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21 Cards in this Set
- Front
- Back
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1) what major differential diagnoses must be considered for acute onset of focal spinal cord dysfunction?
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Trauma
ie Fracture, Subluxation Hemorrhage ie hemostatic Disorder, ie Neoplasia – Lymphosarcoma, Hemangiosarcoma Acute Intervertebral Disk Dz ie Hansen Type I Aucte rupture of intervertebral disk ~~~ Herniation through annular fibers ~~~ Small Breed Dogs via chondroid degeneration ~~~ Large Breed Dogs via Caudal Cervical Vertebral Instability Fibrocartilaginous Embolism |
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What Clinical feature will help differentiate IVDD from the other differential Diagnosis?
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Pain
via extruded material cpmpressing nerver roots and meninges ~~~ +/- Neuro Deficits via volume of extrusion and degree of compression ~~~ proprioception > ability to rise / walk > voluntary movement > deep pain ~~~ C1 – C5 large canal dia tf less chance of neuro deficits Symmetry ~~~ usually |
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2) What are the radiographic feature “typical” of acute IVDD with herniation?
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Calcified Disk Spaces
~~~ generalized intervertebral disk dz Thoracolumbar Region ~~~Narrowed or Wedged Disk Space ~~~ Small or Cloudy Intervertebral Foramen ~~~~~~ Remember the Horses Head ~~~ Narrowing of Facetal Joints ~~~ Calcified Density in Spinal Canal Above Involved Disk Cervical Region ~~~ Narrowing of Intervertebral Space ~~~ Dorsal Displacement of of Mineralized Disk Material |
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3) What would your specific recommendations for treatment be in:
a. First episode of disk disease causing acute TL pain, mild proprioceptive loss in rear limbs and rear limb weakness in a dog that is still able to walk |
Assume Thoracolumbar region bc proprioceptive loss in rear limbs only
Initial Tx Medical NSAIDs or Opiods if pain severe ~~~ 1st 3 days ~~~ caution re increased activity Monitor for escalation of Neuro Signs 2 TIMES per DAY If No improvement or any deterioration within 5 – 7 Days = Sx Confinement ~~~ 3 – 4 Weeks Cage ~~~ 3 Weeks House Arrest and Leash ~~~ Gradual Return to Exercise Communicate ~~~ high likelihood of recurrence – persistent or recurrent pain ~~~ ~~~ = Sx |
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What would your specific recommendations for treatment be in:
b. First episode of cervical disk disease causing acute pain, mild proprioceptive loss in all 4 limbs and limb weakness but still able to walk. |
Cervical and Neuro tf
~~~ Sx for Ventral Slot Decompression |
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3) What would your specific recommendations for treatment be in:
c. A patient TL disk disease causing a severe motor deficit, inability to walk using rear legs |
Sx Emergency
~~~ Rapid Surgical Decompression ~~~ Laminectomy and Removal of Disk Material |
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3) What would your specific recommendations for treatment be in:
d. First episode of cervical disk disease causing neck pain but no neurological defects |
Initial Tx Medical
NSAIDs or Opiods if pain severe ~~~ 1st 3 days ~~~ caution re increased activity Monitor for escalation of Neuro Signs 2 TIMES per DAY If No improvement or any deterioration within 5 – 7 Days = Sx Confinement ~~~ 3 – 4 Weeks Cage ~~~ 3 Weeks House Arrest and Leash ~~~ Gradual Return to Exercise Communicate ~~~ low success with medical management bc of high amount of prolapsed material ~~~ ~~~ tf Sx likely if ~~~ ~~~ ~~~ repeated episodes of cervical pain ~~~ ~~~ ~~~ cervical pain that does not resove with cage rest ~~~ ~~~ ~~~ neuro deficits |
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4) What are the important components of medical management of disk disease in dogs?
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Confinement
Pain Management via NSAID or opiod ~~~ caution re increase in activity Observation and Evaluation ~~~ emergence of neuron deficits ~~~ deterioration Corticosteroids IV ~~~ When Loss of Deep Pain Perception ~~~ Manage Inflammation that is increasing damage |
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5) What surgery will you use to decompress the spinal cord of a dog with Type 1 disk prolapse in the LS, TL, Cervical region?
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LS
~~~ Dorsal Laminectomy – no lateral access through pelvis TL ~~~ Hemilaminectomy – access to ventral, lateral & Dorsal aspects ~~~ but know which side the lesion is on Cervical ~~~ Ventral Slot – watch for the large venous sinuses on the ventral floor |
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6) What is ascending/descending (progressive) myelomalacia?
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Progressive Myelomalacia of Spinal Cord
~~~ progressive damage to spinal cord cranial and caudal to lesion ~~~ progressive ischemia via intramedjullary hemorrhage and edema ~~~ typically presents 24 – 36 hrs after insult ~~~ 3 – 6% of dogs with severe thoracolumbar disk extrusions |
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Ascending/descending (progressive) myelomalacia? How will you recognize it?
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Suspect When
~~~ loss of Panicculus Reflex and Cutaneous Sensation moves Cranially ~~~ progression from UMN signs in Hind limbs to loss of Patellar and Withdrawal Reflexes |
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Ascending/descending (progressive) myelomalacia? Why is it important?
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Its Blue Juice Time
~~~ avoid death via respiratory paralysis within a few days |
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1) what features of a clinical case could make Fibrocartilaginous FCE more likely than acute intervertebral disk disease?
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Not Painful After Insult – even with manipulation
Asymmetry |
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FCE Signalment
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Signalment
~~~ Medium and Large breed Dogs – most common ~~~ Small Dogs esp Miniature Schnauzer – “been described” ~~~ a few cats – but there are lots of cats… ~~~ most cases 3 – 7 yo – but occasionally < 1 – esp Irish Wolf Hound ~~~ gender - Niet |
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FCE History
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History
~~~ Sudden Onset of Neuro signs – rarely progresses up to 6 hrs ~~~ follows minor trauma or during exertion – 50% of cases ~~~ often painful upon onset but abates |
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FCE Tests
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Rads
~~~ NORMAL tf ~~~ rule out ~~~ ~~~ diskospondylitis ~~~ ~~~ fractures ~~~ ~~~ lytic vertebral neoplasia ~~~ ~~~ intervertebral disk dz CSF ~~~ usually normal – 50% have increase protein esp albumin Myelography ~~~ usually normal – possible subtle focal swelling |
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FCE Diagnosis
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Exclusion
~~~ Acute Compressive Spinal Cord Disorders ~~~ Acute Inflammatory Spinal Cord Disorders |
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3) Over what time course can improvement be expected in a dog with FCE?
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7 – 10 Days after Onset
~~~ see most clinical improvement 6 – 8 Weeks ~~~ complete return to function if it is in the cards 21 Days and No Improvement ~~~ this dog or a dog ~~~ there are lots of cats |
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Good Prognostic Indicators for FCE
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Good
~~~ Intact Voluntary Movement ~~~ Strictly UMN – esp increased muscle tone and hyperactive reflexes |
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Bad Prognostic Indicators for FCE
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Bad
~~~ Brachial (C6 - T2) or Lumbosacral (L4 – S3) Intumescence ~~~ ~~~ LMN – rapid muscle atrophy ~~~ ~~~ LMN – loss of muscle tone ~~~ ~~~ LMN – diminished limb reflexes ~~~ Incontinence – Urinary and or Fecal |
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Really Bad Prognostic Indicators for FCE
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Really Bad
~~~ loss of deep pain – sort of the inverse of dental rads it is never right ~~~ Severe LMN |
