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Flashcards in Gaitero - Neurology Deck (84)
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1

Neurological Exam (6 steps)

1. Mental status
2. Gait / posture
3. CN exam
4. Postural reactions: Proprioception/Hopping
5. Spinal reflexes
- PL: Patellar / Withdrawal (flexor)
- TL: Withdrawal
- Cutaneous trunci, perineal
6. Palpation (back / neck pain)

2

3 goals of the neuro exam

1. Identify/confirm presence of a neurological problem
2. Localize the lesion within the nervous system
3. Others
 Assess severity/extension lesion  Prognosis

3

VITAMIN D stands for…

VASCULAR
INFLAMMATORY / INFECTIOUS
TRAUMATIC / TOXIC ANOMALOUS (congenital) METABOLIC
IDIOPATHIC
NEOPLASTIC / NUTRITIONAL
DEGENERATIVE

4

Spinal Cord Enlargements

There are two regional enlargements of the spinal cord for the innervation of the limbs:
· cervical intumescence C6-T2
composed of cord sections C6, C7, C8, T1, (T2)
· lumbosacral intumescence L4 to S3
composed of cord sections L4, L5, L6, L7, S1, S2, S3 (some say L5 to S1)

5

Intervertebral disc disease

Degenerative changes increase with repetitive compression (e.g. heavy lifting in flexion) or trauma (e.g. fall); degenerative changes may be asymptomatic

6

Where does the spinal cord terminate in large breed/small breed dogs & cats?

Large breed - L6
Small breed - L7
Cats - L7/S1

7

Canine Vertebral Formula

C-7, T-13, L-7, S-3

8

Spinal cord segmentation

Spinal cord divided in segments:
8 cervical
13 thoracic
7 lumbar
3 sacral
>= 2 caudal

9

3 types of ataxia

Proprioceptive
Cerebellar
Vestibular

10

Where is the LMN Cell body? Axon?

Ventral Grey horn
From PNS to muscle
Reflex motor activity

11

UMN Clinical signs

Paresis (weakness)
Decrease of inhibitory LMN reflex so spinal reflexes are increased or normal
Disuse mucle atrophy, increased muscle tone.
Usually proprioceptive ataxia

12

LMN Clinical signs

Paresis/paralysis
Decreased or absent reflex
Loss of muscle tone
Neurogenic muscle atrophy

13

Functional classification of the spinal cord (segments)

C1-C5
C6-T2
T3-L3
L4-S3

14

Extradural
Intradural-Extramedullary
Intramedullary

Outside the dura matter, but pushing pressure on the spinal cord
Inside the dura matter, but not in the actual cord
In the actual spinal cord

15

Clinical signs of spinal cord compression

1. Back/neck pain
2. Proprioceptive losses
3. Loss of motor/paresis
4. paralysis
5. loss of nociception (deep pain)

16

Differentials for acute myelopathies

Febrile cartilagonis embolism myleopathy
Spinal trauma
Intervertebral disc (IVD) herniation: extrusion

17

Annulus fibrosus

fibrous ring of intervertebral disk

18

Intervertebral disc (IVD) herniation: Extrusion vs. protrusion

Extrusion of mineralized nucleus pulposus into the vertebral canal (hansen type 1)- usually acute
Protrusion - usually chronic

19

Chondrodystrophic breeds/ages (w.r.t IVD herniation)

Daschunds, beagles, cockers, shih tzu (3-6 years old, rare < 2)

20

Location for IVD extrusion herniation

T11 - L3, cervical (uncommon to be T1-10;inter capital ligament)

21

IVD Extrusion diagnosis

Thoracic rads
Myelogram (CT)

22

IVD Extrusion treatment (surgical/when to use)

Surgical:
Thoracic:
Hemilaminectomy
Pediculectomy
Cervical: Ventral Slot
Use surgical if pain or neurological deficits

23

Hemilaminectomy

Remove part of a lamina of the vertebral arch in order to decompress the corresponding spinal cord and/or spinal nerve root.

24

pediculectomy

surgical removal of portions of vertebral pedicles at the level of the intervertebral foramen.

25

IVD Extrusion emergency

Loss of deep pain
Quick onset
Non-ambulatory (thoracic)
Tetraplegia (cervical)

26

IVD Extrusion treatment (conservative)

Strict cage confinement for 3-4 weeks
Pain killers (NSAIDs Opioids) +/-
First episode of pain without deficits (50% get better)

27

IVD Extrusion treatment (what not to use)

Never use NSAIDs + steroids
Never use anti-inflammatories without cage rest
Steroid use at all is controversial

28

IVD Extrusion - prognosis

Deep pain present? Yes: 90%
No? < 50%

29

Fibrocartilaginous embolic myelopathy (FCEM) - what is it?

Detachment of the IVD substance (nucleus pulposus) and lodging into a blood vessel - acute. Causes spinal cord ischemia due to the embolism in a spinal cord vessel
(thoracolumbar/cervical)

30

Fibrocartilaginous embolic myelopathy (FCEM) - breeds

Non-chondrodystrophic large breed dogs
Miniature schnauzers