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Neurology > Spinal disease > Flashcards

Spinal disease Flashcards

1
Q

Contents - grey matter

A

nn cell bodies

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2
Q

Contents - white matter

A

AXONS (‘tracts’):

  • dorsal funiculus
  • lateral funiculi
  • ventral funiculus
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3
Q

Function - dorsal and lateral funiculi

A

sensory and proprioceptive tracts. Dysfunction –> ataxia

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4
Q

Function - ventral and lateral funiculi

A

motor (or UMN) tracts ). Dysfunction –> (UMN) paresis.

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5
Q

Function - LMN cell bodies

A

Ventral horn grey matter. Dysfunction –> (LMN) paresis

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6
Q

Name the 4 functional segments of SC

A
  • C1-5
  • C6-T2
  • T3-L3
  • L4-S3
    (localising SC problem is essential for determining ddx)
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7
Q

T/F: spinal cord segments = vertebral bodies

A

false

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8
Q

What is the tapered termination of the spinal cord called?

A

conus medullaris

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9
Q

What is the cauda equina?

A

bundle of spinal nn and roots which originate in the conus medullaris of the SC

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10
Q

Define myelopathy. Categories?

A

= disorder of SC

  • EXTRINSIC: extradural or intradural
  • INTRINSIC: intramedullary (diffuse or focal)
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11
Q

Synonym - ataxia

A

incoordination

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12
Q

Define ataxia

A

loss of sense of awareness of body/limb position in space

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13
Q

What is ataxia? What type do you get in spinal disease?

A
  • sensory phenomenon

- sensory or proprioceptive ataxia in spinal dz

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14
Q

Define paresis

A
  • decreased voluntary mvt
  • motor phenomenom
  • UMN or LMN types
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15
Q

Define plegia

A

= complete loss of voluntary movement

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16
Q

Distinguish mono, para, tetra

A
  • Mono = one limb affected
  • Para = both HL affected
  • Tetra = all 4 limbs affected
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17
Q

Define urinary/ faecal continence

A

ability to ‘fill’ and empty bladder/intestines voluntarily

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18
Q

Define urinary/faecal incontinence. Where is the problem?

A
  • loss of ability to fill and empty bladder/intestines voluntarily
  • UMN (CATS L2-5, DOGS L1-4) or LMN (S1-3)
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19
Q

How do you recognise animal with spinal disease?

A

CS and neuro exam

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20
Q

Why perform a neuro exam with suspected spinal dz?

A
  1. confirms neuro nature of CS
  2. determine neuro-anatomical localisation
  3. determine prognosis (selected cases)
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21
Q

WHich parts of the neuro exam are important for spinal dz ddx?

A
  • posture
  • gait
  • postural reactions
  • spinal reflexes
  • palpation
  • nociception
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22
Q

Define kyphosis

A

spine curvature

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23
Q

What should you determine with gait in a neuro exam with a suspicion of spinal disease? 3 What might this mean?

A
  • only paresis - neuromuscular or lumbosacral problem
  • only ataxia - cerebellar or vestibular problem
  • ataxia and paresis - spinal or brainstem problem
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24
Q

What is proprioception a reliable indicator for?

A

the presence of neurological disease. Not always useful for assessment of neuro-anatomical localisation

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25
Q

How do CS of extrinsic (compressive myelopathies) correlate with progression?

A 
EARLY:
proprioception deficits
movment problems
nociception problems
LATE
(improvement occurs in reverse order to progression - i.e.  proprioception will come back last)
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26
Q

Name 3 spinal reflexes

A
  • patella
  • withdrawal
  • cutaneous trunci / panniculus
  • important to ID which SC segment affected
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27
Q

What do decreased spinal reflexes suggest?

A
  • LMN signs
  • lesion located in reflex arc
  • C6-T2 or L4-S3
28
Q

What do exaggereated spinl reflexes suggest?

A
  • UMN sign
  • lesion located cranial from reflex arc
  • C1-5 or T3-L3
29
Q

Function - motor (UMN) tracts

A
  • UMN ‘tells’ LMN what to do

- synapse on LMN in ventral horn grey matter

30
Q

Function - UMN system

A

facilitates and to a greater extent inhibits mm goups. Net effect: inhibition of mm tone and reflexes

31
Q

CS - UMN lesions

A

= disinhibition –> increased mm tone and reflexes

32
Q

What part of the neuro exam should be done last?

A

palpation as can be painful (aggression etc). Start gently.

33
Q

Outline use of nociception for spinal dz

A
  • not always necessary
  • can assist in determining prognosis
  • do NOT confuse with withdrawal reflex
  • positive reflex when there is conscious perception of pinch (head turn, pinch)
34
Q

What does prognosis depend on?

A
  1. diagnosis

2. function (neuro exam)

35
Q

What is the msot important prognostic indicator?

