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Neuro > Spinal Dz > Flashcards

Spinal Dz Flashcards

1
Q

What are the white and grey matter in the spinal cord?

A 
> Grey matter
- Butterfly shape 
- nerve cell bodies
> White matter 
- axons 
- dorsal, lateral and ventral funiculus
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2
Q

What is contained in the dorsal and lateral funiculi? What would damage to thee cause?

A
  • sensory and proprioceptive tracts (Ascending)

> ataxia

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3
Q

What is contained in the ventral and lateral funiculi? What would damage to these cause?

A
  • motor (UMN) tracts (descending)

> UMN paresis

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4
Q

What is comtained in the ventral horn of the grey matter? What would damage here cause?

A

LMN cell bodies

> LMN paresis

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5
Q

Where do the majority of spinal diseases affect?

A

Most dorsal and ventral equally. Some only dorsal or ventral .

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6
Q

What are the 4 functional segments of the SC?

A
  • C1-C5
  • C6-T2
  • T3-L3
  • L4-S4
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7
Q

Do spinal cord segments = vertebral bodies?

A

NO!!

  • Spinal cord doesnt reach end of vertebral canal (cauda equina from L6/&)
  • so L7, S1, S2, S3 spinal cord segments exit around L5 vertebral body
  • then “conus medullaris” then becomes cauda equina
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8
Q

What does “myelopathy” mean?

A 
- disorder of the SC 
> extrinsic (pushes on cord) 
- extradural/intradural 
> intrinsic 
- intramedullary (diffuse or focal)
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9
Q

Define ataxiA

A
  • incoordination
  • sensory phenomenon
  • sensory/proprioceptive ataxia seen w/ spinal dz
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10
Q

Define paresis

A
  • v voluntary movement
  • motor phenomenon
  • can be UMN or LMN
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11
Q

Define plegia

A
  • abscence (complete loss) of voluntary movement
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12
Q

What do mono- para- hemi- and tetra- describe?

A

= one limb
= both pelvic limbs
= both limbs one side
= all 4 limbs

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13
Q

Define incontinence

A
  • loss of ability to fill and empty the bladder/intestines voluntariy (can be UMN or LMN)
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14
Q

Are nociception tests always indicated in the neuro exam?

A

NO if gait fine and no proprioceptive losses then no need (will be last tract to go)

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15
Q

What postural signs may be see nwith spinal dz?

A
  • crouched, kyphosis
  • low head carriage
  • shiff-sherrington (T3-L3 lesions specifically)
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16
Q

What gait abnormalaities may be seenw tih spinal dz?

A

> often ataxia and paresis combination

  • ataxia and paresis ddx: spinal or brainstem
  • only paresis: consider NMJ or lumbosacral problems
  • only ataxia: consider cerebellar/vestibular problems
17
Q

How do large breed neck problems commonly present?

A
  • hindlimbs affected, minimal forelimb involvement (HL tracts are more superficial than FL)
18
Q

What are proprioceptive deficits useful for?

A
  • determining presence of neurological disease

- NOT useful for assessing neuro-anatomical location of disease

19
Q

With compressive (extrinsic) myelopathies, what clinical signs manifest early/late in the disease?

A

lost first and regained last
- proprioception (so if gait is abnormal, should have lack of proprioception)
- movement (paresis/plegia and voluntary urination)
- nociception (superficial then deep pain)
lost last and regained first

20
Q

So if the gait is abnormal but there are NO propriception deficits, what can be inferred?

A
  • not a compressive spinal dz

> eg. may be bilat cruciate rupture

21
Q

What are spinal cord reflexes important for?

A
  • ID which spinal cord segment is affected
    > patella
    > withdrawal
    > cutaneous trunci
  • decreased indicate LMN signs of a lesion within the reflex arc (ie. C6-T2 or L4-S3)
  • increased/exagerated reflexes indicate UMN sign of lesion CRANIAL to reflex arc (ie. C1-C5 or T3-L3)
22
Q

Where do UMN and LMN synapse?

A
  • ventral horn grey matter
23
Q

Action of UMN?

A
  • facilitates and to a greater extent inhibits muscle groups (net effect = inhibition of muscle tone and reflexes)
  • UMN lesions -> disinhibiition -> ^ tone and reflexes
24
Q

When should palapation be perfeormed within the neuro exam?

A

end!! start gently

25
Q

What is nociception useful for?

