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Flashcards in Spinal Dz Deck (38):

What are the white and grey matter in the spinal cord?

> Grey matter
- Butterfly shape
- nerve cell bodies
> White matter
- axons
- dorsal, lateral and ventral funiculus


What is contained in the dorsal and lateral funiculi? What would damage to thee cause?

- sensory and proprioceptive tracts (Ascending)
> ataxia


What is contained in the ventral and lateral funiculi? What would damage to these cause?

- motor (UMN) tracts (descending)
> UMN paresis


What is comtained in the ventral horn of the grey matter? What would damage here cause?

LMN cell bodies
> LMN paresis


Where do the majority of spinal diseases affect?

Most dorsal and ventral equally. Some only dorsal or ventral .


What are the 4 functional segments of the SC?

- C1-C5
- C6-T2
- T3-L3
- L4-S4


Do spinal cord segments = vertebral bodies?

- Spinal cord doesnt reach end of vertebral canal (cauda equina from L6/&)
- so L7, S1, S2, S3 spinal cord segments exit around L5 vertebral body
- then "conus medullaris" then becomes cauda equina


What does "myelopathy" mean?

- disorder of the SC
> extrinsic (pushes on cord)
- extradural/intradural
> intrinsic
- intramedullary (diffuse or focal)


Define ataxiA

- incoordination
- sensory phenomenon
- sensory/proprioceptive ataxia seen w/ spinal dz


Define paresis

- v voluntary movement
- motor phenomenon
- can be UMN or LMN


Define plegia

- abscence (complete loss) of voluntary movement


What do mono- para- hemi- and tetra- describe?

= one limb
= both pelvic limbs
= both limbs one side
= all 4 limbs


Define incontinence

- loss of ability to fill and empty the bladder/intestines voluntariy (can be UMN or LMN)


Are nociception tests always indicated in the neuro exam?

NO if gait fine and no proprioceptive losses then no need (will be last tract to go)


What postural signs may be see nwith spinal dz?

- crouched, kyphosis
- low head carriage
- shiff-sherrington (T3-L3 lesions specifically)


What gait abnormalaities may be seenw tih spinal dz?

> often ataxia and paresis combination
- ataxia and paresis ddx: spinal or brainstem
- only paresis: consider NMJ or lumbosacral problems
- only ataxia: consider cerebellar/vestibular problems


How do large breed neck problems commonly present?

- hindlimbs affected, minimal forelimb involvement (HL tracts are more superficial than FL)


What are proprioceptive deficits useful for?

- determining presence of neurological disease
- NOT useful for assessing neuro-anatomical location of disease


With compressive (extrinsic) myelopathies, what clinical signs manifest early/late in the disease?

lost first and regained last
- proprioception (so if gait is abnormal, should have lack of proprioception)
- movement (paresis/plegia and voluntary urination)
- nociception (superficial then deep pain)
lost last and regained first


So if the gait is abnormal but there are NO propriception deficits, what can be inferred?

- not a compressive spinal dz
> eg. may be bilat cruciate rupture


What are spinal cord reflexes important for?

- ID which spinal cord segment is affected
> patella
> withdrawal
> cutaneous trunci
- decreased indicate LMN signs of a lesion within the reflex arc (ie. C6-T2 or L4-S3)
- increased/exagerated reflexes indicate UMN sign of lesion CRANIAL to reflex arc (ie. C1-C5 or T3-L3)


Where do UMN and LMN synapse?

- ventral horn grey matter


Action of UMN?

- facilitates and to a greater extent inhibits muscle groups (net effect = inhibition of muscle tone and reflexes)
- UMN lesions -> disinhibiition -> ^ tone and reflexes


When should palapation be perfeormed within the neuro exam?

end!! start gently


What is nociception useful for?

Determining prognosis in severe cases
- not necessary to always perform
- if you do perform, must be an unequivocally noxious stimulus (haemostats on periosteum) Dont go light!
- do nto confuse with withdrawal REFLEX
- concious nocicpetion requires behavioural response


Other than deep pain, what is prognosis based on?

- diagnosis
- function (neuro exam)


What signs do C1-C5 spinal cord lesions present with?

- tetraparesis and ataxia in all 4 limbs
- proprioceptive deficits in all 4 limbs
- intact or INcreased spinal reflexes in all 4 limbs
- normal/increased muscle tone all 4limbs
+- Horner's syndrome
+- urinary dysfunction (uncommon)
+- tetraplegia uncommon (respiratory distress d/t phrenic n. involvement will occour before tetraplegia)


What signs do C6-T2 spinal cord lesions present with?

- tetraparesis and ataxia in all 4 limbs
- proprioceptive deficits in all 4 limbs
- intact or DEcreased tone and spinal reflexes in thoracic limbs
- intact or INcreased tone and spinal reflexes in pelvic limbs
+- 2 engine disconnected gait
+- Horner's syndrome
+- urinary dysfunction (uncommon)
+- tetraplegia uncommon (respiratory distress d/t phrenic n. involvement will occour before tetraplegia)


What signs do T3-L3 spinal cord lesions present with?

- normal thoracic limbs
- paraparesis and ataxia of the pelvic limbs
- paraplegia possible
- intact or INcreased tone and spinal reflexes pelvic limbs
- Urinary dysfunction common ("UMN bladder")
+- Shiff-Sherrington


What is Shiff-Sherrington and when is it seen?

> Acute T3-L3 SC injury
> Border cells (L1-L7 segments) affected
- project to cervical intumescence
- provide inhibitioin to extensory muscles thoracic limbs -> disinhibition
- paraplegia with ^ extensor tone in the thoracic limbs
> Ddx cervical lesion
- thoracic limbs neurologically normal (reflexes and movement)
> indicates localisatino not prognosis


What signs do L4-S4 spinal cord lesions present with?

- thoracic limbs normal
- paraparesis and ataxia pelvic limbs
- paraplegia possible
- intact/decreased tone (pelvic limbs) and spinal reflexes all imbs
- urinary dysfunction common ("LMN bladder")
+- flaccid tail
+- possible decreased perianal reflex


Clinical spinal neuro-anatomical localisation

> neuological?
- look for proprioceptive deficits
> how many limbs affected?
- 4 = C1-C5 or C6-T2
- pelvic only = T3-L3 or L4-S3
> Spinal reflexes to narrow down
- ^ = C1-C5 or T3-L3
- v = C6-T2 or L4 - S3
> 2 engine gait?
- C6-T2


2 main ways of obtaining accurate ddx ?

> Classical pathophysiological - DAMNITV
> 5 or 6 finger rule (Holger and Patricks)


What are the 6 fingers of the 6 finger rule?

1. localisation
2. signalment (cats v dogs, look up uncommon breeds, age)
3. onset (peracute/acute/chronic)
4. progression (few disorders spontaneously improve, care in 1st 24hrs)
5. symmetry (few disorders truly assymetric)
6. pain (excludes several condiitons)


Most common spinal dz in dogs

- IVDD (type 1 and 2)
- Ischaemic myelopathy
- Neoplasia
- Syringomyelia
- Immune-mediated/inflammatory


Most common spinal dz in cats

- Infectious/inflammatory (FIP)
- Trauma (Fx/luxation)
- Neoplasia (lymphoma if young, meningioma if older)


Look at flow chart for diagnosing spinal disease



further reading

- a practical guide to canine and feline neurology 2nd edition 2008 (Ed. DW Dewey) Chp 10: myelopathies
- BSAVA manual of SA neurology 4th edition, 2013 (Eds S Platt and N Olby) chp 13 neck and back pain; chp 14 tetraparesis, chp 15 paraparesis