A
  • deep pain perception

- use an unequivocally noxious stimuli (haemostats on periosteum)

36
Q

CS - C1-C5 lesion

A
  • tetraparesis and ataxia all limbs
  • proprioceptive deficits all limbs
  • intact or increased spinal reflexes all limbs
  • normal or increased mm tone all limbs
  • horner’s possible
  • urinary dysfunction possible, uncommon
  • tetraplegia uncommon (respiratory dysfunction - phrenic nn - occurs before plegia)
37
Q

CS - lesion in C6-T2

A
  • tetraparesis and ataxia all limbs
  • proprioceptive deficits all limbs
  • intact or decreased spinal reflexes in TL, intact or increased in HL*
  • intact/decreased mm tone TL, intact/increased mm tone HL
  • ‘two-engine’ or disconnected gait possible
  • horner’s possible
  • urinary dysfunction possible, uncommon
  • tetraplegia uncommon - respiratory dysfunction - phrenic nn - before plegia
38
Q

Describe a ‘two-engine gait in animals with C6-T2 myelopathy

A
  • wide based ataxic HL
  • short stilted TL
  • TL and HL have different rhythm/engine
39
Q

CS - lesion of T3-L3

A
  • normal TL
  • paraparesis and HL ataxia
  • paraplegia possible
  • intact/increased spinal reflexes pelvic limbs
  • intact/ increased mm tone pelvic limbs
  • urinary dysfunction common (‘UMN bladder’)
  • Schiff-Scherrington posture (sometimes)
40
Q

Describe the Schiff-Sherrington posture

A
  • acute T3-L3 spinal injuries
  • Borders cells affected (L1-L7): project to cervical intumescence, provide inhibition to extensor mm TL –> disinhibition with dysfunction –> paraplegia with increased extensor tone in TL
  • ddx cervical lesion (TL neurologically normal)
  • Indicates localisation, NOT prognosis
41
Q

Where are border cells?

A
  • dorsolateral border of ventral grey column of lumbar SC

- when affected –> Schiff-Scherrington posture

42
Q

CS - lesion of L4-S3

A
  • TL normal
  • paraparesis and ataxia HL
  • paraplegia possible
  • intact/decreased spinal reflexes
  • intact/decreased mm tone to HL
  • urinary dysfunction uncommon (‘LMN bladder’)
  • possible flaccid tail
  • possible decreased perianal reflex
43
Q

Which spinal cord segment(s) are affected if all 4 limbs affected?

A

C1-5 or C6-T2

44
Q

Which spinal cord segment(s) are affected if only HL affected?

A

T3-L3 or L4-S3

45
Q

If only HLs are affected or all 4 limbs are, how do you differentiate the cause?

A

look at spinal reflexes:
INCREASED: C1-5 or T3-L3 problem
DECREASED: C6-T2 or L4-S3

46
Q

Where is the lesion in a two-engine gait?

A

C6-T2

47
Q

Components of 5/6 finger rule

A
  • localisation
  • signalment
  • onset
  • progression
  • symmetry
  • pain
48
Q

T/F: presence of pain excludes several problems

A

True

49
Q

T/F: not many disorders are truly asymmetrical

A

True

50
Q

Ddx - common spinal diseases in dogs

A
  • IVDD (Type 1 and 2)
  • Ischaemic myelopathy (IM)
  • neoplasia
  • syringomyelia (SM)
  • immune-mediated
  • inflammatory
51
Q

Ddx - common spinal diseases in CATS

A
  • Infectious/inflammatory - FIP
  • Trauma: fracture/ luxation
  • Neoplasia: lymphoma (young), meningioma (old)
52
Q

Define CSM

A

Cervical spondylomyelopathy

53
Q

Define CM/SM

A

Chiari-like malformation/ syringomyelia

54
Q

Define IVDE

A

Intervertebral disc extrusion

55
Q

Which spinal diseases have pain only (no neurological deficits)? 2

A
  • CM/SM

- SRMA

56
Q

Define SRMA

A

Steroid responsive Meningitis and Arteritis

57
Q

Which spinal diseases have neuro deficits +/- pain? 6

A
  • IM or HVLV
  • IVDE
  • IVDP
  • CSM
  • Neoplasia
58
Q

Define HVLV

A

High velocity low volume disc extrusion

59
Q

How many disease account for 91% spinal disease cases?

A

91%

60
Q

Outline CSM

A
  • younger dogs

- chronic onset

61
Q

Outine spinal neoplasia

A
  • older, larger
  • chronic onset
  • localised
  • deteriorating
62
Q

Outline IVDD

A
  • older
  • chronic onset
  • often stable
  • painful
63
Q

Outline IVDE

A
  • middle aged and older
  • smaller
  • acute
  • non-lateralised
  • deteriorating
  • painful
64
Q

Outline IM / HVLV

A
  • medium/large breed
  • peracute onset
  • stable or improving
  • lateralised
  • often non-painful
65
Q

Outline CM/ SM

A
  • CKCS
66
Q

What age does SRMA affect?

A

usually

Neurology (26 decks)

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