Neurology: Spinal Cord Disease Flashcards
What history should be taken for spinal disease?
- General
- Signalment
- Duration of CS
- Speed of onset
- Progressive or not
- Pain
What are the grades of spinal clinical signs?
Grade 1- no defecits, just pain
Grade 2- paresis, ambulatory
Grade 3- paresis, non-ambulatory
Grade 4- paralysis
Grade 5- no pain sensation
Lesion location needs to be done
What are the differentials for spinal disease?
- V- ishaemic myelopathies
- I- SRMA, MUOs, discospondylitis, toxoplasmosis, neosporosis
- T- fractures and luxations, ANNPE, AA instability
- A- AA instability, chiari-like malformation, vertebral anomalies
- N- spinal/vertebral neoplasia
- D- IVDD, I and II, CSM, LSDS, DM
What vascular diseases can cause peracute onset of spnial disease?
FCE (fibrocartilaginous emboilism)
Stroke- cats
What trauma can cause peracute onset of spinal disease?
- Acute non-compressive annulus pulposis extrusion
- Fractures/luxations
- What causes ishaemic myelopathies?
- How do they present?
- What causes and FCE?
- Blood supply to spinal cord interupted
- Peracute, non-painful- signs often very lateralised, usually at excercise
- Fibrocartilage from nucleus pulposus embolises in spinal cord vasculature
What causes acute non-compressive nucleus pulposus extrusion?
Herniated nucleus pulposus is non-mineralised, causing mainly cord contusion with minimal compression
Aucte, non-painful, non-progressive
How is FCE and traumatic disc treated?
Surgery is not indicated
Tx
* supportive care and physiotherapy
* Median time to ambulation- 2 weeks
* Time to max recovery 3m
Prognosis
* neurological score at presentation
* extension of the lesion on MRI
How are fractures and luxations diagnosed?
What is the three compartment model?
- Careful neurological examination
- Thoracic and abdominal radiographs
- Survey lateral radiographs of spine
- Orthogonal views essential
- CT/MRI may be helpful
Spine split- Dorsal, middle, ventral
How are fractures and luxations treated?
What shows poor prognosis?
- Initial- stabilise and analgesia
- Use 3 compartment rule- if unstable surgery or splint
- Decompression if fragments compressing spinal cord
- Splint if transporting
Lack of deep pain perception- usually spinal cord laceration- poor prognosis
What are acute/subacute causes of spinal disease?
IVDD type I (extrusion)
Infectious/inflammatory
* SRMA
* Discospondlylitis
* Spinal MUO meningomyelitis
What is a chondrodystrophic breed?
Short legs, long body
What is the difference between intervertebral disc degeneration between chondrodystrophic breeds and non-chondrodystrophic breeds?
Chondrodystophic- sausage dogs
* During first 2 years
* Chondroid metamorphosis
* IVD dehydrates and nucleus is invaded by hyaline cartilage
* Nucleus can mineralise
Non-chondrodystrophic breeds
* After middle age
* Fibroid metamorphosis
* IVD dehydrated and nucleus invaded by fibrocartilage
* Mineralisation less common
What is the difference between type I and II IVDD?
Type I
* herniation of the nucleus pulposus through annular fibres and extrusion of the nuclear material into the spinal canal
Type II
* Annular protrusion caused by shifting of central nuclear material, commonly associated with fibroid disc degeneration
- What age is usually affected by type I IVDD and type II?
- How does onset and signs vary between type I and II?
- Type I- 3-6y (sausage), 6-8 (non-sausage).
Type II older non-sausage - Type I- peracute, progressive, painful.
Type II- slowly progressive, chonic onset, sometimes painful
How is intervertebral disc disease treated surgically and conservatively?
Conservative
* Strict rest 4-6 weeks
* Analgesia
Surgical
* Severe neurological defecits (3-5)
* Severe or recurrent pain
* Lack of improvement with conservative
When is there very poor prognosis with IVDD?
Grade 5
Grade 4 without surgical
What is the most common cause of neck pain in young dogs (6m-18m)
Steroid responsive meningitis-arteritis
What are the clinical signs of steroid responsive meningitis-arteritis?
How is it diagnosed?
How is it treated?
Clinical signs
* Lethargy, anorexia, fever
* Cervical rigidity, spinal pain
* Often concurrent IMPA
Diagnosis
* CSF analysis- neutrophillic pleocytosis in acute form
mononuclear pleocytosis in chronic form
Treatment
* Corticosteroids for 6-9m
* Monitor with repeated CSF analysis or CRP
What is discospondylitis?
How is it diagnosed and treated?
Discospondylitis- infection of IVD and adjacent vertebrae
Diagnosis:
* imaging- radiography- narrowing of IVD, roughening of endplates, proliferation of adjacent bone
* Bacteriology- blood, urine
Treatment
* Antibiotics- 8 weeks
* Analgesia
Most common L7-S1
How does meningomyelitis of unknown orign present?
How it is diagnosed and treated?
