Small ani. Med- Neuro- Congenital and Degenerative Myelopathies

wilsbach's version from 2016-04-17 02:58


Question Answer
congenital disorders obv affect younger patients more- how painful do they tend to be? how progressive do they tend to be? how easy is tx?Tend to be non-painful and static in level of dysfunction, but there is Little in the way of treatment options
4 types of Vertebral Malformations? What should you know about vertebral malformations in terms of problems you are seeing in your patient?TYPES: Hemivertebrae (wedge-shaped vertebrae), Block vertebrae(failure of separation of two or more adjacent vertebral bodies), Butterfly vertebrae (failure of fusion of the lateral halves of the vertebral body), Transitional vertebrae (have the characteristics of two 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 with a hemivert and 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 with 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 and part of the spinal cord through a bone defect in the vertebral column), or Myelomeningocele (including SC).... Treatment is largely symptomatic
Sacrocaudal dysgenesis/agenesis-- WHO tends to get this? what problems is it associated with? tx? Autosomal dominant trait in Manx cat, Associated with megacolon/constipation. Symptomatic treatment
Atlantoaxial Instability-- (obv between C1 and C2) what are the two 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 with taking radiographs to dx?how they are positioned!!
what are the possible medical/sx treatments for AA instability? prog? Medical: External coaptation (padded brace), cage rest 6-8wk. SX: Various implants, bone graft. PROG: Fair to excellent with surgery ( If survive perioperative period, Better pre-op status= better prognosis post-op). Fair to good with conservative treatment
Chiari-like Malformation: signalment? (age and 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 and herniation of the cerebellum, and Brainstem kinking/cervicomedullary compression. SEQUELAE: (1) Secondary meningeal hypertrophy/band 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, Scoliosis, Vestibular syndrome, Facial paresis, seizures, deafness
what will you see on MRI with 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 treatment for chiari-like malformation?Medical: As for hydrocephalus and 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 disease entity of its own, Develops secondary to primary CNS or nerve injury. With Syringohydromyelia, Pathology in the dorsal part of the spinal cord, Itch/pain perceived with lack of stimulus: Paresthesia (an abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves.), Dysesthesia (act of touching a part of the body causes 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, and finally progress to include Nerve involvement= LMN signs.
how do you dx degenerative myelopathy?DNA test-- SOD 1 mutation!
tx and px of degenerative myelopathy?tx is Nothing specific, but PT has been shown to help. prog is Invariably progressive and Most dogs euthanized within 6 months of diagnosis
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 causes?Stenosis of the spinal canal in the cervical area. Could be due to: (1) Vertebral malarticularion (2) Intervertebral disk protrustion (3) Ligamentous hypertrophy (4) Joint capsule hypertrophy
signalment of who gets wobblers? (based on signalment, most likely etiological cause? there are 2 diff signalments with 2 diff causes)Young giant breed dogs (great dane, mastif), usually due to Articular facet pathology (Bone and/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 (intermittant), 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?WITH 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 one 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 causes of lumbosacral stenosis?(it's backend wobblers) Disk protrusion, Ligament hypertrophy, Joint capsule hypertrophy, Fibrosis of foramina, Vertebral malarticulation (Can be associated with transitional vertebrae)
Lumbosacral Stenosis: Signalment? CSs?Signalment: Older, large breed dogs. Clinical signs: 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 with 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 with surgery ( Worse prognosis if ↓ proprioception or incontinence pre-op ). Variable with 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 significance (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 meylopathies?IVDD, Trauma, Meningitis, Diskospondylitis,Tumors