SA Med - Neuro - Myelopathies 2

drraythe's version from 2017-09-19 02:12


Question Answer
Congenital disorders obv affect younger PTxs more - how painful do they tend to be? How progressive do they tend to be? How easy is Tx?Tend to be non-painful & static in level of dysfunction, but there is little in the way of Tx options
4 types of Vertebral Malformations? What should you know about vertebral malformations in terms of problems you are seeing in your PTx?TYPES: Hemivertebrae (wedge-shaped vertebrae), Block vertebrae(failure of separation of 2 or more adjacent vertebral bodies), Butterfly vertebrae (failure of fusion of the lateral halves of the vertebral body), Transitional vertebrae (have the characteristics of 2 types of vertebra)--- know that these malformations are often RED HERRINGS-- as in they are obvious an easy to Dx, but rarely the actual problem unless the signalment matches up. If its a 12yo bulldog w/ a hemivert & new neuro signs...its prolly not the hemivert thats the prb
What can vertebral malformations lead to?Misshapen vert canal- kyphosis (hunchback), lordosis (saddleback), scoliosis (side to side malformation)
Which breeds are most likely to get hemiverts?Squishy faced curly tailed dogs are most at risk for hemi verts. the hemiverts make the tail curly, but prob if hemiverts are further up
What is Spina Bifida? Where does this tend to occur?Failure of the vertebral column to close on midline. Can be varying degrees of severity. There is Predilection for caudal lumbar vertebrae
What CSs might be associated w/ spina bifida? Tx?Has predilection for Ca lumbar verts, so can see Urinary/fecal incontinence, Rare paraparesis/ataxia. Can also have Can have accompanying neural tissue abnormalities, such as Meningocele (Protrusion of the membranes that cover the spine & part of the spinal cord through a bone defect in the vertebral column), or Myelomeningocele (including SC).... Tx is largely symptomatic
Sacrocaudal dysgenesis/agenesis - WHO tends to get this? What problems is it associated w/? Tx?Autosomal dominant trait in MANx cat, Associated w/ megacolon/constipation. Symptomatic Tx
Atlantoaxial Instability - (obv btwn C1 & C2) what are the 2 types of malformations which can lead to this problem?can be due to Dens hypoplasia or aplasia, or Lack of ligamentous support
Which is more likely to move in atlantoaxial instability- atlas or axis? In what direction? What major problem results in this movement?Dorsal subluxation/luxation of axis compared to atlas → Spinal cord compression
Typical signalment for Atlantoaxial Instability? (age/breed)Young toy breeds
CSs of atlantoaxial stability?C1-5 myelopathy (varying severity), Intermittent pain
For AA instability, what should you consider w/ taking radiographs to Dx?How they are positioned!!
What are the possible medical/sx Txs for AA instability? Prog?Medical: External coaptation (padded brace), cage rest 6-8wk. SX: Various implants, bone graft. PROG: Fair to excellent w/ surgery (If survive perioperative period, Better pre-op status= better prognosis post-op). Fair to good w/ conservative Tx
Chiari-like Malformation: signalment? (Age & breed)Young to middle aged, Cavalier King Charles spaniel, Other toy breed dogs
What is Chiari-like Malformation again? How does it affect the SC?Basically, Caudal fossa is too small for its contents bc of Occipital hypoplasia. This leads to Compression & herniation of the cerebellum, & Brainstem kinking/cervicomedullary compression. SEQUELAE: (1) Secondary meningeal hypertrophy/b& of fibrosis
(2) Can lead to the development of syringohydromyelia*** (syrinx) (CSF collecting in spinal cord)
CSs of Chiari-like malformation?*****Cervical pain
Phantom scratching
Vestibular syndrome
Facial paresis
What will you see on MRI w/ Chiari-like malformation?Occipital hypoplasia or dysplasia, Herniation of the cerebellum, Kinking of the brainstem/cervical spinal cord, SYRINGOHYDROMYELIA (syrinx) (pic of syrinx on MRI)
What is the medical vs sx Tx for Chiari-like malformation?Medical: As for hydrocephalus & quadrigeminal cyst, (1) Omeprazole ((it's a H+ pump blocker but they have no idea why this help, it just does).
