Neurology 2 - Conditions Involving Both Hind Limbs

Question 1

What is degenerative myelopathy

Answer 1

degenerations of axons and myelin in the thoracolumbar spinal cord, causing unilateral or bilateral paresis/paralysis

Question 2

Cause of degenerative myelopathy?

Answer 2

thought to be genetic

Question 3

Signalmet for degenerative myelopathy

Answer 3

> 8years old German Shepherds

also Chesapeake, boxer, corgi, ridgeback, poodle, Kerry blue

Question 4

Signs associated with degenerative myelopathy

Answer 4

pelvic limb: knuckling, dragging, crossing, dysmetria, ataxia
often asymmetrical
continence and pain spared
later get LMN signs

Question 5

PE findings of a dog with degenerative myelopathy

Answer 5

CP deficits, UMN signs in the hind limb (hyperreflexia, normal pain sensation), no spinal hyperesthesia

Question 6

How would you diagnose degenerative myelopathy

Answer 6

signalment, histopathology, exclusion, DNA test for superoxide dismutase 1 protein

Question 7

Treatment for degenerative myelopathy

Answer 7

none, can give supportive therapy + physio but inevitable euthanasia

Question 8

What type of disc degeneration is involved with lumbosacral degenerative stenosis?

Answer 8

type II disc degeneration

Question 9

What compresses the spinal cord in lumbosacral degenerative stenosis?

Answer 9

ventrally: annulus fibrosis
dorsally: ruptured interarcuate ligament heals by scar tissue formation (fibrosis)
osteophytes

Question 10

Which part of spinal cord is affected by lumbosacral degenerative stenosis?

Answer 10

cauda equina, L7-S1

Question 11

Signalment of lumbosacral degenerative stenosis

Answer 11

older, large breeds, working dogs

Question 12

Signs of lumbosacral degenerative stenosis

Answer 12

hunched, flaccid tail, later see incontinence, sunken hock
pseudohyperreflexia of patella reflex (no resistance from mm. on back of leg, sciatic n.)
cannot flex hock or knee (sciatic n.)
LMN of pudendal n.

Question 13

A dog comes into your clinic presenting with a hunched back. You conduct radiographs and notice a lumbosacral step as well as a transitional vertebrae. What are your treatment options?

Answer 13

This is characteristic of lumbosacral degenerative stenosis. Treat with cage rest and NSAIDs for pain. Can consider doing dorsal laminectomy +/- joint stabilization with pins

Question 14

Where do you inject contrast media for a myelogram?

Answer 14

into the CSF

Question 15

Hansen Type I and II are subcategories of?

Answer 15

Thoracolumbar intervertebral disc disease

Question 16

T/F: The nucleus pulpous appears more ventral when comparing to the vertebrae

Answer 16

False, more dorsal which is why if it prolapses it goes dorsally

Question 17

Hansen Type I thoracolumbar intervertebral disc disease

Answer 17

explosive extrusion, calcified hyalin cartilage ruptures through fibrosis and dorsal longitudinal ligaments into spinal canal hitting CS, “bullet like”
seen more in chondrodystrophic breeds

Question 18

Hansen Type II thoracolumbar intervertebral disc disease

Answer 18

Slow protrusion of annulus fibrosis into spinal cord due to continuous tear and healing by fibrosis
seen more in large dogs

Question 19

Clinical signs of Grades 1-5 thoracolumbar intervertebral disc disease

Answer 19

1 - spinal hyperesthesia w/o neural deficits
2 - paresis but ambulatory
3 - paresis but non-ambulatory
4 - paralysis + deep pain intact
5 - paralysis with loss of deep pain

Question 20

What is the order that you would lose nervous function?

Answer 20

conscious proprioception
voluntary motor + continence
superficial pain sensation
deep pain sensation

Question 21

You are looking at a radiograph of the spine of a dog that you have diagnosed with type 1 thoracolumbar intervertebral disc disease. What would you expect to see between the vertebrae of the affected area?

