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SA Med - Neuro - Myelopathies 1

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drraythe's version from 2017-09-19 02:39

Discospondylitis (DS)

Question Answer
What is Discospondylitis?Infxn of the intervertebral disk & adjacent vertebrae
Where is the most to least common locations to get discospondylitis?Lumbosacral > thoracolumbar > cervical
How does discospondylitis Infxn start?Hematogenous spread
Most common etiological agents for discospondylitis?Staphylococcus spp., Always consider Brucella canis if PTx is intact (rare but zoonotic)
Common signalment for Discospondylitis?Young to middle-aged large breed dogs - however, can happen to anyone (including cats).
What are CSs of DS? (neuro & systemic)NEURO: Back pain, stiff gait, kyphosis, reluctance to move. Less commonly paresis/paralysis, ataxia
SYSTEMIC: Inappetence, weight loss, lethargy, level (this is an Infxn, makes sense)
What can you do to Dx discospondylitis?Radiographs (+/- advanced imaging)
Culture of urine
Blood
Disk space
Bloodwork is rarely helpful
Tx & PTx for discospondylitis?TX: Antibiotic choice, often empiric. Also analgesics & confinement. Prog is good, should expect clinical response w/in 1 week. If not responsive, consider anaerobic bacteria or fungal → Aspergillosis (poor prognosis). Do Follow-up radiographs
Discospondylitis ≠ Spondylosis!!! DON'T CONFUSE THEM! What are they?Discospondylitis = Infxn of the intervertebral disk & adjacent vertebrae
Discospondylitis = smooth osteophytes on cranio-ventral & caudo- smooth osteophytes on cranio-ventral & caudo-ventral aspects of vertebral bodies. ventral aspects of vertebral body, can make briding btwn the 2
Infectious Myelitis- rare in dogs & cats, but consider these etiologies?DOGS: Canine distemper virus, Rocky Mountain spotted fever, Ehrlichia canis, Toxoplasma, Neospora
CATS: Feline infectious peritonitis (coronavirus), Toxoplasma
Which is more common- infectious or non-infectious myelitis?Infectious is rare - noninfectious is more common
Non-infectious myelitis/meningitis - what czs this? who gets this?Presumed autoimmune - only in dogs, not cats.
Granulomatous meningoencephalomyelitis -- signalment, Dx, Tx?(***SPINAL CORD DOESNT GET NECROTIZING TYPE) The sig/Dx/Tx is the same as for the brain version (granulomatous meningoencephalitis aka GME) so it's young to middle aged small breed dogs which is acute & progressive. Can do MRI, CSF analysis. Tx w/ immunosuppression.
Steroid responsive meningitis-arteritis (SRMA) is aka? What kinda Dz is this?Aka sterile, suppurative meningitis, ‘beagle pain syndrome’ -- its a non-infectious myelitis/meningitis
What is the common signalment (breed/age) of SRMA?Young (< 1-2 yr), Boxer, beagle, Bernese mountain dog, Nova Scotia duck tolling retriever, others
What are CSs of SRMA? Is it acute or chronic?ACUTE: severe neck pain, fever, malaise.
What will you see on your minimum database that can hint at SRMA?See a Peripheral neutrophilia (its a sterile suppurative meningitis so this makes sense)
CSF analysis w/ SRMA reveals?Marked neutrophilic pleocytosis (Nondegenerate neutrophils!!!!)
Markedly high protein
Xanthochromia
What can you use to monitor response to therapy w/ SRMA?C reactive protein (C-reactive protein (CRP) is a substance produced by the liver in response to inflammation)
How do you treat SRMA? Prog?Well...considering it is called STEROID-RESPONSIVE...steroids are a good bet: Prednisone at a tapering dose. Can stop if in remission for 6 mo- can restart if relapse occurs. Sometimes requires additional immunomodulation. Prog is excellent if no relapse. If relapse occurs, can be more difficult to get back into remission (back to immunosuppressive steroids, loooong taper)
Tumors Affecting the Spine → age? Breed? How does it present? Prog?Usually old, large breed dogs, present as progressive & painful. It is an overall poor prog.
4 types of 1° tumors affecting spine?Vertebral tumors
Neural tumors
Nephroblastoma
lymphoma
4 types of 2* tumors affecting spine?Hemangiosarcoma
Melanoma
Carcinomas
Lymphoma
4 types of vertebral tumors?Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Multiple myeloma
What is the most common spinal tumors of dogs?Sarcomas are most common spinal tumor of dogs (osteosarcoma) - Osteosarcoma is biologically aggressive & there is a Tendency to metastasize similar to appendicular osteosarcoma
