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Flashcards in Spinal disease Deck (66):
1

Contents - grey matter

nn cell bodies

2

Contents - white matter

AXONS ('tracts'):
- dorsal funiculus
- lateral funiculi
- ventral funiculus

3

Function - dorsal and lateral funiculi

sensory and proprioceptive tracts. Dysfunction --> ataxia

4

Function - ventral and lateral funiculi

motor (or UMN) tracts ). Dysfunction --> (UMN) paresis.

5

Function - LMN cell bodies

Ventral horn grey matter. Dysfunction --> (LMN) paresis

6

Name the 4 functional segments of SC

- C1-5
- C6-T2
- T3-L3
- L4-S3
(localising SC problem is essential for determining ddx)

7

T/F: spinal cord segments = vertebral bodies

false

8

What is the tapered termination of the spinal cord called?

conus medullaris

9

What is the cauda equina?

bundle of spinal nn and roots which originate in the conus medullaris of the SC

10

Define myelopathy. Categories?

= disorder of SC
- EXTRINSIC: extradural or intradural
- INTRINSIC: intramedullary (diffuse or focal)

11

Synonym - ataxia

incoordination

12

Define ataxia

loss of sense of awareness of body/limb position in space

13

What is ataxia? What type do you get in spinal disease?

- sensory phenomenon
- sensory or proprioceptive ataxia in spinal dz

14

Define paresis

- decreased voluntary mvt
- motor phenomenom
- UMN or LMN types

15

Define plegia

= complete loss of voluntary movement

16

Distinguish mono, para, tetra

- Mono = one limb affected
- Para = both HL affected
- Tetra = all 4 limbs affected

17

Define urinary/ faecal continence

ability to 'fill' and empty bladder/intestines voluntarily

18

Define urinary/faecal incontinence. Where is the problem?

- loss of ability to fill and empty bladder/intestines voluntarily
- UMN (CATS L2-5, DOGS L1-4) or LMN (S1-3)

19

How do you recognise animal with spinal disease?

CS and neuro exam

20

Why perform a neuro exam with suspected spinal dz?

1. confirms neuro nature of CS
2. determine neuro-anatomical localisation
3. determine prognosis (selected cases)

21

WHich parts of the neuro exam are important for spinal dz ddx?

- posture
- gait
- postural reactions
- spinal reflexes
- palpation
- nociception

22

Define kyphosis

spine curvature

23

What should you determine with gait in a neuro exam with a suspicion of spinal disease? 3 What might this mean?

- only paresis - neuromuscular or lumbosacral problem
- only ataxia - cerebellar or vestibular problem
- ataxia and paresis - spinal or brainstem problem

24

What is proprioception a reliable indicator for?

the presence of neurological disease. Not always useful for assessment of neuro-anatomical localisation

25

How do CS of extrinsic (compressive myelopathies) correlate with progression?

EARLY:
proprioception deficits
movment problems
nociception problems
LATE
(improvement occurs in reverse order to progression - i.e. proprioception will come back last)

26

Name 3 spinal reflexes

- patella
- withdrawal
- cutaneous trunci / panniculus
* important to ID which SC segment affected

27

What do decreased spinal reflexes suggest?

- LMN signs
- lesion located in reflex arc
- C6-T2 or L4-S3

28

What do exaggereated spinl reflexes suggest?

- UMN sign
- lesion located cranial from reflex arc
- C1-5 or T3-L3

29

Function - motor (UMN) tracts

- UMN 'tells' LMN what to do
- synapse on LMN in ventral horn grey matter

30

Function - UMN system

facilitates and to a greater extent inhibits mm goups. Net effect: inhibition of mm tone and reflexes

31

CS - UMN lesions

= disinhibition --> increased mm tone and reflexes

32

What part of the neuro exam should be done last?

palpation as can be painful (aggression etc). Start gently.

33

Outline use of nociception for spinal dz

- not always necessary
- can assist in determining prognosis
- do NOT confuse with withdrawal reflex
- positive reflex when there is conscious perception of pinch (head turn, pinch)

34

What does prognosis depend on?

1. diagnosis
2. function (neuro exam)

35

What is the msot important prognostic indicator?

