Week 4- Head and Spinal Pain In Young Cats and Dogs Flashcards
What are the three different types of spinal tumours?
- Extradural
- Intradural Extramedullary
- Intramedullary
How would you do a vertebral column assesment?
- Press on either side of the spinous processes.
- Epaxial muscles: Pressing can help identify muscleassociated pain.
- Articular or transverse processes: Squeezing these can
confirm nerve root pain, especially in the caudal
cervical and lumbar regions.
How would you do a neck evaluation?
- Perform cautious flexion, extension, and lateral turning
of the head and neck. - Place the palm on the side of the neck to detect
resistance. - Encourage voluntary movement by tempting the animal
with food moved side to side. - Dogs with neck pain may restrict head and ear shaking
(less vigorous movement). - Cervical pain should be localised to the cranial, middle,
or caudal cervical segments.
How might you do a thoracolumbar spine assesment?
Place a hand on the abdomen to detect muscle
tension as painful areas are approached.
* Press on the ribs to check for thoracic vertebral pain
How might you do a lumbosacral spine assesment?
Usually performed with the animal standing, but some
prefer lateral recumbency to minimise pressure
transfer to the hips.
* Hip extension may provoke a pain reaction in caudal
lumbar and lumbosacral disease
How might you do a tail manipulation?
- Dorsiflexion of the tail may worsen lumbosacral joint
pain by shifting the craniodorsal sacrum forward. - Important for assessing the lumbosacral,
sacrococcygeal, and coccygeal intervertebral discs
How would you examine head and cranial structures?
Palpate the temporal muscles and mandible
* Open and close the mouth to assess for cranial
pain or TMJ involvement.
How would you do a peripheral nerve assesment?
Palpate the axilla to check for brachial plexus
involvement.
* Palpate the sciatic nerve where it passes caudal
to the greater trochanter, femur, and stifle.
What are the two most common immune-mediated diseases?
Meningoencephalitis of unknown origin (MUO) – 47.5%
* Steroid-responsive meningitis-arteritis (SRMA) – 30.7%
What are the two most common infectious conditions?
Discospondylitis – 9.3%
* Otogenic intracranial infection – 2.2%
What is SRMA?
Immune-mediated, non-infectious inflammatory disease of young to juvenile
dogs.
* Affects the meninges and blood vessels, leading to pain, fever, and neurological
deficits.
What is the pathogenesis of SRMA?
Immune dysregulation
Th2 and Th17-mediated immune response
Overproduction of IL-4 and IL-6 and IL-17
Neutrophil infiltration leads to severe inflammation in the
meninges.
What are the clinical signs of acute form SRMA?
Fever (pyrexia)
* Severe cervical pain (neck hyperesthesia)
* Reluctance to move (hunched posture)
* Depression and lethargy
* Mild neurological deficits (in some cases)
What are the clinical signs of chronic SRMA?
Occurs after insufficient treatment or relapses.
* Neurological deficits (ataxia, paresis).
* Spontaneous haemorrhage
What would be the laboratory findings for SRMA?
Elevated C-reactive protein (CRP) and
other acute phase proteins.
Neutrophilia with left shift.
What are the likely diagnostic findings in SRMA?
Associated immune
medicated polyarthritis
common
Can have cardiac
abnormalities
What is the first-line therapy for SRMA?
Glucocorticoids (Prednisolone
Initial dose: 2–4 mg/kg q24h.
* Gradual tapering over 6+ months.
What is the immunosuppressive therapy for SRMA?
Azathioprine (2 mg/kg q24h)
* Cytosine arabinoside (IV or SC protocols)
* Mycophenolate mofetil (20 mg/kg q24h)
What is the supportive care for SRMA?
Pain management, monitoring CRP levels, periodic CSF analysis.
What is the future research/ clinical implications on SRMA?
Need for prospective studies on new
immunomodulatory treatments.
* Monoclonal antibodies targeting IL17 as a potential therapy.
* Genetic research to improve
breeding strategies and reduce SRMA
prevalence.
* SRMA as a model for human
immune-mediated vasculitis (e.g.,
Kawasaki disease)
Name 4 types of meningoencephalitis of unknown origin
- Granulomatous meningoencephalomyelitis
- Necrotising meningoencephalitis
- Necrotising leukoencephalitis
- Eosinophillic meningencephalomyelitis
What is GME?
Angiocentric granulomatous inflammation, primarily
affecting the brainstem and cerebellum
What is NME?
Necrotic lesions in the cortical grey matter, with T-cell infiltration.
What are the clinical signs of MUO?
Spinal pain
* Seizures
* Ataxia and proprioceptive deficits
* Vestibular signs (head tilt, circling, loss of balance)
* Cranial nerve deficits
* Blindness
What is MUA characterised by?
immune dysregulation
What are the main treatments for MUO?
Glucocorticoid (prednisolone)
* Immunosuppression to reduce inflammation but does not cure
* Long terms use adverse effects
* Attempts to withdraw lead to disease relapse
What are the additional immunosuppressive medications for MUO?
Cytarabine (Cytosine Arabinoside)
*A chemotherapy agent that suppresses immune cell proliferation.
*Often given as intermittent injections or continuous infusions.
*Cyclosporine
*Suppresses T-cell activation, potentially useful for T-cell-driven NME.
*Mycophenolate mofetil
*Inhibits lymphocyte function.
*Leflunomide
*Used for autoimmune diseases, but data on MUO is limited.
*Azathioprine
*A purine analog that inhibits DNA synthesis in rapidly dividing immune cells.
What factors are associated with a poor MUO prognosis
- Severe neurological signs (seizures, altered mentation, cranial nerve deficits).
- Higher body weight and advanced age.
- Elevated CSF cell counts and CSF hyperlactatemia.
- Severe MRI abnormalities, including foramen magnum herniation and brainstem involvement
What is canine chiari and syringomyelia?
brain is too big for the skull
What are the clinical/ behavioural signs of Chiari pain?
- activity change
- sleep disruption
- sleep with elevated head
- change in behaviour to other people
What is syringomyelia?
central spinal cord syndrome with central
neuropathic pain
presence of fluid filled cavity- syrinx
What are the symptoms of syringomyelia?
- Phantom scratching
- Weakness
- Thoracic limb muscle atrophy
*Proprioceptive deficits
What is discospondylitis?
Infection of IVD and vertebral endplate
What animals is discospondylitis most common in?
Young and Old Large breed dogs- e.g great Danes
What is the main source of discospondylitis infection?
- UTI
- Haematogenous
- Migrating foreign body
How might you diagnose a discospondylitis infection?
- Diagnostic imaging
- Culture
- Brucellosis testing
What is acute intervertebral disc extrusion?
sudden and severe herniation of the gel-like centre
What dogs is atlantoaxial instability most common in?
Young toy dog breeds
