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Neuro junior > Spinal disorders > Flashcards

Spinal disorders Flashcards

1
Q

Objectives (4)

A
  1. Recognize clinical signs of spinal disorders
  2. Localize spinal lesion to appropriate segment
  3. Recognize classic signalments for various disorders
  4. List appropriate ddx for neuroloc and signalment
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2
Q

Thoracic limb reflexes

A

Withdrawal is only reliable reflex

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3
Q

Pelvic limb reflexes

A

Patellars and withdrawals reliable

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4
Q

Other reliable reflexes (3)

A
  1. Panniculus
  2. Perineal
  3. Anal tone
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5
Q

Acutely down dog non-neurologic DDX (6)

A
  1. Hemoabdomen
  2. Sepsis
  3. Heart failure
  4. Arrythmia
  5. Polyarthritis
  6. Orthopedic dz
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6
Q

Acutely down dog neurologic categories (3)

A
  1. Brain
  2. Spine
  3. Motor unit (LMN)
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7
Q

Acutely down dog neuro (5)

A
  1. IVDD
  2. FCE, other vascular lesion - NON PAINFUL
  3. Inflammatory
  4. Trauma
  5. Motor unit dz
    - Nerve: Polyradiculoneuritis
    - Junction: Myasthenia gravis
    - Muscle: not often down
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8
Q

Painful spinal lesions (5)

A
  1. IVDD
  2. Meningitis/meningomyelitis (covering of cord)
  3. Diskospondylitis (disk and vertebra)
  4. Fracture/luxation
  5. Neoplasia (bone or meninges)
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9
Q

There are no nerve endings…

A

Within the cord

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10
Q

DDX signalment: Immature ~ 9 mo (4)

A
  1. trauma
  2. congenital
  3. infectious
  4. degenerative
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11
Q

DDX signalment: Mature (3)

A
  1. IVDD
  2. FCE/vascular
  3. Neoplasia
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12
Q

DDX signalment: Geriatric (3)

A
  1. IVDD
  2. Neoplasia
  3. Degenerative
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13
Q

DDX signalment Chondrodystrophoid (1)

A

IVDD

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14
Q

DDX Course of dz: Acute non-progressive (3)

A
  1. Vascular
  2. Trauma
  3. IVDD
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15
Q

DDX course of dz: Acute progressive (5)

A
  1. Trauma
  2. IVDD
  3. Neoplasia
  4. Inflammatory
  5. Infectious
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16
Q

DDX course of dz: Chronic progressive (5)

A
  1. Neoplasia
  2. Degenerative
  3. IVDD
  4. Inflammatory
  5. Infectious
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17
Q

Minimum database

A
  1. Bloodwork
    - NOVA/PCV/TS vs CBC/Chem/UA (age/hx/finances)
  2. UA/culture (chronic back dog bladder!)
    - Chronicity/concurrent dz
  3. Thoracic rads
    - Age, Motor unit dz
    - LMN - look for megaesophagus
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18
Q

Indications for spinal rads (3)

A
  1. Trauma-was it really trauma (found at stairs)
  2. Diskospondylitis (severely painful, shouldn’t be down)
  3. Osseous neoplasia - hx osteosarc
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19
Q

Indications for CT (4)

A
  1. Chondrodystrophoid (IVDD susp)
  2. Better if recent surg < 4mo (MRI hot mess)
  3. Traditionally more sens for bone
  4. Fast, safer, cheapish
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20
Q

Indications for MRI (4)

A
  1. Indramedullary dz
  2. FCE, vascular dz
  3. Neoplasia
  4. Lower risk than myelogram
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21
Q

Down cat (6)

A

VASCULAR UNTIL PROVEN OTHERWISE

  1. check pulses, then doppler flow, then paired NOVAs
  2. Not ush surgical
  3. CBC/Chem/UA
  4. BP
  5. Met check thorax +/- AUS
  6. +/- MRI
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22
Q

Cervical Spinal Diseases (6)

A
  1. AA
  2. COMS/SM
  3. CSM
  4. IVDD
  5. Neoplasia
  6. Inflammatory - SRMA/GME
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23
Q

Congenital AA instab def and breeds

A
  1. Hypoplasia/aplasia of dens

2. Toy/teacups - Yorkies, poms, poodles, chihuahuas

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24
Q

Acquired AA instab

A

Traumatic, rare

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25
Q

AA med manag (3)

A
  1. Cervical splint
  2. Young dogs affected < 30 days
  3. > 2mo in splint- complications (sores/airway obst/relapse)
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26
Q

AA surgical cor (2)