A

Determining prognosis in severe cases

  • not necessary to always perform
  • if you do perform, must be an unequivocally noxious stimulus (haemostats on periosteum) Dont go light!
  • do nto confuse with withdrawal REFLEX
  • concious nocicpetion requires behavioural response
26
Q

Other than deep pain, what is prognosis based on?

A
  • diagnosis

- function (neuro exam)

27
Q

What signs do C1-C5 spinal cord lesions present with?

A
  • tetraparesis and ataxia in all 4 limbs
  • proprioceptive deficits in all 4 limbs
  • intact or INcreased spinal reflexes in all 4 limbs
  • normal/increased muscle tone all 4limbs
    +- Horner’s syndrome
    +- urinary dysfunction (uncommon)
    +- tetraplegia uncommon (respiratory distress d/t phrenic n. involvement will occour before tetraplegia)
28
Q

What signs do C6-T2 spinal cord lesions present with?

A
  • tetraparesis and ataxia in all 4 limbs
  • proprioceptive deficits in all 4 limbs
  • intact or DEcreased tone and spinal reflexes in thoracic limbs
  • intact or INcreased tone and spinal reflexes in pelvic limbs
    +- 2 engine disconnected gait
    +- Horner’s syndrome
    +- urinary dysfunction (uncommon)
    +- tetraplegia uncommon (respiratory distress d/t phrenic n. involvement will occour before tetraplegia)
29
Q

What signs do T3-L3 spinal cord lesions present with?

A
  • normal thoracic limbs
  • paraparesis and ataxia of the pelvic limbs
  • paraplegia possible
  • intact or INcreased tone and spinal reflexes pelvic limbs
  • Urinary dysfunction common (“UMN bladder”)
    +- Shiff-Sherrington
30
Q

What is Shiff-Sherrington and when is it seen?

A

> Acute T3-L3 SC injury
Border cells (L1-L7 segments) affected
- project to cervical intumescence
- provide inhibitioin to extensory muscles thoracic limbs -> disinhibition
- paraplegia with ^ extensor tone in the thoracic limbs
Ddx cervical lesion
- thoracic limbs neurologically normal (reflexes and movement)
indicates localisatino not prognosis

31
Q

What signs do L4-S4 spinal cord lesions present with?

A
  • thoracic limbs normal
  • paraparesis and ataxia pelvic limbs
  • paraplegia possible
  • intact/decreased tone (pelvic limbs) and spinal reflexes all imbs
  • urinary dysfunction common (“LMN bladder”)
    +- flaccid tail
    +- possible decreased perianal reflex
32
Q

Clinical spinal neuro-anatomical localisation

A 
> neuological? 
- look for proprioceptive deficits
> how many limbs affected? 
- 4 = C1-C5 or C6-T2
- pelvic only = T3-L3 or L4-S3
> Spinal reflexes to narrow down 
- ^ = C1-C5 or T3-L3
- v = C6-T2 or L4 - S3 
> 2 engine gait? 
- C6-T2
33
Q

2 main ways of obtaining accurate ddx ?

A

> Classical pathophysiological - DAMNITV

> 5 or 6 finger rule (Holger and Patricks)

34
Q

What are the 6 fingers of the 6 finger rule?

A
  1. localisation
  2. signalment (cats v dogs, look up uncommon breeds, age)
  3. onset (peracute/acute/chronic)
  4. progression (few disorders spontaneously improve, care in 1st 24hrs)
  5. symmetry (few disorders truly assymetric)
  6. pain (excludes several condiitons)
35
Q

Most common spinal dz in dogs

A
  • IVDD (type 1 and 2)
  • Ischaemic myelopathy
  • Neoplasia
  • Syringomyelia
  • Immune-mediated/inflammatory
36
Q

Most common spinal dz in cats

A
  • Infectious/inflammatory (FIP)
  • Trauma (Fx/luxation)
  • Neoplasia (lymphoma if young, meningioma if older)
37
Q

Look at flow chart for diagnosing spinal disease

A

print??

38
Q

further reading

A
  • a practical guide to canine and feline neurology 2nd edition 2008 (Ed. DW Dewey) Chp 10: myelopathies
  • BSAVA manual of SA neurology 4th edition, 2013 (Eds S Platt and N Olby) chp 13 neck and back pain; chp 14 tetraparesis, chp 15 paraparesis

Neuro (30 decks)

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