Neurology Flashcards
Neuropraxia
degeneration of the myelin sheath due to loss of blood supply, pressure from the weight of the animal during anesthesia, tourniquets etc.
Axonotmesis
degeneration of axons but the endoneurium and Schwann cells remain intact allowing regeneration
Neurotmesis
complete severance of a nerve and degeneration of the distal portion and its Schwann cells
No regeneration can occur
symptoms of Peripheral nerve injury
non- progressive LMN signs
Treatment of peripheral nerve injuries
glucocorticoids to decrease inflammation
protect the limb during recovery
decompress nerve surgically
Amputation after 6 months
What can occur with peripheral nerve injuries?
Self-mutilation due to abnormal sensations
Brachial plexus avulsion
abduction of the front limb forcing it cranially or caudally resulting in avulsion of the nerve roots
Disruption of the nerve roots at C6-T1 leads to what signs?
denervation of the extensors and flexors of the elbow and carpus
Disruption of the nerve roots at C6-C7
Denervation of the extensors and flexors of the shoulder
What reflex is lost with damage to the C6-T1?
Panniculus reflex
What syndrome develops from injury to T1 ventral nerve roots and the preganglionic sympathetic nerve fibers?
Horner's Syndrome: Miosis ptosis enophthalmos Protrusion of the membrana nictitans
What is the treatment for brachial plexus avulsion?
Protect the affect limb
Physiotherapy
Amputate after 6 months of no improvement
STEROIDS DO NOT HELP!!
What is a predictor of recovery for brachial plexus avulsion?
deep pain response
What are the signs of a Nerve root or peripheral nerve neoplasia?
Chronic progressive monoparesis
neurogenic muscle atrophy
hyperesthesia with limb palpation and manipulation
What do you use to diagnose Nerve root or peripheral nerve neoplasia?
CT scan
Myelogram
MRI
What is the treatment for Nerve root or peripheral nerve neoplasia?
Surgical resection
Amputation depending on the nerve affected
Where do fibrocartilaginous emboli originate from?
the nucleus pulposus of the intervertebral discs
What do fibrocartilaginous emboli cause?
Ischemic myelopathy
What breed is fibrocartilaginous emboli common in?
Large breed dogs
Miniature Schnauzers
What aggravates/causes fibrocartilaginous emboli?
vigorous exercise
What is used to diagnose fibrocartilaginous emboli?
MRI
CSF examination
Myelogram
What is the treatment for fibrocartilaginous emboli?
Dexamethasone
Supportive therapy
cage rest
physio therapy
Degenerative myelopathy
degeneration of axons and myelin sheaths in the thoracolumbar spinal cord
What are the breeds affected by Degenerative Myelopathy?
Large breed dogs
GSDs
What are the clinical signs of Degenerative Myelopathy?
Gradual loss (over 6-20 months) of voluntary motor functions and position sense
Knuckling, dragging of the toes, crossing of legs
dysmetria and ataxia of pelvic limbs
muscle atrophy of pelvic limbs
UMN hind limbs
What is the treatment for Degenerative Myelopathy?
None
Supportive therapy
physio therapy
Lumbosacral malarticulation malformation, cauda equina syndrome, lumbosacral stenosis, spondylolisthesis
forces generated by the hind limbs are transferred to the spinal column leading to Hansen type II degeneration of the L7/S1 disc and compression of the cauda equina
Also causes the proliferation of the interarcuate ligaments and formation of osteophytes on articulation facets
What are the clinical signs of Cauda Equina syndrome?
Pain on palpation of the lumbosacral area
LMN signs in the sciatic and pudendal nerves
Difficulty rising and negotiating stairs
What are the tests used to diagnose Cauda Equina syndrome?
“Lordosis test”
“Tail Jack test”
What is used to diganose Cauda Equina syndrome?
Radiographs Myelography epidurography MRI CT scans
What is the treatment for Cauda Equina syndrome?
Cage Rest NSAIDs Dorsal Laminectomy Surgery to remove bone and ligaments putting pressure on the nerves Surgical stabilization Dorsolateral foramenotomy
Thoracolumbar Intervertebral disk-disease
As the dog ages the gel-like nucleus pulposus degenerates and is replaced with cartilage (hyaline or fibrocartliage)
Dorsal displacement of the nucleus pulposus can result in stretching of the dorsal ligament and spinal cord damage
What are the two types of Thoracolumbar Intervertebral disk-disease?