A
  1. Cross pinning C1-C2 kirschner wires
    - pot penetrations spinal cord and migration of wire
  2. Screws and PMMA to vert floor
    - > 90% success but high risk (10% die)
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27
Q

Syringomyelia (2)

A
  1. Fluid buildup in parencyma of spinal cord from altered CSF dynamics
    - fluid bright white on MR
  2. secondary syringomyelia
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28
Q

Secondary syringomyelia (5)

A
  1. abn caudal fossa
  2. tethered spinal cord
  3. trauma
  4. arachnoiditis
  5. tumor
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29
Q

COMS

A

Caudal occipital malformation syndrome

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30
Q

Syringomyelia CS and TX

A 
CS (King charles cavalier)
1. Phantom scratching
2. Pain
3. Lameness
TX: multimodal
1. Gabapentin
2. Omeprazole
3. NSAIDS and Pred if NSAIDS don't work
4. Surgery (foramen magum decomp)
-sx imp pain, not syrinx and prog is variable (worse with larger syrinx)
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31
Q

Classic CS cervical spondylomyelopathy

A

TWO ENGINE GAIT

-classical caudal cervical CS

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32
Q

Disc Assoc Wobbler synd (DAWS)

A

7-9 yr old dobie

  1. VENTRAL SPINAL CORD COMP FROM DISC
  2. Type II IVDD (Caudal cerv C5, C6, C7)
  3. +/- dynamic comp
  4. chronic protrusion of disk
  5. Med manag - NSAIDS, pred, PT (Caution), acupuncture (pain)
  6. SX - V-slot, distractoin-fusion (many complications)
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33
Q

Osseus-assoc wobbler

A

Young dog/giant breed

  1. DORSO/DORSOLATERAL compression
  2. Articular process degenerative joint dz
  3. Malformations
  4. Articular cysts (comp C2, C3, C4)
  5. Med manag - NSAIDS, Pred, PT, acupuncture
  6. SX - dorsal laminectomy/fusion (rough, prolonged recov)
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34
Q

Steroid Responsive meningitis +/- arteritis

MAIN R/O

A

Diskospondylosis from bact infection

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35
Q

Steroid responsive meningitis +/- arteritis (7)

A
  1. Boxer, Bernese, Beagle, German SH pointer
  2. Pembroke Welsh corgi?
  3. < 2 yrs old
  4. SEVERE cervical pain
  5. Stiff, stilted gait, reluctant to move
  6. Often febrile
  7. Minimal neuro deficits
36
Q

Painful walking on egg shell dzes (2)

A
  1. Steroid resp meningitis +/- arteritis

2. Immune mediated polyarthritis

37
Q

Ster. Resp Men +/- art (exam, labs) (3)

A
  1. PE: NSF, +/- fever
  2. CBC: +/- leukocytosis
  3. CSF
    - Acute: marked neutrophillic pleocytosis
    - Chronic: mixed pleocytosis, esp if steroids
    - Will shift to mononuclear pop (I think)
38
Q

Ster. Resp Men +/- art TX/PX (3)

A
  1. Immunosuppression: steroids, azathioprine, MMF
    - treat at least 4-6 months
  2. Good prognosis
    - worse if recurs and older dogs with longer time to dx
  3. Potential for recurrence if wean from ster. too soon
39
Q

Granulomatous Meningoencephalomyelitis (5)

A
  1. Females
  2. Toys and terriers
  3. forms: Ocular, Focal, Diffuse
  4. Peracute
  5. Fatal if untreated
40
Q

GME Lesions and CS (5)

A
  1. Caudal fossa
  2. Cerebrum
  3. Cervical spine
  4. Any white matter
  5. Can present with cervical pain as only CS
41
Q

GME CSF (3)

A
  1. Pleocytosis
  2. Often Mononuclear
  3. Can be Normal
42
Q

GME MRI

A
  1. Infiltrative lesions
  2. Irregular margins
  3. Mass effect
  4. T2 and FLAIR hyperintensities
43
Q

GME TX (7)

A
  1. Corticosteroids
  2. Radiation
  3. Cyclosporine
  4. Cytosine arabinoside
  5. Procarbazine
  6. Azathioprine
  7. Mycophenolate mofetil
44
Q

Thoracolumbar dz (5)

A
  1. IVDD
  2. Trauma
  3. Congenital malformations
  4. Degenerative myelopathy
  5. Fibrocartilagenous Embolism
45
Q

Congenital Spinal Malformations (3)