Answer 21

The nucleus pulposus would have ruptured dorsally into the spinal canal, so the two vertebrae should appear closer in proximity compared to the rest that still have nucleus pulposus between them

Question 22

How would you treat a dog with grade 1-3 thoracolumbar intervertebral disease?

Answer 22

strict cage rest, conduct physio. if no improvement in 2weeks, surgery

Question 23

How would you treat a dog with grade 4 thoracolumbar intervertebral disease?

Answer 23

strict cage rest, will need to manually express bladder. Surgery (dorsolateral hmmilaminectomy + fenestration) is best

Question 24

How would you treat a dog with grade 5 thoracocolumbar intervertebral disease?

Answer 24

Dorsal hmmilaminectomy and durotomy, poor prognosis

Question 25

An infection of the end plates and disk is called

Answer 25

diskospondylitis

Question 26

common etiologies of diskospondylitis?

Answer 26

S. intermedius
B. canis
Strep

Question 27

T/F: diskospondylitis usually originates in the spinal cord

Answer 27

false, it is usually somewhere else and spreads hematogenously

Question 28

Clinical signs of diskospondylitis

Answer 28

hyperesthesia, fever, depression, weight loss

Question 29

T/F: bony proliferation caused by diskospondylitis can cause spinal cord compression

Answer 29

True

Question 30

treatment for diskospondylitis?

Answer 30

antibiotics based on cluture results, want to use bactericidal drug, PO for 54weeks (until radiographic resolution)

Question 31

3 locations for vertebral and spinal neoplasia

Answer 31

intramedullary
intradural-extramedullary
extradural

Question 32

With which type of spinal neoplasia would you see a golf-tee sign?

Answer 32

intradural-extramedullary

Question 33

best imaging tool to diagnose intramedullary or extradural spinal neoplasia?

Answer 33

radiographs

Question 34

Best imaging to localize a spinal tumor

Answer 34

MRI and CT

Question 35

For which spinal neoplasia could it be beneficial to sample the CSF?

Answer 35

lymphomas

Question 36

Do cats or dogs have better prognosis for a meningioma after resection?

Answer 36

cats (6-12m), dogs are 6m

Question 37

An owner comes in worried that her toddler hurt her cat when they were playing yesterday. She saw her child pull on the cats tail and it has appeared droopy since then. The cat has also been peeing on the floor. What do you suspect?

Answer 37

tail tug, vertebral luxation

Question 38

T/F: Shiff-Sherrington can be seen in vertebral fractures and luxations

Answer 38

true

Question 39

What fluids are best to give an animal with a vertebral luxation?

Answer 39

colloids - would rather draw water out of tissues than give additional fluids and worsening edema

Question 40

Treatment for an animal with a vertebral luxation/trauma?

Answer 40

Treat shock/life threats first (colloids). Opioids for pain. 20% mannitol to reduce spinal edema. Sx to decompress and stabilize
Large dogs - external coaptation device, small ogs and cats - splinting and rest

Question 41

Hemivertebrae

Answer 41

bulldogs and Bostons

lack of formation of one hand of vertebrae

Question 42

Block or fused vertebrae

Answer 42

disc moved but didnt affect spinal cord, vertebrae fuse

Question 43

Spinal dysraphism

Answer 43

bulldogs and Bostons

spina bifida where spinal column doesn’t properly close, potential for meninges to poke through

Question 44

Sacrococcygeal dysgenesis

Answer 44

manx cats
lack of development of sacrum and associated nerves
incontinence

Question 45

Spondylosis

Answer 45

ventral bridging of vertebrae

75% dogs have it by 9y

Question 46

Old Dog hind limb tremors

Answer 46

any breed, esp terriers and larger breeds
mild in one or both hind limbs
especially when standing or sitting, disappears with movement
treatment not needed is just cosmetic

Question 47

Dancing Dobermans

Answer 47

6m-7y
contraction of gastrocnemius muscle
normal neuro exam