Neurodegenerative Disease Flashcards
Define spondylosis
•Descriptive term for the production of new bone
Is spondylosis diagnostically significant?
- Usually an incidental finding
- Can cause problems if extensive, or impinging upon neural structures
- May indicate that other problems are present
Define discospondylitis
•Infectious inflammation within the intervertebral disc (abscess in the disc)
What is the clinical presentation of Discospondylitis?
–Chronic, progressive
–Pain (localisable to site)
–Variable paresis (rarely paralysis)
How do you diagnose discospondylitis?
–Radiography
- Destructive changes in vertebral body
- Loss of definition of vertebral body end plates
- May take weeks for changes to become apparent (ie radiography may be negative)
–Advanced imaging
–Culture –blood/urine
- UTI
- Bacteraemia
How can you treat discospondylitis?
–6 weeks of an appropriate antibiotic
- Hence urine/blood culture
- Broad spectrum antibiotic
–Monitor on clinical signs and radiography
What are the 2 parts of the intevertebral disc? What are they made up of?
- Annulus fibrosus
- Fibrocartilage
- Nucleus pulposus
- Collagenous protein
- Non-collagenous protein
- Proteoglycan
- Glycoproteins
What are the 2 kind of breed affected by the age related changed of intevertebral disc disease?
Chondrodystophic
- Queen Anne legs (legs with both a concave and convex component)
- Dachshund, pug, spaniels, basset, beagle, JRT …
non chondrodystrophic
What is the pathophysiology of IVDD?
Progressive changes with age within the
nucleus pulposus
• Resulting in changes in physical properties
of the disc
• In chondrodsytrophic breeds these
changes start earlier (from 1 year of age)
and differ in nature
• Degenerate – dehydrate the disc. Change
the disc to a hard rather than jelly. Which
normally shock absorbs and allows
movement. Failure of the disc
Name 2 other terms for intervertebral disc failure(4)
- Slipped disc (lay term)
- Intervertebral disc prolapse (means both of the next 2 terms)
- Intervertebral disc extrusion
- Intervertebral disc protrusion
What are the incidences of:
A) Type 1 disc? Why?
B) Type 2 disc?
A) Type I discs: Chondrodystrophic breeds
Dachshund breed incidence 10%
(62% in some families)
Prone to type one! Because the way they degenerate the NP degeerates and can calcify
B) Type II discs: non-chondrodystrophic breeds
How can we diagnose disc extrusion?
•Clinical picture
–Compress spinal cord and you will see paresis. The severity of compression will decide the clinical signs
–Extrusion – depends how aggressive it happens. Can get oedema and brusining in S. Depend how much nucleus comes out? Do we just bruise or compress?
–PAIN!!!!!+/- paresis +/- paralysis
•Radiography
–Pretty useless doesn’t give too much info just its there
•Advanced imaging
- Myelography
- CT
- MRI
What are the clinical presentations of disc extrusion?
E.g. acut? Chronic? Progess? Stable?
•Acute vs Chronic
–Acute – explode
–Chronic – degeneration
•Progressive vs stable
–Progress if it will continue to buldge
–Stable – once extruded it will stay there
•Pain to ataxia to paralysis
–PAIN IS MOST COMMON
How do you treat acute pathology:
A) Compression?
B) Concussion?
Compression – relieve by removing the compression agent
Concussion - leave allow bruising to go down
How long does spinal cord pathophysiology continue for?
•Pathology continues over 24-48 hours following acute concussive injury
What can we do for conservative therapy in disc extrusion?
How long for?
- Cage rest
- Bladder management
- Good nursing
- Physiotherapy
- Analgesia
- May need to continue for 4 weeks, but should see some improvement within 2 weeks
Should we give steroids to acute spinal injury?
What are the signs of cervical IVDD?
all 4 legs affected
What are the signs of thoracolumbar IVDD?
Hindlimbs affected
What is the progression of CDRM/DM? When does it happen? Who does it happen in?
Chronic degenerative radiculomyelopathy (CDRM) Non-painful
Degenerative myelopathy (DM)
- Progressive degenerative pathology affecting the spinal cord. TL then progresses to the C region.
- Commonest in the aged GSD
- 6-9 years of age. 9 months from when they go wobbly to when they get PTS.
- Clinical picture of progressive hindlimb ataxia–> paresis and eventually they become non-ambulatory
- Become non-ambulatory
- Eventually affects forelimbs
- 9 month progression
- Diagnosis by exclusion
- (? Over diagnosed)
- No effective treatment
- Some palliation with physiotherapy meaning they can walk for longer so slows down clinical picture not the pathological process
- Now DNA genetic test becoming available but not diagnostic
- Common d/dx is chronic protrusion of disc.
What are the signs of CDRM/DM?
- Clinical picture of progressive hindlimb ataxia
- Become non-ambulatory
- Eventually affects forelimbs
–Then affects respiratory
•9 month progression
How can we diagnose CDRM/DM?
By exclusion common ddx is chronic disc protusion
How can we treat CDRM/DM?
- No effective treatment
- Some palliation with physiotherapy
What is a differential of CDRM/DM? How do we distinguish?
•Protusive IDDV is a DDx
–Not uncommon to have 5 protrusive disc so the only confirmation is surgery which can make then worse
How can we treat age related brain atrophy?
•Dietary alteration
–Hills BD
–Aktivait
- Drug therapy – selegiline
- Treatment combined with behavioural therapy
What happens with lysosomal storage disorders?
- A diverse group of inherited disorders of metabolism
- Enzyme deficiencies within specific intracellular metabolic pathways
- All the metabolites cant go to the step that is blocked and cant go alternative path so will accumulate. Only thing they can do is put in lysosome. Eventually so many.
- Result in the accumulation of abnormal metabolites within cells which eventually becomes toxic
- Manifest in cells which cant replicate themselves. E.g. neurones and there are no ways to regenerate
L-2-hydroxyglutaric aciduria:
A) How does a dog get it?
B) What are the signs?
C) How can we eradicate?
D) Where is it common?
A) Inherit
B) Progressive mental retardation seizures tremor or stiffness at exercise
C) DNA testing and breeding
D) Staffie
What is the problem here?
Radiographic appearance
L6-L7 L7-S1
Bridge of bone joining
What is the issue?
Lost end plate definition
Something is destroying this
Neoplasia Vs infection
Not neoplasia – Bone based neoplasia DOESN’T cross the joint. Has to metastasis. So destruction of the adjacent end plate cannot. Destroy end plate think neoplasia. Destro 2 adjacent neoplasia
What can be seen here?
Extrusion – extrude nuclear pulposus out – compressing the spinal cord
What is the issue here?
Protrusion (tread on doughnut) – buldges. Firbous tissue
What do these show in terms of hanen classification?
A) Type 1 - extrusion
B) Normal
C) Type 2 - protrusion
Where do type 1 and type 2 IVDDs occur?