  1. breed
  2. presenting compl
  3. age onset
A
  1. Breed predilections
    - frenchies, pugs, english bulldogs, bostons, screw tails
  2. Presenting complaint
    - progressive ataxia, paresis
    - Ush non-painful
  3. Age of onset is variable
46
Q

Congenital Spinal Malformations TX

A 
Med manage
1. Strict rest
2. Pred: 0.5-1 mg/kg/day
3. pain control
SX
4. Decompressive sx w/ stabilization (poor prog)
47
Q

Congenital Spinal Malformations Pathology (2)

A
  1. Compression from canl stenosis

2. microinstability - wedge shaped vertebrae

48
Q

IVDD Compressive extrusion

A
  1. Acute IVD extrusion with mass of nucleus causing cord compression
49
Q

IVDD Concussive extrusion

A
  1. Acute IVD extrusion w/ no residual compression

2. ANNPE - acute non-compressive nucleus pulposus extrusion

50
Q

IVDD Contraindications for Med ther.

A
  1. Non-ambulatory

2. absent pain perception

51
Q

When to image and cut (7)

A
  1. Progression in 24-48
  2. Progression/lack of response in 1-2 weeks med manag
  3. relapse off meds
  4. Cervical pain with ANY DEFICIT
  5. Recurrent pain, multiple episodes
  6. Lower motor neuron deficits
  7. non ambulatory status
52
Q

Scan all little white fluffy dogs b/c

A

possibility of inflammatory dz

53
Q

Things that may look like IVDD….?!?!?! Don’t cut….?!?!?!

A
  1. Young, small breed dogs with cervical pain and no other obvious signs
    - Concern for inflammatory brain disease
    - Not uncommon presentation
    - Yorkies, pugs, poms, malteses, shih tzus
54
Q

Degenerative Myelopathy

A
  1. GSD, Husky, Corgi, Boxer, Chessie, Rhodesians
    - mean age 9 and 11 yrs old
  2. Non-painful, slowly progressive
  3. Diagnosis of exclusion
  4. No tx, PT may slow progression PX 1 yr
55
Q

DM work-up (6)

A
  1. Neuro exam
  2. CBC/Chem
  3. UA/urine culture
  4. Thoracic rads
  5. MRI/CT/myelogram T3-L3
  6. CSF
56
Q

DM testing (3)

A
  1. SOD-1 mutation - homozygous at risk or diseased
  2. can support dx with imaging
  3. not replacement for imaging
57
Q

Myelomalacia

A
  1. Clinical dx
  2. rapid progression of T3-L3 parapersis UMN -> LMN
  3. Imaging and CS supportive
  4. Ascending panniculus, loss of PL reflexes, anal tone, TL paresis, loss of ventilatory fxn
  5. NO TX -> Euthanasia
58
Q

Non-compressive myelopathies

A
  1. Fibrocartilagenous embolic myelopathy
    - these get better
  2. Acute non-compressive nucleus pulposus extrusion-ANNPE, Type III IVDD, COncussive/traumatic disc
  3. Ischemic infarction
59
Q

Evaluating non-compressive myelopathies

A
  1. peracute-acute
    - can progress w/in first 24 hours
  2. Non-painful
    - distinguish from anxiety
  3. Often assymmetrical
  4. Intramedullary spinal cord disease
    - non-surgical (generally improve on own)
60
Q

Typical FCE HX

A

young, large-breed dog, possible vigorous activity, animal jumps and screams and goes down

61
Q

Work up FCE, ANNPE, infarcs b/c

A
  1. If there is an underlying cause (for a stroke) want to treat underlying cause
  2. CBC/Chem - endocrinopathies, hepatopathy
  3. UA/UPC/TEG - Proteinuria, hypercoagulability
62
Q

FCE, ANNPE, Infracts TX

A
  1. Physiotherapy - only thing shown to help
  2. Great prog unless….
    - loss of pain, LMN localizations (lack muscle tone)
    - Intramedullary hemorrhage on MRI
63
Q

Diskospondylitis (5)

A
  1. Radiographic dx
  2. Usually multifocal
  3. Crosses joints/takes out endplates
  4. VERY PAINFUL
  5. rarely neuro deficits
64
Q

Disko common bact (4)

A
  1. Staph
  2. Strep
  3. E. coli
  4. Brucella - zoonotic, reportable
65
Q

Disko diagnostics/TX (3)

A
  1. urine culture; +/- blood culture
  2. Cephalexin, Clavamox, Baytril
  3. NSAIDS, Tramadol
    * if you’ve chosen correct abx will be less painful within days
66
Q

Disko Prog (3)

A
  1. good prog
  2. Requires long-term tx
  3. do rads every 2-3 months - monitor all the lesions
    * Avoid surgery
67
Q

