Spinal disease Flashcards
1
Q
Contents - grey matter
A
nn cell bodies
2
Q
Contents - white matter
A
AXONS (‘tracts’):
- dorsal funiculus
- lateral funiculi
- ventral funiculus
3
Q
Function - dorsal and lateral funiculi
A
sensory and proprioceptive tracts. Dysfunction –> ataxia
4
Q
Function - ventral and lateral funiculi
A
motor (or UMN) tracts ). Dysfunction –> (UMN) paresis.
5
Q
Function - LMN cell bodies
A
Ventral horn grey matter. Dysfunction –> (LMN) paresis
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)
7
Q
T/F: spinal cord segments = vertebral bodies
A
false
8
Q
What is the tapered termination of the spinal cord called?
A
conus medullaris
9
Q
What is the cauda equina?
A
bundle of spinal nn and roots which originate in the conus medullaris of the SC
10
Q
Define myelopathy. Categories?
A
= disorder of SC
- EXTRINSIC: extradural or intradural
- INTRINSIC: intramedullary (diffuse or focal)
11
Q
Synonym - ataxia
A
incoordination
12
Q
Define ataxia
A
loss of sense of awareness of body/limb position in space
13
Q
What is ataxia? What type do you get in spinal disease?
A
- sensory phenomenon
- sensory or proprioceptive ataxia in spinal dz
14
Q
Define paresis
A
- decreased voluntary mvt
- motor phenomenom
- UMN or LMN types
15
Q
Define plegia
A
= complete loss of voluntary movement
16
Q
Distinguish mono, para, tetra
A
- Mono = one limb affected
- Para = both HL affected
- Tetra = all 4 limbs affected
17
Q
Define urinary/ faecal continence
A
ability to ‘fill’ and empty bladder/intestines voluntarily
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)
19
Q
How do you recognise animal with spinal disease?
A
CS and neuro exam
20
Q
Why perform a neuro exam with suspected spinal dz?
A
- confirms neuro nature of CS
- determine neuro-anatomical localisation
- determine prognosis (selected cases)
21
Q
WHich parts of the neuro exam are important for spinal dz ddx?
A
- posture
- gait
- postural reactions
- spinal reflexes
- palpation
- nociception
22
Q
Define kyphosis
A
spine curvature
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
24
Q
What is proprioception a reliable indicator for?
A
the presence of neurological disease. Not always useful for assessment of neuro-anatomical localisation
25
How do CS of extrinsic (compressive myelopathies) correlate with progression?
```
EARLY:
proprioception deficits
movment problems
nociception problems
LATE
(improvement occurs in reverse order to progression - i.e. proprioception will come back last)
```
26
Name 3 spinal reflexes
- patella
- withdrawal
- cutaneous trunci / panniculus
* important to ID which SC segment affected
27
What do decreased spinal reflexes suggest?
- LMN signs
- lesion located in reflex arc
- C6-T2 or L4-S3
28
What do exaggereated spinl reflexes suggest?
- UMN sign
- lesion located cranial from reflex arc
- C1-5 or T3-L3
29
Function - motor (UMN) tracts
- UMN 'tells' LMN what to do
| - synapse on LMN in ventral horn grey matter
30
Function - UMN system
facilitates and to a greater extent inhibits mm goups. Net effect: inhibition of mm tone and reflexes
31
CS - UMN lesions
= disinhibition --> increased mm tone and reflexes
32
What part of the neuro exam should be done last?
palpation as can be painful (aggression etc). Start gently.
33
Outline use of nociception for spinal dz
- 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
What does prognosis depend on?
1. diagnosis
| 2. function (neuro exam)
35
What is the msot important prognostic indicator?
- deep pain perception
| - use an unequivocally noxious stimuli (haemostats on periosteum)
36
CS - C1-C5 lesion
- 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
CS - lesion in C6-T2
- 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
Describe a 'two-engine gait in animals with C6-T2 myelopathy
- wide based ataxic HL
- short stilted TL
- TL and HL have different rhythm/engine
39
CS - lesion of T3-L3
- 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
Describe the Schiff-Sherrington posture
- 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
Where are border cells?
- dorsolateral border of ventral grey column of lumbar SC
| - when affected --> Schiff-Scherrington posture
42
CS - lesion of L4-S3
- 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
Which spinal cord segment(s) are affected if all 4 limbs affected?
C1-5 or C6-T2
44
Which spinal cord segment(s) are affected if only HL affected?
T3-L3 or L4-S3
45
If only HLs are affected or all 4 limbs are, how do you differentiate the cause?
look at spinal reflexes:
INCREASED: C1-5 or T3-L3 problem
DECREASED: C6-T2 or L4-S3
46
Where is the lesion in a two-engine gait?
C6-T2
47
Components of 5/6 finger rule
- localisation
- signalment
- onset
- progression
- symmetry
- pain
48
T/F: presence of pain excludes several problems
True
49
T/F: not many disorders are truly asymmetrical
True
50
Ddx - common spinal diseases in dogs
- IVDD (Type 1 and 2)
- Ischaemic myelopathy (IM)
- neoplasia
- syringomyelia (SM)
- immune-mediated
- inflammatory
51
Ddx - common spinal diseases in CATS
- Infectious/inflammatory - FIP
- Trauma: fracture/ luxation
- Neoplasia: lymphoma (young), meningioma (old)
52
Define CSM
Cervical spondylomyelopathy
53
Define CM/SM
Chiari-like malformation/ syringomyelia
54
Define IVDE
Intervertebral disc extrusion
55
Which spinal diseases have pain only (no neurological deficits)? 2
- CM/SM
| - SRMA
56
Define SRMA
Steroid responsive Meningitis and Arteritis
57
Which spinal diseases have neuro deficits +/- pain? 6
- IM or HVLV
- IVDE
- IVDP
- CSM
- Neoplasia
58
Define HVLV
High velocity low volume disc extrusion
59
How many disease account for 91% spinal disease cases?
91%
60
Outline CSM
- younger dogs
| - chronic onset
61
Outine spinal neoplasia
- older, larger
- chronic onset
- localised
- deteriorating
62
Outline IVDD
- older
- chronic onset
- often stable
- painful
63
Outline IVDE
- middle aged and older
- smaller
- acute
- non-lateralised
- deteriorating
- painful
64
Outline IM / HVLV
- medium/large breed
- peracute onset
- stable or improving
- lateralised
- often non-painful
65
Outline CM/ SM
- CKCS
66
What age does SRMA affect?
usually