- deep pain perception
- use an unequivocally noxious stimuli (haemostats on periosteum)

36

CS - C1-C5 lesion

- tetraparesis and ataxia all limbs
- proprioceptive deficits all limbs
* intact or increased spinal reflexes all limbs
- normal or increased mm tone all limbs

- horner's possible
- urinary dysfunction possible, uncommon
- tetraplegia uncommon (respiratory dysfunction - phrenic nn - occurs before plegia)

37

CS - lesion in C6-T2

- tetraparesis and ataxia all limbs
- proprioceptive deficits all limbs
* intact or decreased spinal reflexes in TL, intact or increased in HL*
- intact/decreased mm tone TL, intact/increased mm tone HL
* 'two-engine' or disconnected gait possible
- horner's possible
- urinary dysfunction possible, uncommon
- tetraplegia uncommon - respiratory dysfunction - phrenic nn - before plegia

38

Describe a 'two-engine gait in animals with C6-T2 myelopathy

- wide based ataxic HL
- short stilted TL
- TL and HL have different rhythm/engine

39

CS - lesion of T3-L3

- normal TL
- paraparesis and HL ataxia
- paraplegia possible
* intact/increased spinal reflexes pelvic limbs
- intact/ increased mm tone pelvic limbs
* urinary dysfunction common ('UMN bladder')
- Schiff-Scherrington posture (sometimes)

40

Describe the Schiff-Sherrington posture

- acute T3-L3 spinal injuries
- Borders cells affected (L1-L7): project to cervical intumescence, provide inhibition to extensor mm TL --> disinhibition with dysfunction --> paraplegia with increased extensor tone in TL
- ddx cervical lesion (TL neurologically normal)
- Indicates localisation, NOT prognosis

41

Where are border cells?

- dorsolateral border of ventral grey column of lumbar SC
- when affected --> Schiff-Scherrington posture

42

CS - lesion of L4-S3

- TL normal
- paraparesis and ataxia HL
- paraplegia possible
* intact/decreased spinal reflexes
- intact/decreased mm tone to HL
- urinary dysfunction uncommon ('LMN bladder')

- possible flaccid tail
- possible decreased perianal reflex

43

Which spinal cord segment(s) are affected if all 4 limbs affected?

C1-5 or C6-T2

44

Which spinal cord segment(s) are affected if only HL affected?

T3-L3 or L4-S3

45

If only HLs are affected or all 4 limbs are, how do you differentiate the cause?

look at spinal reflexes:
INCREASED: C1-5 or T3-L3 problem
DECREASED: C6-T2 or L4-S3

46

Where is the lesion in a two-engine gait?

C6-T2

47

Components of 5/6 finger rule

- localisation
- signalment
- onset
- progression
- symmetry
- pain

48

T/F: presence of pain excludes several problems

True

49

T/F: not many disorders are truly asymmetrical

True

50

Ddx - common spinal diseases in dogs

- IVDD (Type 1 and 2)
- Ischaemic myelopathy (IM)
- neoplasia
- syringomyelia (SM)
- immune-mediated
- inflammatory

51

Ddx - common spinal diseases in CATS

- Infectious/inflammatory - FIP
- Trauma: fracture/ luxation
- Neoplasia: lymphoma (young), meningioma (old)

52

Define CSM

Cervical spondylomyelopathy

53

Define CM/SM

Chiari-like malformation/ syringomyelia

54

Define IVDE

Intervertebral disc extrusion

55

Which spinal diseases have pain only (no neurological deficits)? 2

- CM/SM
- SRMA

56

Define SRMA

Steroid responsive Meningitis and Arteritis

57

Which spinal diseases have neuro deficits +/- pain? 6

- IM or HVLV
- IVDE
- IVDP
- CSM
- Neoplasia

58

Define HVLV

High velocity low volume disc extrusion

59

How many disease account for 91% spinal disease cases?

91%

60

Outline CSM

- younger dogs
- chronic onset

61

Outine spinal neoplasia

- older, larger
- chronic onset
- localised
- deteriorating

62

Outline IVDD

- older
- chronic onset
- often stable
- painful

63

Outline IVDE

- middle aged and older
- smaller
- acute
- non-lateralised
- deteriorating
- painful

64

Outline IM / HVLV

- medium/large breed
- peracute onset
- stable or improving
- lateralised
- often non-painful

65

Outline CM/ SM

- CKCS

66

What age does SRMA affect?

usually