?

Not at all

Perfectly

Degenerative myelopathy mainly affects what animals?

Large and giant breed dogs

GSD, boxer, corgi, Siberian husky, cheasapeake bay retrievers and Rhodesian ridgebacks

How well did you know this?

Not at all

Perfectly

Is degenerative myelopathy an acute or chronic onset disease

Chronic - over 6 to 20 months

How well did you know this?

Not at all

Perfectly

GSD, 8yrs old
Knuckling, dragging toes, crossing legs when walking , ataxia of pelvic limbs. UMN signs. No hyperesthesia
What would be on your DDX?

Degenerative myelopathy

Lumborosacral degenerative stenosis -> pain on tail jack test

Thoracolumbar intervertebral disk disease -> can be associated with pain due to stretching on longitudinal ligaments

Diskospondylitis -> other signs of infection (pyrexia, depression, and weight loss)

Vertebral and spinal neoplasia

Fibrocartiaginous emboli -> non painful but usually lateralizing

Vertebral fracture/luxation -> history of trauma, spinal hyperesthesia, anesthesia, decreased voluntary motor activity, crepitus, Schiff-Sherrington

How well did you know this?

Not at all

Perfectly

How do you clinically diagnose degenerative myelopathy??

Signs
Exclusion of inflammatory and compressive causes
Myelin based protein

How well did you know this?

Not at all

Perfectly

What is the treatment for degenerative myelopathy?

None

Good nursing care and intensive physiotherapy can give the animal a few more months

How well did you know this?

Not at all

Perfectly

What disease results from an instability of th L7/S1 area and can cause spinal cord compression?

Lumbosacral degenerative stenosis/Lumbosacral malarticuation-malformation(instability)/ cauda equina syndrome

How well did you know this?

Not at all

Perfectly

T/F: in lumborosacral degenerative stenosis, compression of the spinal cord results in LMN signs in the femoral, sciatic, and pudendal nerves

False

Femoral nerve is spared -> retain ability to flex hip

LMN-sciatic and pudendal -> inability for flex/extend hock and urinary/fecal incontinence

How well did you know this?

Not at all

Perfectly

T/F: in lumbosacral degenerative stenosis, there is no disc degeneration, but changes in ligaments and articulation facets

True

How well did you know this?

Not at all

Perfectly

What is the signalment of dogs with cauda equina syndrome ?

Large breed dogs, especially working dogs.
GSDs and Border collies
5-8yrs

How well did you know this?

Not at all

Perfectly

Border collie 6yr old

Lumborosacral pain
Difficulty rising and negotiating stairs
Decreased extension of the hock
Flaccid tail with pain elicited on tail jack test
What is your top DDX?

Lumborosacral degenerative stenosis

How well did you know this?

Not at all

Perfectly

What tests would you do to support a suspected diagnosis of cauda equina syndrome?

Radiographs

Myelography can confirm compression, but most dogs the subarachnoid space ends and L6/L7

How well did you know this?

Not at all

Perfectly

What is the treatment for lumbosacral degenerative stenosis ???

Medical management - muscle relaxants/tramadol/pred (good results but often signs recur when exercise levels increase)

Lumbosacral dorsal laminectomy and removal of ligaments and bone generating pressure on nerves

How well did you know this?

Not at all

Perfectly

T/F:: in most breeds, there is almost complete replacement of the annulus fibrosis with fibrocartilage by 7-8yrs of age

True

How well did you know this?

Not at all

Perfectly

Dorsal displacement of the nucleus pulposus can result in stretch of the _________________ ligaments

Dorsal longitudinal

How well did you know this?

Not at all

Perfectly

What is a Hansen type 1 disc disease

Explosive extrusion of nucleus pulposus material into spinal canal

Chondrodystrophic breeds- Dashshunds, Pekingese, Welsh corgi, Beagles, Bassets, and Cocker Spaniels
And poodles

How well did you know this?

Not at all

Perfectly

What is a Hansen type 2 disc disease? What type of dogs does it occur in?

Small tears appear in he annulus fibrosis and a slow protrusion of the nucleus pulposus

Large breed dogs

How well did you know this?

Not at all

Perfectly

Why do disc protrusions rarely occur between T2 and T10?

Intercapital ligament

Spinal cord compression typically results in the sequential looks of neurological function in what order?

