Neuro pt.2 Flashcards
spinal cord
How do we classify myelopathies
- across the diameter of the spinal cord (partial or transverse)
- along the length of neuroaxis (focal, multifocal, diffuse)
General rules of spinal disease
- Neuro signs are similar regardless of underlying causes
2. severity of signs variable w/in a region of localization
6 parts of the neuro exam
- mentation
- cranial nerves
- gait
- postural rxns
- segmental reflexes
- 3 P’s (palpation, painfulness, pain perception)
T/F: mentation and cranial nerves should be normal with a myelopathy
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Intervertebral Disk Disease
- the most common spinal cord disorder
Function of a normal intervertebral disk
- compression resistance for the vertebrae
- maintaining disk space between vertebrae
Anatomy of a normal IVD (3 parts)
- annulus fibrosis –> annular, fibrous ring that surrounds the pulp and serves to keep the pulp in place. comprised of lamelae to provide strength
- nucleus pulposus –> distributes biomechanical load.. the jelly filling
- cartilagenous endplates –> supplies nutrients to the annulus and nucleus
Two types of IVDD
- Type 1 = Chondroid degeneration –> extrusion
2. Type 2 = Fibroid degeneration –> protrusion
Type 1 IVDD (signalment)
- small breeds 1-6 yrs old
- large breeds any age (less common)
- cats (rare)
Type 1 IVDD
- acute onset
- can be progressive or not
- usually painful
Type 1 IVDD (clinical signs)
- pain
- paresis
- ataxia
- hyperesthesia
- incontinece
- loss of pain sensation
- lameness
Type 1 IVDD (imaging)
- narrow disc spaces
- in situ calcification
- calcification in foramen
Type 1 IVDD (Diagnosis)
- imaging via MRI (loss of disc hydration, deviation of spinal cord, loss of CSF/ epidural fat)
Type 1 IVDD (medical management) (indications, treatment, prongosis)
Indications: pain only, ambulatory, non-amb. but good motor fxn
Treatment: rest/ confinement, analgesia, NSAIDs
Prognosis: ok in not severe; recurrence common
Type 1 IVDD (Surgical management) (indications, benefits, goals, techniques)
Indications: any severe grade, rapid progression, failed medical management, severe pain
Benefits: great outcome, low recurrence rates, faster resolution of pain
Goals: decompression, control hemorrhage, disc fenestration
Techniques: hemilaminectomy, ventral slot
Type 1 IVDD ( post-op management)
- nursing care
- rehabilitation
When to refer a Type 1 IVDD
- when it’s grade 0-3 always
Type 1 IVDD (lookout for this)
- dogs w/out deep pain perception might be having a peracute decline associated w/ myelomalacia (~10-15%) which is 100% fatal
Progressive Hemorrhagic Myelomalacia
- myelomalacia = necrotic spinal cord
- Ascending/ descending form caused by severe, acute SCI w/ infarctio, ischemia, and hem. necrosis
- 100% fatal d/t resp. paralysis
Progressive Hemorrhagic Myelomalacia (Diagnosis)
- fever, inappetance, pain
- diffuse, progressing, myelopathy
- LMN signs develop above/ below
- Imaging sometimes helps
Type 2 IVDD
- fibrocartilage degeneration + torsional biomechanical stress
- separation of annular fibers
- bulging/ protrusion of annulus –> SC compression and meningeal irritation
Type 2 IVDD (Signalment)
- older, larger breed dogs (most common)
Type 2 IVDD (History)
- chronic (> 2 weeks)
- reluctance to do strenuous activity
- myelopathy (variable progression)
- +/- lameness, incontinence
Type 2 IVDD ( Clinical Signs)
- paraparesis or tetraparesis
- ataxia
- pain w/ palpation
- +/- lameness, incontinence
Type 2 IVDD (diagnosis)
- radiography (narrow disc space, end-plate sclerosis, osteophyte production, spondylosis)
- CT
- MRI (gold standard)
Type 2 IVDD (Medical treatment)
Indications: mild disease, slowly progressing, non-painful, continent
Treatments: anti-inflammatories, physical rehab, supportive care
Prognosis: variable
Type 2 IVDD (Surgical Treatment)
Indications: mod-severe myelopathy, short hx or acute onset, deterioration of signs , painful
Prognosis: good if short hx, focal lesion, pain in main finding and not at risk for degenerative myelopathy
Acute Non-compressive Nucleus Pulposus Extrusion (ANNPE)
- tear in annulus fibrosis (from high impact forces) causing extrusion of normal nucleus pulposus
- typically peracute injury (high impact injury)
ANNPE (clinical signs + diagnosis)
Clinical signs: paresis/ paralysis, ataxia, +/- LMN signs, +/- hyperesthesia
Diagnosis: MRI
ANNPE (Treatment)
- medical – crate rest, time, physical therapy
- if compressive, consider surgery (ventral slot or hemilaminectomy)
ANNPE (prognosis)
- intact nociception = good
T/F: all animals w/ CSM (Cervical Spondylomyelopathy) have some degree of stenosis.