- Subacute, progressive
- Often multifocal
- Care as same breeds and often similar presentation to IVDD
Diagnosis
* MRI
* CSF- mononuclear or mixed pleocytosis (lot os lymphocytes)
Treatment
* Corticosteroids
What are likely causes of chronic onset of spinal disease?
Neoplasia
Degenerative
* IVDD type II (protrusion)
* Cervical spondylomyelopathy
* Lumbosacral degenerative stenosis
* Vertebral and spinal abnormalities
* Degenerative myelopathy
Anomalous
* Spinal malformations
* Atlantoaxial instabiliity
* Chiari like malformations
What are the three locations possible for spinal neoplasia?
How is it treated?
- Extradural: primary, vertebral, metastatic, lymphoma
- Intradural extramedullary: meningoma, nephroblastoma, nerve sheath, metastatic
- Intradullar intramedullary: gliomas, ependymomas, metastatic
Treatment:
* Decompressive surgery
* Radiation
* Palliative
What is the technical term for wobblers?
Cervical spondylomyelopathy
- Short stilted gait and muscle atrophy in thoracic limbs
- Signs worse in pelvic limbs
What can cause cervical spondylomyelopathy?
- Protrusion of IVD (type II)
- Hypertrophy of ligamentum flavum and dorsal longitudinal ligament
- Hypertrophy of synovial membrane
- Stenosis of spinal canal
- Degenerative joint disease
How can cervical spondylomyelopathy be treated?
Conservative
* Anti-inflammatories
Surgical
* Decompression vs distraction-stabilisation
What are the signs of lumbosaral degenerative stenosis?
- Reluctance to excercise, rise, jump into car, stairs
- Lameness- nerve root (L7) signature
- Lumbosacral pain
- Monoparesis/paraparesis
- Proprioceptive defecits, reduced withdrawal reflex, muscle atrophy
- Urinary and/or faecal incontinence
What can cause lumbosacral degenerative stenosis?
How is it treated?
- type II IVDD
- Sclerosis of vertebral endplates and articular processes
- Hypertrophy of ligaments
- Hypertrophy of synovial membranes
- Foraminal stenosis
- Ventral subluxation of sacrum
Conservative
* anti-inflammatories
* Gabapentin
Surgical treatment
* dorsal laminectomy
* dorsal fusion-fixation
* foraminotomy
What are vertebral and spinal anomalies?
- Spinal arachnoid diverticulae (SAD)
- Butterfly vertebrae
- Block vertebrae
- Transitional vertebrae
- Hemivertebrae
- Spinal stenosis
Surgical decompression/stabilisation
Chronic onset, slowly progressive, non-painful
What is degenerative myelopathy?
How is it diagnosed and treated?
Insidious, progressive ataxia and paresis of pelvic limbs, ultimately leading to paralysis
* T3-L3
* Asymmetrical
* Not painful
Diagnosis of exclsuion
No treatment- physio prolongs QoL
What is atlantoaxial instability associated with?
What breeds are affected?
What are the clinical signs and treatment?
- Aplasia/hypoplasia of dens
- Young toy breeds
- CS- neck pain, ataxia or tetraparesis
- Tx- conservative splint for 6-12w, surgical
What is chiari like malformation?
Mismatch between caudal fossa volume and its contents (cerebellum and brainstem)
Caudal displacement of cerebellum through foramen magnum
- Hydromyelia- dilation of central canal
- Syringomyelia- fluid filled cavity
- Syringohydromyelia- both
- What are the clinical signs of chiari-like malformation?
- How is it medically treated?
- How is it surgically treated?
- Neck pain, neck scratching (air guitar), torticollis (twisting of neck), thoracic limb weakness and atrophy
- Gabapentin, NSAIDs, furosemide, omeprazole
- 50% success
What spinal disease can affect cats?
- Neoplasia
- Inflamm- abscess, FIP, discospondylitis, toxoplasmosis
- Trauma
- Vascular
- IVDD
What are indications for neurosurgery?
- IVDD
- CSM
- LSDS
- Trauma
- Neoplasia
- Malfomations
- Infectious disease
What is a hemilaminectomy?
- Removal of one half of the vertebral arch mainly used in TL spine
- Access to lateral and ventral SC allows for IV fenestration
- What is a dorsal laminectomy?
- What is a ventral slot?
- Removal of dorsal spinous process and laminae- access to dorsal and dorsolateral SC (IVDD at LS, congenital malf, neoplasia)
- Slot like opening through IVD and cranial and caudal endplates of cervical vertebrae (Acess to ventral SC- IVDD)
What to UMN bladder lesions cause?
What do LMN bladder lesions cause?
What are the following drugs used for to treat bladder problems?
Diazempam, Prazosin/phenobenzamine, bethanecol
UMN
* Lesions cranial to sacral SC
* Tense bladder difficult to express
LMN
* Lesions in sacral SC, sacral spinal nerces and plexus/pudenal nerve
* Floppy bladder- overflow and drippling
Diazepam- reduce urethral tone
Prazosin or phenobenzamine- reduce urethral tone (smooth muscle)
Bethanecol- detrusor contractoin- cholinergic stimulation