Hansen Type I
Hansen Type II
Where is cauda equine syndrome seen in the vertebral column?
L7/S1
Thoracolumbar Intervertebral disk-disease Hansen Type 1
an explosive extrusion of nuclear pulposus material into the spinal canal through the annulus fibrosis
What breeds are more prone to Hansen Type 1?
Chrondrodystrophic breeds
Thoracolumbar Intervertebral disk-disease Hansen Type II
small tears appear in the annulus fibrosis and there is slow protrusion of the nucleus pulposus
What breeds are more prone to Hansen Type II
Large breed dogs
Where is calcification seen in cats?
upper cervical and mid-lumbar areas
What are the clinical signs of Thoracolumbar Intervertebral disk-disease?
hyperesthesia
paralysis
anesthesia
What is the order of loss of function in Thoracolumbar Intervertebral disk-disease?
- Conscious Proprioception
- voluntary motor function
- control of urination and defecation
- superficial pain sensation
- deep pain sensation
How do you diagnose Thoracolumbar Intervertebral disk-disease?
Myelography
CT scan
MRI imaging
How do you treat Thoracolumbar Intervertebral disk-disease?
depending on the clinical signs and severity
Cage Rest
NSAIDs
Predisone
NO STEROIDS!!
Surgery: Dorsolateral hemilaminectomy and durotomy
Physiotherapy
What are the Grades of Thoracolumbar Intervertebral disk-disease?
Grades 1-5
Thoracolumbar Intervertebral disk-disease Grade 1 neurological effects
Spinal hyperesthesia without neurological defects
Thoracolumbar Intervertebral disk-disease Grade 2 neurological defects
Paresis but ambulatory
Thoracolumbar Intervertebral disk-disease Grade 3 neurological defects
paresis but non-ambulatory
Thoracolumbar Intervertebral disk-disease Grade 4 neurological defects
paralysis with deep pain sensation intact
Thoracolumbar Intervertebral disk-disease Grade 5 neurological defects
paralysis with no deep pain sensation
What treatment is recommended for all Grade 4 animals?
Surgery
What is the surgery of choice for a Grade 4 Thoracolumbar Intervertebral disk-disease?
Dorsolateral hemilaminectomy
Diskospondylitis
infection of the cartilaginous endplates
What are the most common agents causing Diskospondylitis?
S. Intermedius
B. canis
Streptococcus spp.
What are the clinical signs of Diskospondylitis?
hyperesthesia pyrexia depression weight loss Spinal cord signs due to compression
How do you diagnose Diskospondylitis?
Radiographs
MRI
Serology for B. canis on intact dogs
How do you treat Diskospondylitis?
analgesics
antibiotics parenterally
Treatment is usually 1 year long
What are the 4 types of neoplasia seen in the spine?
- intramedullary
- metastatic intramedullary
- Intradural-extramedullary
- extradural
What are the most common neoplasia of the spine?
Extradural: vertebral osteosarcoma, chondrosarcoma, multiple myeloma, hemangiosarcoma, and fibrosarcoma or metastases
What is the second most common tumor in dogs?
Hemangiosarcoma
What is the most common spinal cord neoplasia in cats?
Extradural lymphosarcoma
How does the Intramedullary tumor appear on the myelogram?
dye columns thin and diverge
How does the intradural-extramedullary tumor appear on the myelogram?
characteristic “golf-tee” sign
How does the extradural tumors appear on the myelogram?
cause one side of the dye column to deviate towards the lumen of the spinal cord
What is the treatment for a Meningioma?
resection
What is the treatment for neoplasia of the spine?
Resection if possible
Radiation
Chemo therapy
What are the clinical signs of vertebral fractures or luxations?
history of trauma spinal hyperesthesia decreased or absent voluntary motor activity misalignment of the spine Schiff-Sherrington
Schiff-Sherrington
stiff front legs (like tetanus) from a lesion in the spinal cord that knocks out the inhibitory neurons between the front and back legs leading to stiff front limbs