SPINE - vascular

Question 1

List 6 different hypothesis as to how FCE occurs?

Answer 1

Direct penetration of nucleus pulposus fragment into spinal cord or vertebral vessels (vein>arteries but arteriovenous anastomosis in the epidural and periradicular space exist in dogs). Possibly facilitated by increased intrathoracic and intraabdominal pressure during coughing, straining, exercise or trauma (Valsalva’s manoeuvre)

Chronic inflammatory neovascularization (arterial and venous) of the degenerated intervertebral disc (annulus fibrosus)

Presence of embryonic remnant vessels within the nucleus pulposus (which is normally avascular in adults)

Mechanical herniation of nucleus pulposus into the vertebral bone marrow sinusoidal channels with subsequent retrograde entrance into the basivertebral vein and internal vertebral venous plexus.

Fibrocartilage arising from vertebral growth-plate cartilage in immature dogs gains entry into the vasculature

Metaplasia of the vascular epithelium that ruptures into the lumen and embolizes within the intrinsic spinal cord vasculature

Question 2

What are the risk factors for faecal incontinence in ANNPE?

Answer 2

Paraplegia
Spinal shock
No history of NSAIDs
CSA T2-hyperintensity >40%

Question 3

What is the three most common causes of non-traumatic hemorrhagic myelopathy?

Answer 3

Idiopathic (35%)
Angiostrongylus vasorum (18%)
SRMA (13%)

Question 4

Older age, vocalization at onset of clinical signs and spinal hyperesthesia during the clinical examination have all been found to be significantly more probable in dogs with ANNPE compared to dogs with FCE: true or false?

Answer 4

True

Question 5

What is the cut-off value for poor outcome in ANNPE? Urinary incontinence?

Answer 5

Maximal cross-section area of spinal cord on T2w transverse

Outcome: 90% (Se 86% Sp 96%)

Urinary incontinence: 40%

Question 6

What are the MRI and CT angiography findings with spinal epidural arteriovenous fistula in cats?

Answer 6

MRI: focal dilatation of the veins in the epidural space of the thoracic spinal cord.
Dilatation of the interarcuate branch & internal vertebral plexus

CTA: dilatation and enhancement from the intercostal vein to the azygos vein at the same site in the arterial phase.

Question 7

What is the most common presenting sign in dogs with bidirectional and continuous right-to-left shunting patent ductus arteriosus?

Answer 7

Hindlimb collapse

Question 8

Urinary incontinence occurs more frequently than fecal incontinence in ANNPE: true or false?

Answer 8

False

Urinary incontinence: 9%
Faecal incontinence: 24%

Question 9

In non-traumatic hemorrhagic myelopathy, the neurological severity is not associated with the outcome: true or false?

Answer 9

True

Overall, 64% of dogs had a good or excellent outcome, regardless of cause; which was increased to 100% for SRMA, 75% for A. vasorum and 75% for idiopathic NTSH.
Outcome was not associated with neurological severity. Recovery rate was 67% and 50% for nociception-intact and nociception-negative dogs, respectively.

Question 10

What are the risk factors associated with faecal incontinence in ANNPE? Urinary incontinence?

Answer 10

Faecal incontinence:
Paraplegia (4 times more likely)
Intramedullary hyperintensity >40% cross-sectional area (4 times more likely)
No NSAIDs (3 times more likely)
Spinal shock (2 times more likely)

Urinary incontinence:
Paraplegia (3 times more likely)
Intramedullary hyperintensity >40% cross-sectional area (4 times more likely)