(2) Corticosteroids *SHORT TERM use only. ) Plus gabapentin (To treat neuropathic pain). SURGICAL: Foramen magnum decompression, +/- cranioplasty
How does neuropathic pain happen?A Dz entity of its own, Develops secondary to primary CNS or nerve injury. W/ Syringohydromyelia, Pathology in the dorsal part of the spinal cord, Itch/pain perceived w/ lack of stimulus: Paresthesia (an abnormal sensation, typically tingling or pricking (“pins & needles”), czd chiefly by pressure on or damage to peripheral nerves.), Dysesthesia (act of touching a part of the body czs some unpleasant sensation, such as pain), Allodynia (painful response to nonpainful stimuli)
Degenerative Myelopathy signalment? (Age, breeds)Older medium to large breed dogs, GSD, Boxer, corgi, Bernese mountain dog, Chesapeake Bay retriever, Rhodesian ridgeback
What is the pathophys of degenerative myelopathy?SOD-1 mutation Unknown exact mechanism of action of degeneration
What are the CSs of degenerative myelopathy? are they acute or chronic?Chronic, NONPAINFUL, progressive T3-L3 myelopathy. (Paraparesis → paraplegia) can progress to Tetraparesis/tetraplegia, brain stem involvement, & finally progress to incld Nerve involvement= LMN signs.
How do you Dx degenerative myelopathy?DNA test - SOD 1 mutation!
Tx & PTx of degenerative myelopathy?Tx is Nothing specific, but PT has been shown to help. Prog is Invariably progressive & Most dogs euthanized w/in 6 mos of Dx
Wobbler Syndrome is aka? Aka?(Caudal) cervical spondylomyelopathy or (C)CSM, or Disk associated Wobbler’s syndrome or DAWS
What IS wobblers syndrome? 4 possible etiologial czs?Stenosis of the spinal canal in the cervical area. Could be due to:
(1) Vertebral malarticularion
(2) Intervertebral disk protrusion
(3) Ligamentous hypertrophy
(4) Joint capsule hypertrophy
Signalment of who gets wobblers? (Based on signalment, most likely etiological cz? there are 2 diff signalments w/ 2 diff czs)Young giant breed dogs (great dane, mastiff), usually due to Articular facet pathology (Bone &/or joint capsule hypertrophy). Old Doberman pinschers on the other hand get DAWS (disk associated wobblers syndrome), Ligament hypertrophy, or Vertebral malarticulation
What are the CSs of wobblers? are they acute or chronic?CHRONIC (intermittent), PAINFUL, see C6-T2 myelopathy (2 engine gait)
Conservative vs surgical Tx for wobblers?CONSERVATIVE: Confinement, +/- steroids (1 mg/kg/day), Lifestyle change. SX: Depends on the lesion: Ventral slot, dorsal laminectomy, Distraction-stabilization, Disk substitute
Prog of wobblers?W/ MEDICAL TX: Good, if initial response, Relapses not uncommon, Is a progressive condition. SX: Good prognosis, LONG recovery, Intensive nursing care, Better prognosis if ambulatory pre-op or only 1 segment involved (domino lesions)
Lumbosacral Stenosis is aka? What is happening here?AKA cauda equina syndrome, it is Compression of the nerves of the cauda equina. it Is like Wobblers in the back end!
Possible etiological czs of lumbosacral stenosis?(its backend wobblers)
Disk protrusion
Ligament hypertrophy
Joint capsule hypertrophy
Fibrosis of foramina
Vertebral malarticulation
(Can be associated w/ transitional vertebrae)
Lumbosacral Stenosis: Signalment? CSs?Signalment: Older, large breed dogs
CSs: Painful (can mimic hip dysplasia), Abnormal tail carriage, Paraparesis → bunny hopping (LMN), Proprioceptive ataxia*, Urinary/fecal incontinence* (idk why she starred these)
What will neuro exam look like w/ lumbosacral stenosis?+/- LMN sciatic, perineal reflexes
Sx vs conservative Tx for lumbosacral stenosis?Surgical: Dorsal laminectomy (+/- foraminotomy, fenestration)
Conservative: Confinement, Analgesics, Epidural steroids
Prog of LS stenosis?Good to excellent w/ surgery (Worse prognosis if ↓ proprioception or incontinence pre-op ). Variable w/ medical management (Relapses/progression not uncommon)
What is Spondylosis Deformans? What should you know about it if you see it?Common degenerative condition of the spine that is ventrolateral bridging of new bone formation. RARELY of clinical significant (RED HERRING!) seen as a Radiographic abnormality
****WHAT ARE THE 3 NON-PAINFUL MYELOPATHIES???Fibrocartilaginous Embolism (FCE)
Degenerative myelopathy (SOD1 mutation, progressive T3-L3 myelopathy)
Most congenital malformations
5 painful myelopathies?IVDD