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Year 4 Small Animal Studies > Neurology: Spinal Cord Disease > Flashcards

Neurology: Spinal Cord Disease Flashcards

1
Q

What history should be taken for spinal disease?

A
  • General
  • Signalment
  • Duration of CS
  • Speed of onset
  • Progressive or not
  • Pain
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2
Q

What are the grades of spinal clinical signs?

A

Grade 1- no defecits, just pain
Grade 2- paresis, ambulatory
Grade 3- paresis, non-ambulatory
Grade 4- paralysis
Grade 5- no pain sensation

Lesion location needs to be done

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3
Q

What are the differentials for spinal disease?

A
  • V- ishaemic myelopathies
  • I- SRMA, MUOs, discospondylitis, toxoplasmosis, neosporosis
  • T- fractures and luxations, ANNPE, AA instability
  • A- AA instability, chiari-like malformation, vertebral anomalies
  • N- spinal/vertebral neoplasia
  • D- IVDD, I and II, CSM, LSDS, DM
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4
Q

What vascular diseases can cause peracute onset of spnial disease?

A

FCE (fibrocartilaginous emboilism)
Stroke- cats

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5
Q

What trauma can cause peracute onset of spinal disease?

A
  • Acute non-compressive annulus pulposis extrusion
  • Fractures/luxations
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6
Q
  1. What causes ishaemic myelopathies?
  2. How do they present?
  3. What causes and FCE?
A
  1. Blood supply to spinal cord interupted
  2. Peracute, non-painful- signs often very lateralised, usually at excercise
  3. Fibrocartilage from nucleus pulposus embolises in spinal cord vasculature
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7
Q

What causes acute non-compressive nucleus pulposus extrusion?

A

Herniated nucleus pulposus is non-mineralised, causing mainly cord contusion with minimal compression

Aucte, non-painful, non-progressive

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8
Q

How is FCE and traumatic disc treated?

A

Surgery is not indicated

Tx
* supportive care and physiotherapy
* Median time to ambulation- 2 weeks
* Time to max recovery 3m

Prognosis
* neurological score at presentation
* extension of the lesion on MRI

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9
Q

How are fractures and luxations diagnosed?

What is the three compartment model?

A
  • Careful neurological examination
  • Thoracic and abdominal radiographs
  • Survey lateral radiographs of spine
  • Orthogonal views essential
  • CT/MRI may be helpful

Spine split- Dorsal, middle, ventral

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10
Q

How are fractures and luxations treated?

What shows poor prognosis?

A
  • Initial- stabilise and analgesia
  • Use 3 compartment rule- if unstable surgery or splint
  • Decompression if fragments compressing spinal cord
  • Splint if transporting

Lack of deep pain perception- usually spinal cord laceration- poor prognosis

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11
Q

What are acute/subacute causes of spinal disease?

A

IVDD type I (extrusion)
Infectious/inflammatory
* SRMA
* Discospondlylitis
* Spinal MUO meningomyelitis

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12
Q

What is a chondrodystrophic breed?

A

Short legs, long body

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13
Q

What is the difference between intervertebral disc degeneration between chondrodystrophic breeds and non-chondrodystrophic breeds?

A

Chondrodystophic- sausage dogs
* During first 2 years
* Chondroid metamorphosis
* IVD dehydrates and nucleus is invaded by hyaline cartilage
* Nucleus can mineralise

Non-chondrodystrophic breeds
* After middle age
* Fibroid metamorphosis
* IVD dehydrated and nucleus invaded by fibrocartilage
* Mineralisation less common

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14
Q

What is the difference between type I and II IVDD?

A

Type I
* herniation of the nucleus pulposus through annular fibres and extrusion of the nuclear material into the spinal canal

Type II
* Annular protrusion caused by shifting of central nuclear material, commonly associated with fibroid disc degeneration

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15
Q
  1. What age is usually affected by type I IVDD and type II?
  2. How does onset and signs vary between type I and II?
A
  1. Type I- 3-6y (sausage), 6-8 (non-sausage).
    Type II older non-sausage
  2. Type I- peracute, progressive, painful.
    Type II- slowly progressive, chonic onset, sometimes painful
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16
Q

How is intervertebral disc disease treated surgically and conservatively?

A

Conservative
* Strict rest 4-6 weeks
* Analgesia

Surgical
* Severe neurological defecits (3-5)
* Severe or recurrent pain
* Lack of improvement with conservative

17
Q

When is there very poor prognosis with IVDD?

A

Grade 5
Grade 4 without surgical

18
Q

What is the most common cause of neck pain in young dogs (6m-18m)

A

Steroid responsive meningitis-arteritis

19
Q

What are the clinical signs of steroid responsive meningitis-arteritis?
How is it diagnosed?
How is it treated?

A

Clinical signs
* Lethargy, anorexia, fever
* Cervical rigidity, spinal pain
* Often concurrent IMPA

Diagnosis
* CSF analysis- neutrophillic pleocytosis in acute form
mononuclear pleocytosis in chronic form

Treatment
* Corticosteroids for 6-9m
* Monitor with repeated CSF analysis or CRP

20
Q

What is discospondylitis?

How is it diagnosed and treated?

A

Discospondylitis- infection of IVD and adjacent vertebrae

Diagnosis:
* imaging- radiography- narrowing of IVD, roughening of endplates, proliferation of adjacent bone
* Bacteriology- blood, urine

Treatment
* Antibiotics- 8 weeks
* Analgesia

Most common L7-S1

21
Q

How does meningomyelitis of unknown orign present?

How it is diagnosed and treated?