Sequelae Disko

A

Pathologic fracture/luxation

68
Q

Lumbosacral dz (3)

A
  1. Working dogs - GSD/malinois
  2. Congenital - malformations
  3. Acquired - IVDD/proliferative
69
Q

Lumbosacral dz CS (5)

A
  1. Pain - reluctance to jump/climb
  2. Decreased withdrawal reflex
  3. +/- proprioceptive deficits
  4. Flaccid tail
  5. Urinary and fecal incontinence
70
Q

Lumbosacral dz TX

  • med
  • sx
A
  1. Med management
    - NSAIDS/prednisone
    - Gabapentin/tramadol
    - PT/acupuncture
  2. Surgical managment
    - dorsal laminectomy
    - foraminotomy
    - stabilization
71
Q

Lumbosacral dz prog (4)

A
  1. if only pain - attempt medical management
  2. If only pain and mild deficits - good with sx
  3. If severe deficits
    - fecal & urinary incontinence
    - poor prognosis
72
Q

Feline Spinal Diseases (6)

A
  1. Degenerative: IVDD (uncommon)
  2. Neoplasia: LSA, Meningioma
  3. Immune mediated/Inflammatory (uncommon)
  4. Infectious: Toxo, Crypto (COMMON)
  5. Trauma: traction inj/tail pull, fx/luxation
  6. Vascular: hemorrhagic/ischemic infarctions (common)
73
Q

Remember cats have no

A

nuchal ligament

74
Q

The down cat (5)

A
  1. Check for pulses, then doppler flow then paired novas
  2. CBC/Chem/T4/UA
  3. BP
  4. Met check thorax +/- AUS
  5. +/- MRI and CSF
75
Q

Feline IVDD (6)

A
  1. Extremely rare
  2. Older cats ~ 10 yrs old
  3. LUmbar L4-L5 most common
  4. Mineralized discs on rads
  5. Extrememly painful and fractious
  6. Very good px with sx
76
Q

Feline spinal Neoplasia (6)

A
  1. Spinal cord LSA
  2. Spinal cord Glial (cervical)
  3. Spinal cord fibrosarc (Thoracic)
  4. Vertebral column OSA
  5. Meningeal neoplasia
  6. Non-vertebral extradural neoplasia - plasma cell tum
77
Q

Feline Spinal infections (5)

A
  1. FIP: < 2 years old
  2. Bacterial myelitis
  3. Cryptococcus
  4. Toxoplasma
  5. Idiopathic inflammatory
78
Q

Recumbent care (3)

A
  1. Urine scald
  2. Decubital ulcers
  3. Muscle atrophy
79
Q

Bladder management (2)

A
  1. Acutely: indwelling u cath or express q6, or intermit cath if male
  2. Pharm:
    - Prazosin (1mg/15 kg PO q8h)
    - diazepam (0.5-1 mg/kg IV q8h)
80
Q

IVDD summary and can’t R/O…. (6)

A
  1. Can’t R/O GME
  2. Chondrodystrophoid breeds
  3. PEracute to acute onset
  4. Often painful
  5. Concussion vs compression
  6. CT/myelogram
81
Q

Vascular summary (6)

A
  1. FCE
  2. Ischemic/hemorrhagic event
  3. 3 yr old lab, frisbee, screams, down
  4. Can progress w/in 24 hrs
  5. Often assymetrical
  6. Non-painful - very anxious
82
Q

Chronic/slowly down dog summary (4)

A
  1. IVDD
  2. Wobbler-type lesions
  3. Degenerative: degenerative myelopathy
  4. LMN: polyneuropathy
83
Q

Wobbler-type Disorders IVDD, Type II (6)

A
  1. Caudal cervical
  2. Dobies, Weims
  3. Middle-aged
  4. Ventral compression
  5. Maybe dynamic
  6. chronic disorders
84
Q

Wobbler-type Disorder Dorsolateral compression (5)

A
  1. Osseus
  2. Articular proliferation, synovial cysts
  3. Malformed vertebrae/lamina
  4. Young giant breed dogs
  5. Cronic disorders
85
Q

Stereotypes

  1. IVDD
  2. FCE
  3. DM
  4. Other
A
  1. IVDD
    - Dachshund, beagle, shih tzu, Boston terrier
    - German Shepherd, Doberman, Labrador
  2. FCE
    - Lab, young-middle aged, active large breed dog
  3. DM
    - German shepherd, boxer, corgie, rhodesian ridgeback
  4. Other
    - Great dane, rottie, frenchie

Neuro junior (14 decks)

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