Conscious proprioception
Voluntary motor function and urinary/fecal continence
Superficial pain sensation
Deep pain sensation

How can intervertebral disc disease be diagnosed?

Spinal radiographs
-collapsed disc spaces with calcified material in vertebral canal

Myelography
-dye deviates around the disc

What is treatment of intervertebral disc disease dependent on?

Grade of injury
Grade 1 - hyperesthesia wout neuro defects
Grade 2- paresis but ambulatory
Grade 3- paresis but non-ambulatory
Grade 4- paralysis with deep pain intact
Grade 5- paralysis with no deep pain reflex

What is treatment option as the best outcome for intervertebral disc disease that is a grade 1-3?

Strict cage rest -2wks

Pain-> NSAIDS (not effective), Pred (effective but can cause PU/PD/PP, panting, potbelly, GI need, UTI, addisons)
-> diazepam/methocarbamol to reduce muscle spasm

PHYSIO

What treatment option has the greatest probability of success with a grade 4 intervertebral disc disease?

Surgery -90% improve
On cage rest only 50-70% recovery that is very slow

Dorsolateral hemilaminectomy and fenestration

What is the prognosis of a grad 5 intervertebral disc disease?

Very poor - severe and often irreversible SC injury
50% recover with surgery
-dorsal hemilaminectomy and durotomy

Requires intensive nursing and physio

Is there a way to prevent thoracolumbar intervertebral disc disease?

Percutaneous laser disc ablation - percutaneous placed needles at T10 to L4 Only 4% of recurrence vs 10-20%

Diskospondylitis results from???

Infection of end plates and disk | -> usually Staph intermedius, B canis, or strep

What is the usual signalment of dogs with diskospondylitis?

Large, middle-aged male dogs | More common in males due to UTI and prostatitis

What are the signs of diskospondylitis?

Hyperesthesia, fever, depression, weight loss -> disc destroyed -> replacement with osteophyte and fiberous CT -> bony proliferation causes compression to spinal cord

You suspect diskospondylitis based on clinical signs of paresis to the hindlimbs with fever and depression. What would you do to confirm your diagnosis?

Radiographs —> would see lysis, sclerosis, or spondylosis CSF—> normal Serology

Treatment of diskospondylitis ?

Antibiotics -> parenteral high dose for 5 days (bacteriocidal antibiotic that can penetrate bone) up to 54wks oral antibiotics Treat until radiographic resolution

What is the most common intramedullary tumor in dogs?

Metastatic hemangiosarcoma

What are the most common extradural neoplasias in dogs?

Osteosarcoma/chondrosarcoma/fibrosarcoma Meningioma Hemangioma

What is the most common vertebral and spinal neoplasia in cats?

Lymphoma (often seen in cats with FeLV)

Radiograph shows punched out lesions in the dorsal spinal processes of the vertebrae, what is your top DDX?

Multiple myeloma

What type of tumor would result in a myelogram where the columns become thin and diverge?

Intramedullary

What type of neoplasia will appear in a myelogram as a “golf tee” outline ?

Intradural-extramedullary

What type of neoplasm appears in a myelogram as a deviation on one side which compresses the opposing spinal column?

Extradural

What is the BEST way to diagnose an vertebral neoplasia?

CT/MRI

What is the best treatment of most vertebral neoplasias?

Resection, most recur and only prolong life by 6-12months

History of trauma, Shock PE: Spinal hyperesthesia, paresis of both hindlimbs, and crepitus What would be your top DDX and what would your next diagnostic step be?

Vertebral fracture/luxations Radiograph and myelogram -> look for misalignments

What would be your treatment for a vertebral fracture

Treat shock first -> colloids (decrease shock and inflamm in spinal cord) Pain -opioids Spinal edema -> 20% mannitol (after addressing shock and hypovolemia) Surgery decompress and stabilization -> in under 4hrs from injury and if there is a deep pain response

Radiograph shows a vertebrae with a triangular shape instead of rectangular. What is this and what breeds is it most common in??

Hemivertebrae | Bulldogs and Bostons

Manx cats have lack of development of the sacral nerve area, sometimes leading to lack of development of the pudenal nerve. What is the name of this condition?

Sacrococcygeal dysgenesis

Old dog Shaking with standing, sitting, and laying. Disappears with movment Neuro exams is normal, all reflexes intact Good strength of flexor withdrawal What is your dx ?

Old god hind limb tremors | -no treatment just cosmetic