A
  • Subacute, progressive
  • Often multifocal
  • Care as same breeds and often similar presentation to IVDD

Diagnosis
* MRI
* CSF- mononuclear or mixed pleocytosis (lot os lymphocytes)

Treatment
* Corticosteroids

22
Q

What are likely causes of chronic onset of spinal disease?

A

Neoplasia
Degenerative
* IVDD type II (protrusion)
* Cervical spondylomyelopathy
* Lumbosacral degenerative stenosis
* Vertebral and spinal abnormalities
* Degenerative myelopathy

Anomalous
* Spinal malformations
* Atlantoaxial instabiliity
* Chiari like malformations

23
Q

What are the three locations possible for spinal neoplasia?

How is it treated?

A
  • Extradural: primary, vertebral, metastatic, lymphoma
  • Intradural extramedullary: meningoma, nephroblastoma, nerve sheath, metastatic
  • Intradullar intramedullary: gliomas, ependymomas, metastatic

Treatment:
* Decompressive surgery
* Radiation
* Palliative

24
Q

What is the technical term for wobblers?

A

Cervical spondylomyelopathy

  • Short stilted gait and muscle atrophy in thoracic limbs
  • Signs worse in pelvic limbs
25
Q

What can cause cervical spondylomyelopathy?

A
  1. Protrusion of IVD (type II)
  2. Hypertrophy of ligamentum flavum and dorsal longitudinal ligament
  3. Hypertrophy of synovial membrane
  4. Stenosis of spinal canal
  5. Degenerative joint disease
26
Q

How can cervical spondylomyelopathy be treated?

A

Conservative
* Anti-inflammatories

Surgical
* Decompression vs distraction-stabilisation

27
Q

What are the signs of lumbosaral degenerative stenosis?

A
  • Reluctance to excercise, rise, jump into car, stairs
  • Lameness- nerve root (L7) signature
  • Lumbosacral pain
  • Monoparesis/paraparesis
  • Proprioceptive defecits, reduced withdrawal reflex, muscle atrophy
  • Urinary and/or faecal incontinence
28
Q

What can cause lumbosacral degenerative stenosis?

How is it treated?

A
  • type II IVDD
  • Sclerosis of vertebral endplates and articular processes
  • Hypertrophy of ligaments
  • Hypertrophy of synovial membranes
  • Foraminal stenosis
  • Ventral subluxation of sacrum

Conservative
* anti-inflammatories
* Gabapentin

Surgical treatment
* dorsal laminectomy
* dorsal fusion-fixation
* foraminotomy

29
Q

What are vertebral and spinal anomalies?

A
  • Spinal arachnoid diverticulae (SAD)
  • Butterfly vertebrae
  • Block vertebrae
  • Transitional vertebrae
  • Hemivertebrae
  • Spinal stenosis

Surgical decompression/stabilisation

Chronic onset, slowly progressive, non-painful

30
Q

What is degenerative myelopathy?
How is it diagnosed and treated?

A

Insidious, progressive ataxia and paresis of pelvic limbs, ultimately leading to paralysis
* T3-L3
* Asymmetrical
* Not painful

Diagnosis of exclsuion
No treatment- physio prolongs QoL

31
Q

What is atlantoaxial instability associated with?
What breeds are affected?
What are the clinical signs and treatment?

A
  • Aplasia/hypoplasia of dens
  • Young toy breeds
  • CS- neck pain, ataxia or tetraparesis
  • Tx- conservative splint for 6-12w, surgical
32
Q

What is chiari like malformation?

A

Mismatch between caudal fossa volume and its contents (cerebellum and brainstem)
Caudal displacement of cerebellum through foramen magnum

  • Hydromyelia- dilation of central canal
  • Syringomyelia- fluid filled cavity
  • Syringohydromyelia- both
33
Q
  1. What are the clinical signs of chiari-like malformation?
  2. How is it medically treated?
  3. How is it surgically treated?
A
  1. Neck pain, neck scratching (air guitar), torticollis (twisting of neck), thoracic limb weakness and atrophy
  2. Gabapentin, NSAIDs, furosemide, omeprazole
  3. 50% success
34
Q

What spinal disease can affect cats?

A
  • Neoplasia
  • Inflamm- abscess, FIP, discospondylitis, toxoplasmosis
  • Trauma
  • Vascular
  • IVDD
35
Q

What are indications for neurosurgery?

A
  • IVDD
  • CSM
  • LSDS
  • Trauma
  • Neoplasia
  • Malfomations
  • Infectious disease
36
Q

What is a hemilaminectomy?

A
  • Removal of one half of the vertebral arch mainly used in TL spine
  • Access to lateral and ventral SC allows for IV fenestration
37
Q
  1. What is a dorsal laminectomy?
  2. What is a ventral slot?
A
  1. Removal of dorsal spinous process and laminae- access to dorsal and dorsolateral SC (IVDD at LS, congenital malf, neoplasia)
  2. Slot like opening through IVD and cranial and caudal endplates of cervical vertebrae (Acess to ventral SC- IVDD)
38
Q

What to UMN bladder lesions cause?
What do LMN bladder lesions cause?

What are the following drugs used for to treat bladder problems?
Diazempam, Prazosin/phenobenzamine, bethanecol

A

UMN
* Lesions cranial to sacral SC
* Tense bladder difficult to express

LMN
* Lesions in sacral SC, sacral spinal nerces and plexus/pudenal nerve
* Floppy bladder- overflow and drippling

Diazepam- reduce urethral tone
Prazosin or phenobenzamine- reduce urethral tone (smooth muscle)
Bethanecol- detrusor contractoin- cholinergic stimulation

Year 4 Small Animal Studies (97 decks)

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