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Disc-Associated CSM
- 1* affecting C5-7
- mostly ventral compression (can be assymetric)
- Risk Factor: vertebral canal stenosis
Disc-Associated CSM (Treatment)
Medical: - milder cases, cost restraint - crate rest, analgesics, NSAIDs, physical rehab - guarded prognosis Surgical: - severe pain, focal lesion - decompressive surgery - good prognosis
Osseous-Associated CSM
- growth malformation of vertebrae (enlarged articular facets, bony proliferation)
- primarily the caudal cervical vertebrae
- typically dorso-lateral compression
OA-CSM (typical exam findings)
- cervical pain, ataxia, tetraparesis, +/- hypermetria
OA-CSM (progression)
- pelvic limbs hit first
- often acute decline
OA-CSM (Imaging)
MRI:
– evaluate spinal cord parenchyma = increased intensity w/in spinal cord indicates chronicity
T/F: the treatment for OA-CSM is the same as DA-CSM
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Atlanto-axial Instability (AAI)
instability of C1-2 joint leading to injury of the cranial cervical spinal cord
AAI (pathogenesis)
- malformation of C1-2
- malformation of dens
- ligamentous abnormalities
- trauma
AAI (Signalment)
- toy/ mini breeds
AAI (Clinical Signs)
- cervical pain
- tetraparesis or palegia
- brainstem signs
- seizure-like episodes
AAI (Treatment)
Medical:
- Indications: immature bones, v small patient, resolving mild signs, cost. concerns
- Tx: splinting/ bandaging, medication, crate rest
Surgery:
- Indications: mod-severe neuro defects, recurrent cervical pain, unresponsive to medical tx
- Tx: Dorsal or ventral approach
GME (Progression, Diagnosis)
Progression: acute, progressive, may wax and wane, most commonly encephalitis, can cause myelitis
Diagnosis: MRI, CSF (pleocytosis, rule out infection), histopath
GME (Treatment, Prognosis)
Treatment: immune suppression (steroids, pred, dex)
Prognosis:
short term - good/ fair
long term - guarded
SRMA (Steroid Responsive Meningitis Arteritis)
- young, large breed dogs
- progression: acute/ progressive, mainly cervical pain
- Clinical sings: no neuro deficits, cervical pain
SRMA (diagnosis)
- rule out other dz via CBC/ Chem/ Rads/ US/ w/ n MRI
- CSF analysis - neutrophilic pleocytosis, high protein
SRMA (treatment)
- immune suppression
Meningitis/ Myelitis (clinical signs and diagnosis)
Clinical Signs: acute onset pain/ hyerpesthesia, +/- myelopathy or CN signs
Diagnosis: MRI, CSF, culture (blood, urine, CSF, tissue)
Meningitis/ Myelitis (CSF analysis findings)
- neutrophilic pleocytosis
- high protein, low glucose
- +/- xanthochromia