What is radiographic Secondary evidence of a tumor?Bony lysis & prolif
What is Multiple Myeloma? What stuff will you see diagnostically (imaging & lab)/ clinically?This is a tumor of PLASMA CELLS, which can be anywhere where there is bone marrow (including spinal column). On rads you will see Lytic bone lesions, including vertebrae. You will also see Monoclonal gammopathy (abnormal protein (monoclonal protein, or M protein) is in the blood. M protein is produced by plasma cells, a type of white blood cell(a fully differentiated B cell which only produces 1 type of Ab).), Bence-Jones proteinuria (A Bence Jones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine, w/ a molecular weight of 22-24 kDa.[1] Detection of Bence Jones protein may be suggestive of multiple myeloma), Bone marrow plasmacytosis, Hypercalcemia (lots of osteolysis= released into blood)
What is Pamidronate- what is it useful for?It is a Bisphosphonate which inhibits bone resorption (bone resorption happens bc the cancerous cells are damaging or inhibiting the healthy ones → lysis) which means it is helpful for bone pain
What should you know about Tx mult myeloma w/ radiation? Sx?Radiation therapy alone will not relieve CSs (Palliative dose may help w/ bone pain). Surgical debulking done can be done, w/ hesitation: May relieve some CSs, but is not curative. Can predispose to pathologic fracture
3 types of neural tumorsMeningioma
Nerve sheath tumor
Glioma
***GOLF TEE SIGN is for which tumor?Meningioma
Where are meningiomas located in terms of the dura & cord? Which part of the spine are they most common in? How do you Dx?Intradural but extramedullary. Tend to occur in the cervical spinal cord. Dx w/ rads (GOLF TEE SIGN w/ contrast), Myelography, MRI
Tx & PTx of meningioma?Tx: Sx debulking or removal, +/- radiation therapy. prog is good to excellent
Nerve Sheath Tumor - location in terms of dura & cord? which segment of the spine do these like to be in? Where does it like to be peripherally?Intradural extramedullary location, Also a predilection for the cervical spinal cord (very similar to meningioma in this regard), If in Brachial plexus Starts in periphery & can travel proximally (locally invasive & extensive)
CSs of nerve sheath tumor?Cervical pain, Root signature, Monoparesis → hemiparesis → tetraparesis. However, Lower motor neuron signs only on affected limb. +/- Ipsilateral Horner’s syndrome, +/- Ipsilateral neg cutaneous trunci
How do you Tx nerve sheath tumor? Prog?Surgical debulking at the level of the spinal cord, then Follow up w/ radiation therapy (usually too extensive to remove the whole thing). Can also do amputation of the affected limb. PROG: If removed while in the periphery = excellent. If not, will be extremely locally invasive & will undoubtedly come back. Can achieve remission for ~ 6 mo
3 types of Gliomas?Astrocytoma
Oligodendroglioma
Ependymoma
Where are gliomas located (in terms of dura & cord), how common are they?Intramedullary in location, extremely rare
Tx options for glioma?(1) Myelotomy (cut into SC & try to remove tumor - but CRAZY invasive tumor) beware of exacerbation of signs though
(2) radiation therapy- Too rare to know survival times
Nephroblastoma - age & breeds? Location it likes to be (in terms of spinal segments as well as in regards to dura & cord)?YOUNG dogs, german shepherds predisposed (lol). Found in the thoracolumbar segments (T10-L2) - it is Intradural, extramedullary location
What IS a nephroblastoma? Tx?(Nephro = kidney, blastoma = tumor of undifferentiated cells) it is Neoplastic embryonic kidney tissue which goes up into spinal canal. Weird. it’s a kidney tumor in the vertebral canal
Tx: Combination of surgical debulking & radiation therapy
What is the most common spinal tumor of cats?Lymphoma (....yep.)
Where are spinal lymphomas located? (Primary & secondary) what are Tx options?1° = Extradural location. Metastatic/multicentric also often located in the extradural space. Tx: sx, radiation, chemo
Most metastatic tumors tend to be where?Tend to be intramedullary location (hemangiosarcoma, melanoma), but carcinomas tend to be extradural
If there is a breed you have to pick to be affected by SC problems...it is who?GSD of course!
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